Field Notes: Shapes of Sorrow
Today. July 16th marks my birthday. And later this week, the anniversary of Isamu’s death—twenty-three years ago.
These two dates live in tandem on the calendar. Just two days between them. And every year, I feel it—an invisible weight pulling through my chest, my breath, my skin. A kind of cellular knowing that this week hints at more than a passage of time. It’s another threshold. One I’m fortunate to cross each year, again and again, even as my late husband’s passing stretches further into the past.
Light
Dark
And yet grief certainly nestles deep in the body, persisting on with life. But so does memory. And love.
We know now what ancient wisdom has always suggested: that long-held grief doesn’t just touch the heart. It threads through the nervous system. It shapes sleep, digestion, inflammation. It can quietly alter our biology over time—and still, it often goes unseen.
Sometimes it feels like a knot in the solar plexus. Sometimes it’s a constriction in the throat, a heaviness in the limbs, a sudden forgetfulness that pulls me from the present moment. And sometimes, it’s in the smallest things—the way a breeze moves through a room, or the ache that shows up in my jaw at night, reminding me of what’s been carried—quietly and continuously—across the years.
In Functional Nutrition, we aim to embrace the stories that shape health. Not just the ones told aloud, but the ones that settle deep in the tissues—the unresolved, the unspoken, the ongoing.
And in Narrative Medicine, we return to those stories with care—not to fix or extract, but to listen. To honor what still lives there. What still longs to be seen.
This month, I’m sharing a letter I wrote to Isamu on his birthday, just a couple of months ago. It’s personal, and intimate. But it also speaks to something I believe is universal:
That the body remembers.
That love endures.
And that grief, like healing, is never linear—but cyclical, cellular, and deeply human.
Warmly,
Andrea
P.S. As you reflect on your own stories of love and loss, I invite you to also hold space with me for those we've collectively lost—and to honor the life and legacy of poet and truth-teller Andrea Gibson, who died of cancer on Monday, July 14th, at 49 years old. Their work gave voice to so much of what we carry in the quiet. May their words live on in us.
“What I know about living is that the pain is never just ours. Every time I hurt I know the wound is an echo, so I keep listening for the moment the grief becomes a window, when I can see what I couldn’t see before.”
What I’m Writing: Anatomy of a Memory
May 12, 2025
Dear Isamu,
Tomorrow is your birthday. For some reason, I always have to do the math in my head more times than I’d like to admit, but you would be turning 57.
We met on your 25th birthday. May 13, 1993. You walked into the cafe for the first time in loose, faded black jeans, black boots, and a crisp white button-down. A black leather belt strapped around your 30-inch waist—the same belt Gilbert wears today. Your narrow waistline is one of the few things you two share in stature. You were in the required uniform, just like the rest of us. But you looked different. We were a hodge-podge of twenty-somethings working the early shift at one of the busiest cafes in San Francisco’s Castro district—years before it too would become a Starbucks.
I was struck first by the shine of your dark hair. And there was something about you that was almost… pretty—those dark eyes framed by round, wire-rimmed glasses, not unlike Harry Potter’s. But, to our knowledge, he didn’t exist quite yet. Your glasses rested on a brow and nose that I would come to think of as regal and Roman in structure, while your height and name revealed your Asian heritage.
You’d arrived for the second morning shift. I’d already been there since 5:30 a.m., half-awake and smelling of coffee grinds and steamed milk. I wonder what I looked like to you that morning as I handed you your red apron and set you up behind the counter. I had to go to the back room several times to read your name off your time card before I finally remembered it.
Isamu. Ee-som-oooh. (Remember how my cousins used to chant your name like that, embracing you into our fold as if you were family, before you even were?)
This December, Gilbert will turn 25. It’s hard for me to believe that he’ll be the age you were when I met you. I bet he could make a perfect cappuccino like you did, if he tried. He’d work the foam with that same slow, steady care, ensuring no airy bubbles, pouring it over the golden filmed espresso in concentric circles. And, like you, he’d get a little frustrated when it didn’t meet his standard. You created coffee designs before they were a sensation, for men who wanted more than just coffee. You’d meet them with a brief nod, but not much else, shutting that door to possibility before it could even be opened.
It didn’t take me long to figure out that you were a handsome straight man living in the Castro, and that too much chit-chat with the customers suggested an unintended response. So, we developed a silent agreement: I worked the register, greeting the customers and discovering details about their previous night out, or their work day ahead, and you manned the espresso machine. We maneuvered around each other in that narrow space behind the bar—a slow dance in a fast-paced frenzy. Our rhythm and banter kept the hours flying by, each shift an excited blur, only because you were there.
We traveled shy of ten years together, and though you died at 34, you’re still here, Isamu. Everywhere. In the home we chose together in Portland. In the stairway banister we designed and had built to help you pull yourself up from one flight to the next when you could no longer trust your legs or your balance. In the piano I bought with money acquired from a class-action lawsuit filed by the last place you worked against their larger holding company—a career far from the cafe.
Some days, I still hear your voice. Deliberate. Melodic. Your gait is etched in my memory. I can still feel the way your arm felt across my back, your hand resting on my hip, my arm thrown around your shoulder. We fit perfectly like that and there’s no street in San Francisco that doesn’t hold a memory of walking with you.
Not a day goes by that I don’t think of you, that I don’t whisper my gratitude for having you in my life. Then, and now. I still recite your social security number in my head, as if the numbers might unlock some portal that could bring you back. Or at least not lose you to busyness, to years. I don’t know Gilbert’s social security number by heart, but his is the only phone number committed to memory other than my own. How strange that when you were diagnosed in 2000, the concern was that cell phones caused brain cancer. We didn’t even have a cell phone then. Now everybody does.
When you were in the hospital the first time, while they were determining what the mass on your brain might be, I brought you your bulky laptop, your choice of coding books, and your CD Walkman along with a travel sleeve of your favorite discs. This way you could drown out the beeps and buzzes of the corridor—South 8, the shouts and murmurs of the patient in the bed next to yours, and tune into something that still felt like you. I still have that Walkman. The hospital sticker with your name stuck to the back, marking it as your property. It’s hard to believe the first iPod was released just six months before you died. That first version could hold up to 1,000 songs. You would have loved to have one of those in your back pocket.
And though you may miss running your hands over the LPs in the neighborhood record store or clicking through CD cases to find your next musical obsession, we can now search to our heart’s content without even leaving home. Every song, every artist, every obscure track you once hunted down in a dusty bin is now just a tap away. The whole world of music compressed into a device that fits in the palm of your hand. But that tactile search, that moment of discovery—it’s gone now. And I wonder what you’d think of that. A lot can change in 23 years.
With you, there was always a reason to wake up early, to stay up late, to show up to work. The anticipation of seeing you walk through the cafe door, your hair still damp from a morning shower. The thrill of our first kiss—which didn’t come until we were already deeply in love. The feeling of your eyes finding mine across the table in a noisy restaurant, the rest of the world fading into the background. The way you’d stride toward me, bow-legged, on a crowded downtown street, your lips curled into that half-smile I came to know so well.
Do you remember when the young neurologist, far younger than I am today, asked me if your face was always crooked, as we sat on the gurney in the ER corridor? It was.
What’s On My Mind: The Physiology of Grief
Grief is not just an emotion. It’s a biological event—felt and metabolized through the body.
It can tighten the throat. Weigh on the chest. Disrupt sleep, digestion, and immunity. Blunt appetite. Fog the mind. Heighten inflammation. Research now confirms what many of us have long sensed: grief alters nearly every major system in the body.
Acute loss activates the sympathetic nervous system, raises cortisol, and increases heart rate and blood pressure. In cases of long-term or “complicated” grief, the effects can be even more profound—linked to higher risk of cardiovascular disease, suppressed immune function, disrupted HPA-axis regulation, and even accelerated cellular aging.
In some, grief has triggered Takotsubo cardiomyopathy—what’s often called “broken heart syndrome.”
But while modern medicine has only recently begun to understand and map these changes, many ancestral traditions have always known that grief lives in the body.
In traditional Jewish practice, mourners tear a piece of their clothing—keriah—a gesture that mirrors the body torn by loss. In parts of West Africa, ritual wailing and communal drumming help move sorrow through the limbs. Among Indigenous communities across the Americas, ceremonial grieving may involve song, smudging, fasting, or a year of mourning in which the bereaved are lovingly tended. In ancient Greece, grieving women keened publicly in ritual procession. In Japan, memorial altars—butsudan—keep the spirit close and honored in the home.
These traditions tell us that historically, grief was not hidden, it was honored. It had a place. A process. A container. And that container—cultural, communal, spiritual—helped the body to metabolize loss.
Today, grief often goes underground. But the body remembers. What isn’t expressed gets stored. Sometimes what we call fatigue, brain fog, jaw pain, or IBS may be grief still working its way through our tissues.
Grief isn’t linear. It loops. It echoes. It leaves traces in the gut, the heart, the breath, and the bones.
To grieve is not to be broken. It is to be changed. To carry what matters—lovingly, imperfectly—through the years that follow.
“Even when the truth isn’t hopeful, the telling of it is.”
What I’m Listening To: The Retrievals, Season 2
The first season of The Retrievals—a powerful investigation into pain mismanagement at a Yale fertility clinic—was haunting, and complete. But the second season surprised me when it appeared in my podcast feed. And now, I can't stop listening.
This season turns its attention to Cesarean sections—one of the most common surgeries performed on women, yet one still rife with unacknowledged pain, inadequate anesthesia, and a systemic failure to listen. The podcast is not just about what happens in the OR. It’s about what happens afterward—in the recovery rooms, the hospital policies, and the silences women are often asked to endure.
The Retrievals, Season 2 continues its commitment to narrative integrity. It elevates the voices of mothers, nurses, anesthesiologists, and ethicists. It exposes medical failure, yes—but it also helps us consider the meaning of pain, the politics of childbirth, and the essential need to center patient stories in care. These episodes are a reminder and a call to reckon with the ways we listen—or don’t—and to insist on the dignity of every human experience, especially when that experience is dismissed. I recommend it not only as a listener, but as a practitioner, educator, patient, and person who believes that real healing starts with bearing witness.
Narrative Medicine Invitation
If you’re interested, I invite you to set your timer for 5 minutes and write freely to the following prompt:
If love leaves a trace, where is it etched within you?
Feel free to send your writing to me at scribe@andreanakayama.com
