The Writing on Our Heads

Chaya Nautiyal Murali


In Tamil, my first language, the word “fate” elongates to a phrase: “thalai ezhuthu.” Literally translated, it means “head writing.” The writing on your head. Consider this image. Each of us walks around with our inevitabilities, the answers to all our possibilities, our destinies and destinations, written on our heads. We are all walking stories.


I am pestering Rick Guidotti. I recognize this, even admit it to him in one of the text messages he actually answers. But I can’t help myself. It’s my final year of residency, and, endowed with several months to pursue a project of my creation, I want Rick to help me come up with something meaningful. But we’re having trouble connecting. The last time we made contact, he was in Europe, traveling between gallery openings and galas. We agreed to meet once he was back stateside.

I first encountered Rick when I was a medical student in Texas, where he gave a lecture for an elective called “Compassion and the Art of Medicine.” The elective was one of two I chose in my first year, both with a humanities bent. So far, the other class, “Medicine and the Art of Observation,” had proven stimulating (I still remember our discussion of Damien Hirst’s End Game, a wall-length, mirrored, be-skeletoned, surgical tool cabinet that underscored the solipsism of modern medicine), but the Compassion course had stuck to hackneyed, albeit laudable, tropes. There was the clear-eyed physician couple who spoke of their deaf-blind daughter, the gastroenterologist who intoned the importance of listening to patients’ stories. Their words fell easily into the grooved record of medical humanism: Remember your patients’ humanity. Listen to their loved ones. No skips. No scratches.

Rick’s lecture was different.

He cut a memorable figure: graying hair, rosy cherubic cheeks, impish grin. He employed hand gestures liberally and had a proclivity for the word “fabulous.”

Unlike the speakers before him, Rick bypassed the podium and stood front and center, talking about his life’s work: photographing people “living with genetic, physical, intellectual, and behavioral differences.” He clicked through images of these people as he spoke. The first few, from history books and antiquated medical references, portrayed freaks of nature, objects of carnival fascination and wonder. In one picture, a family with albinism was literally a circus side-show.

Then photos shot by Rick began to appear, and the tone shifted. These were smiling faces, looking boldly into the camera, their personalities undeniable. Rick was propelled into his current life on a fateful afternoon in 1998. On break from a shoot, he was standing outside his Manhattan studio, gazing idly at the busy street, when he was struck by a beautiful girl with long, white hair and luminously pale skin. She was stunning, an illustration of what Rick had always believed—beauty was everywhere. He bolted towards her, planning to beg her to model for him. As fate would have it, her bus made it to the corner before he did.

Rick knew the girl had albinism, and was captivated by her ethereal features. He went to a bookstore to find photographs of similarly affected people, expecting breathtaking depictions. He found circus freaks and skin cancer patients instead. He vowed to change the portrayal of albinism, and started by finding a model. A teenager named Christine came to his studio.

In his lecture, Rick waxed effusive about Christine. She was “a knockout, long white hair, really tall… stunning!” But instead of walking into the room confidently, Christine was stooped, quiet, avoiding eye contact. He demonstrated, clownishly tramping across the stage hunch-shouldered, his mouth a grim line. He stopped and looked up at us, his expression sober. “This kid has been teased her whole life because of her difference.”

Rick decided not to be delicate with Christine. He would treat her like any other model. She deserved that. Cue the fan, the music. He held up a mirror and said, “Christine! Look at yourself, you’re MAGNIFICENT!” She looked, and then, “She got it!” Her posture morphed, going from “This” (he hunched over once more) to “This!” Spine straight, hands on hips, shoulders thrown back, chest puffed. His mouth unfurled into a huge grin and his face tilted up, a flower seeking the sun. The next slide showed a striking teenager with long, flowing white hair, impossibly pale skin, and eyelashes to match.

On that day, Rick understood the power of photography—it gave Christine a new, positive sense of who she was. He envisioned her carrying that new identity with her to school the next day, daring her classmates to see her beauty. She would be an ambassador for change. After Christine, Rick photographed countless others with albinism. His mission got a cover story in Life magazine, a sunglasses ad campaign using models with albinism. He was soon launched into the wider world of genetic support groups, photographing children with Down syndrome, Costello syndrome, chromosome 18 anomalies. Everywhere he went, he brought his earnest belief that photography could be life-changing. Everywhere he went, that belief was borne out.

Rick ended his talk with his experience at a South African school for the blind. In albinism, the lack of pigment extends beyond the skin, into the eye. Our eyes depend upon a sheet of melanin-rich cells to create an ocular darkroom. Without it, most people with albinism are legally blind. At the school, the children performed a song for him, doing a shuffling dance and clapping along. He played us the video. The song was moving, melodic, goosebump-inducing. Rick was frustrated to learn that their blindness, categorized as a disability, made the choir ineligible to participate in competitions.

Not one to accept barriers, Rick and the choir teacher registered the schoolchildren for a dozen local contests, then flew back home. Soon, an invitation arrived to be a guest choir, performing for a crowd of 10,000. Rick was delighted, but the children were consumed with stage fright, refusing to sing unless he was in the audience. So he got on a plane and flew back across the ocean.

Rick played another video, their dress rehearsal. The children, dressed in yellow suits that were a cross between drum major and circus ringmaster, sang a lilting song in perfect harmony, swaying like reeds in a breeze. One pale young woman stood still, eyes closed, her figure a steady beacon as she sang a downtempo solo. Watching them, the hair on my neck rose in a synesthetic thrill of significance. A universe of possibilities had led Rick to that school in South Africa, and then to that lecture hall in Texas, where, I was certain, he was fated to collide with my world.


I was somewhere in early adolescence when my father told me he planned to make me a doctor. That was the phrasing he used—“make you a doctor.”

“There aren’t any doctors in our family,” he said, “So before my father died, I promised him that I would make you and your sister doctors.” That was it. My fate was sealed with my thatha’s dying wish.

I was taken aback, but not surprised. My parents had always expected excellence. I was a straight-A student because anything else would be unacceptable. Becoming a doctor, the pinnacle of academic achievement, was simply the next logical step. Of course, logic does not beget desire. I had never dreamt of becoming a doctor. My father’s decision didn’t change that.

For a few months, I nurtured my contrarian wish privately, but eventually decided I needed to screw up the courage and tell my father. As with most of our meaningful conversations, this one happened in the car.

In everyday life, my father’s speech is littered with idiosyncratic, nonsensical phrases, the culmination of English being his second language and his mind moving too fast for his mouth to keep up. But in the car, my father’s speech becomes fluid, unhalting, narrative. The physical space of a vehicle frees us from the rigid roles of father and daughter. Outside the car, we talk about work, taxes, politics. Inside the car, we wax philosophical, theological, poetic: encased in steel, we tell the truth. So sitting in the passenger seat while he drove to the grocery store, I figured I stood a chance of reaching him.

Heart pounding madly, I blurted out the words before I could lose my nerve: “Dad, I don’t think I want to be a doctor.” I don’t recall what he said next. I only remember the gravity of his disappointment, settling upon me like humidity on a sticky summer day. Panicking, I tried to puncture the tense silence by pointing out a new building that would house medical offices. “Who cares?” he responded, “You’re not going to be a doctor, so what does it matter?” I knew that his harsh tone masked sadness. I also knew that rejecting his plans would only cause familial strife. I hate familial strife.

I acquiesced.

In order to understand my capitulation, you must know about my family. By my teenage years, I had long since taken on the mantle of family peacekeeper. The combination of an overachieving father who expected no less of his children, a traditional mother prone equally to melodrama and clinical depression, and parents whose marriage often simmered with unspoken resentments that would burst to the surface in spectacular arguments, always violent in language and sometimes violent in action, made me develop a finely tuned sense for techniques to keep everyone happy. I occupied a mode that pleased both parents: academic excellence with traditional cultural practice. The more I did what my parents asked, the less turbulent things seemed to be at home.

But being asked to become a physician was another level of parent-pleasing. Going along with my father’s plan would mean years of study, countless hours of lost sleep, and committing to a career I wasn’t even sure I wanted. Who decides to become a doctor just because their dad thinks it’s a good idea?

I’ll tell you who: I do.

Over the next few years, my focus shifted squarely onto academics. I dropped orchestra to boost my weighted GPA, and eventually quit playing music altogether. Nearly all my extracurricular activities had an academic bent—math honor society, national honor society, academic octathlon. My rebellions ended up taking other forms: a Bachelor of Arts in English and personal essay writing; a growing appreciation for beer (not least the decision to drink alcohol in the first place); an ongoing near-obsessive love of Western music (as opposed to Indian classical) that would propel me to concerts and festivals, to my conservative mother’s chagrin. Luckily for me, I had an aptitude for science and a desire to help people, and I would come to find doctoring enjoyable. The path of filial piety started to feel like the path I was fated to take.


Not long after my father was born in South India, Rick Guidotti was born in South Philadelphia. He was educated in the parochial system, at St. Monica’s, then St. Joseph’s Prep. Rick and his brothers Jimmy and Bobby walked to St. Monica’s every day, a mostly brick building of beige and variegated gray. In his Italian Catholic neighborhood, Rick felt a sense of community, and easily made friends. He reflects now that he never saw any kind of diversity there. Though he never personally experienced bullying, Rick always felt a visceral aversion to injustice, discrimination, and prejudice. He remembers a time in sophomore or freshman year, when he and many of his classmates walked out of a classroom to protest a teacher’s snide remarks about an openly gay student: “those were the kind of things that shaped me as a young adult.”

After graduating from high school, Rick went onto college at Drexel, where he studied architecture. He was fascinated with the “beauty aesthetic” of entryways and stairways, places of movement and choice. As it turned out, he was a terrible architect. Where his classmates would produce “gorgeous models with elevators and escalators and doors that open and turn,” he produced “clenched-up pieces of paper.” He began to rely more and more on photography to do his work, then realized that he loved photography itself. He transferred to New York’s School of Visual Arts, and eventually opened his own studio in Manhattan.

Rick met with considerable success. His subjects and employers included Cindy Crawford, Yves Saint Laurent, L’Oréal; his work took him to Paris, Milan, London. Once when I went to see Rick at work, one of his long-time friends, a makeup artist, told me in a conspiratorial stage whisper that “Rick always got the best clients.” Still, the work left him dissatisfied. Rick saw beauty not just in inanimate spaces, but everywhere: a powerful equalizer, omnipresent like a divine being. The fashion world’s prescriptive approach to beauty drove him crazy. When he speaks about this, the strength of his conviction makes him trip over his words: “No, [beauty] doesn’t exist only there! We’re shortchanging ourselves if that—beauty is, is everywhere, but you just have to look at it!”


At age 15, I started volunteering at the local children’s hospital, deep in the maze of the Texas Medical Center. The hospital offered a medical mentorship program for high school volunteers. On the encouragement of my parents, I halfheartedly applied to the program during my junior year, but didn’t get in. Undeterred, my farther urged me to apply once more, which I did successfully. The summer before college thus found me joining several other would-be physicians for a foray into medicine.

The program assigned each of us to three shadowing experiences with different pediatric specialties. Mine were cardiothoracic surgery, pediatrics residency, and genetics. My first week was with the cardiothoracic surgeons. I came into the week excited: Tiny hearts! Lifesaving operations!

This excitement quickly fizzled. The operating rooms were almost unbearably cold, kept that way for two purposes: to lower metabolic demand in the patient, and to maintain the comfort of the staff who were “scrubbed in,” wearing many sterile layers. I wore a thin pair of hospital-issue scrubs and wasn’t even allowed a jacket. To make matters worse, I couldn’t actually see the surgeries. A half-dozen people gathered around each patient, arrayed according to a strict hierarchy, which left me shivering near the foot of the bed. I scratched my nose under the mask. I stared moodily at the clock as the hours ticked by. I strained to see the surgical images projected onto a small screen, but it may as well have been blank. Between the tools obscuring the field and my complete ignorance of cardiovascular anatomy, I was utterly lost.

I had imagined that these surgeries would feel magical, epic. Instead, they felt interminable, indecipherable. Tedium overwhelmed the fact that I was watching lives get saved. The whole experience left me feeling altogether cold.

My week with the pediatric residents was a little better. As I followed behind them, I began to pick up some knowledge, like the litany of empiric antibiotic choices by age, prosaic medicinal couplets: amp and gent, amp and cef, vanc and cef. The residents were welcoming, friendly, and reassuringly normal. I could envision myself doing what they were doing, felt I was up to the task. Still, I remained unconvinced that I wanted my life to look like theirs.

Ever since the sixth grade, when I first learned about Punnett squares, those mathematical four-square courts that illustrate inheritance, I had been entranced by genetics. I loved the idea that little molecules predestined our physical beings. Before the mentorship, I hadn’t realized that genetics was a medical specialty.

Dr. S was the first geneticist I met. In comparison to my 5’4” frame, he was a tall man, but his size was endearingly diminished by the feathery edges of his accented, lisping speech. He had a boyish, pigeon-toed walk and an astonishing memory. His balding pate, rimmed with dark hair, presided over kind eyes.

In the ensuing days, I traversed the entirety of the hospital, always a few paces behind Dr. S. I saw a baby born with hands split vertically down the middle. We saw a little boy with intellectual disability and behavioral problems, but a completely “normal” face. I found him nondescript, but Dr. S honed in on his unusual hand movements, one of his repetitive behaviors. “Did you notice this?” he asked me, his fingers dancing around each other in an imitation. I hadn’t, but Dr. S had, and it gave him a clue for the diagnosis. I was floored.

Dr. S gave me scientific papers to read (over which I promptly fell asleep), held forth on mitochondrial dysfunction (his research interest), and introduced me to the Bible of dysmorphology: Smith’s Recognizable Patterns of Human Malformation.

Between patients, I sat in a vacant gray cubicle and passed the time. The sepulchral quiet of the office leadened my eyelids, and I made frequent trips to the office kitchenette, which offered free caffeine. Smith’s offered an escape. The gleaming, deep blue cover beckoned, a siren call of pictures, humans, and accessible reading. Syndrome after syndrome was described, accompanied by photographs. This was not a tiny heart with subtle anomalies. These were ear pits and unibrows, small chins and malformed ears. The diseases came alive through the pages of Smith’s. As I examined all the ways humans could be different, I felt my heart quicken the way it did when I listened to my favorite songs, read my favorite books. This was beauty.

I became a geneticist that summer. Absorbing every single detail about the patients we saw, examining the diversity of the human form through Smith’s, being awed by Dr. S’s diagnostic acumen and wanting to know everything he knew—it was the first time I thought I’d enjoy being a doctor.

Looking back, I’m struck by the serendipity of the whole thing. By chance, I was assigned to shadow a geneticist. I could have been assigned to endocrinology, or neurology, or otolaryngology. But no. It was genetics. By that roll of the dice, I stumbled upon a field that offered fulfillment of my paternally-decreed destiny with a career I actually enjoyed. I wonder now how the program leadership assigned specialties. If I had sent in my application a day earlier or later, would I be a young rheumatologist now? What if I had gotten into the program the first time I applied, or refused to go through with a second application?

I constantly wonder at the role of happenstance in the course of a human life. It is a theme that draws me in again and again, that looms large in the lives of my patients. We can reduce inheritance to a series of calculations, fractions and pedigrees and Bayesian analysis. But in doing so, we fail to answer the question that every family asks when a new diagnosis is made: Why?

One misspelled letter in one gene produces a child with achondroplasia. Children with cystic fibrosis are born through layers of chance occurrence: a man and a woman bearing hidden mutations in the same gene happen to meet, happen to fall in love, happen to have a child together who happens to inherit the broken copy from both parents. I could calculate the odds of such a thing happening, with various couples of various ethnicities at various ages. But the application of numbers alone to human conditions feels cold, bloodless. My reaction? In a field where probability reigns, I reach for fate.


Rick and I have become friends since that November day in my first year of medical school. By my last year of residency, I’ve started spending time with him, observing a shoot in his Manhattan studio, meeting him after he gives a guest lecture. On one of our meetings, we discuss Rick’s journey to genetics, the sequence of events pinging along to an inevitable conclusion like a Rube Goldberg.

It’s a dizzying, exhilarating story, and every time I hear it, I embark on a flight of fancy: what if that girl hadn’t been on that street corner that day, or Rick had been traveling for work? What if his studio had been one mere block east or west? To me, this incident is a grand illustration of fate. Fate brought Rick to genetics through that girl with albinism on the street corner, just like fate brought me to genetics through that shadowing program.

But when I tell Rick my theory, he turns the whole idea on its head: “But can I tell you something? This keeps me up at night. How often did I walk by that kid, before I was ready to see her?” She was there every day, he tells me, waiting for the bus to school. I ask him how he knows this. It turns out that her mother saw the Life magazine spread and reached out to him years later. This story, too, makes my synapses positively blaze with the fatedness of it all, but still Rick demurs. Instead of being amazed by the moment that he noticed her, he is disappointed that he didn’t see her before. How did he miss the beauty that had been right there before his eyes?

This inversion of the narrative surprises, and, if I’m being honest, deflates me a little. I press him—do you believe in fate? No, Rick tells me. He doesn’t, and he doesn’t really want to. You could drive yourself crazy overthinking such things, “really pull it to shreds, and I just don’t want to do that.”

I’m surprised by the depth of my disappointment. Fate gives me purpose, meaning, something to hold onto in this world maddeningly full of tragedies. But Rick sees it entirely differently: “We all are given different things that we have to live with, and it’s how we… deal with those obstacles that makes us the people that we’re meant to be. You could be the greatest person in the whole world, and yet you go to a—a country music concert in Vegas, and you’re dead… Did you deserve that? Was that fate?”


I’ve been turning Rick’s last two questions over in my head for months now, and I keep coming back to the same answers—no, you didn’t deserve that, but yes, it was fate. To me, these answers live in perfect harmony. Fate has nothing to do with what you deserve. But it would seem that most people don’t see it this way.

Once I was in a religious study group, and someone asked how pediatricians could bear seeing innocent children suffer. One of two pediatricians there, I laid out my stance: children born with rare diseases were fated to be born that way; their circumstances had nothing to do with their sweet personalities. It was undeniably sad, but I took comfort in the thought that those children did nothing to “deserve” their fate. I thought the explanation was elegant, blameless, but when I looked at the other pediatrician in the room, her face bore a horrified expression. For her, the blame was inextricable from the fate.

I hastened to explain that it wasn’t as bad as it sounded. Of course, I didn’t believe that children with medical problems “deserved” to suffer. The idea of “deserving” didn’t even figure into my thought process. It wasn’t about “deserve,” it was about “meant to be.” I was taking Rick’s idea, that we’re all given different challenges to live with, and writing a prequel: Why are we all given different challenges? Because fate decrees it. It was obvious that she remained unconvinced.

Perhaps my views on fate appear callous when applied to my patients, because I have no idea what their personal experiences are like. I readily admit that this is true. My medical problems are limited to mild asthma and seasonal allergies. I’ve never had surgery, never been admitted to the hospital. I’ve never had to watch a beloved child endure pricks and prods, operations and procedures. I’ve never had to wonder if my would-be son would make it to his next birthday, or watch classmates tease my would-be daughter for her unique facial features. My suffering does not measure up. I know this. But in the times when I have felt pain, I have found solace in fate.


I’m the younger of two daughters, born to parents whose marriage was arranged by their own parents. Our family is close to the point of codependency. I visited my parents’ suburban home nearly every weekend throughout college and medical school. My mother and father see their grandchildren multiple times a week. Looking at us now, you’d never know the emotional storms we weathered during my childhood.

The fights we had back then were knock-down-drag-out, loud and frightening and sometimes violent. Such disturbances are not foreign to many families, may be all the more familiar to immigrant families. I know this now. I know that my family is not much different than most, that beneath our anger there was, always has been, always will be, deep love. But as a child, these truths were out of my reach.

When the yelling began, I often retreated to the bathroom, where I would shut the door, try to block out the noise, and wonder at the cause. Why was it that my parents ended up together, stayed together, yet fought so much? What unseen decision-maker chose to deliver my sister and me into our parents’ arms, and why?

In the bespoke kinship catechism I created, most answers were some version of fate. The four of us were fated to live together, fight with each other, drive one another crazy, and love and depend upon one another, all of it with a stupefying fierceness. It was the only conclusion that made sense to me, an absolving explanation. Like any child would, I wondered, when my parents fought or my family was unhappy, if it was my fault. In my mind, though the four of us could and should try to do better, we could not overcome our fate, which was to suffer together, at least sometimes, at least for a while.

Somewhere along the line, I conflated fate with karma, the cosmic ledger that, in Hinduism, forms the backbone of reincarnation. Working off of various sources, I cobbled together an understanding that I thought was theologically accurate: Every living being contains a soul. Each soul is a piece of an infinite divine entity. When a human or animal dies, the soul continues on in another creature, retaining no memory of its previous manifestation. This is the cycle of reincarnation.

The circumstances and events of each life are determined by the karma incurred by the soul in previous lives. This sounds punitive, but there is no judgment attached to karma. It is simply a neutral result of a soul’s actions, neither good nor bad. It accumulates if the soul acts with attachment to the outcomes: act with detachment, and you don’t accumulate karma.

The karma incurred during one life doesn’t affect that same life. For instance, if you steal bread as a child, that doesn’t mean someone will steal your bread years later. But if you are a victim of bread theft, that may be because you stole bread in your last life. (It isn’t quite that literal, but you get the gist.)

Each soul continues to manifest in another living being, until all of the previously incurred karma is “used up” by life circumstances or events. Then, when the final human life has ended, the soul merges back into that infinite divine entity.

This paradigm is why I believe that tragedy, though born of fate, is not a punishment for past sins. We are all simply wandering souls, small chunks of divinity, trying to make our way through this world, work off our karma by living each life as best we can, and return to where we belong.


I called my father to talk about fate. Our discussion was preceded by a hemming and hawing preamble of pleasantries. [We were on the phone, not in a car, you see—the spell of steel was uncast.] Eventually, he dove in: “Basically…” A wave of Vedantic knowledge followed. I tried to follow along apace, but my do-it-yourself theology proved an unseaworthy craft. I was doggy-paddling in the ocean buoyed only by the bright yellow water wings of childhood. I was navigating whitewater rapids in Huck Finn’s raft and the beams were splintering. I was tumbling over a waterfall in a canoe. In short: I was in over my head.

Oru nimisham, one minute,” I kept interjecting. Hold on. Back up. You’re telling me that karma is dichotomous, that it can be good or bad? That Hindus believe in a heaven, a sort of way station between earthly forms, where the best souls are rewarded with a brief stint in paradise for good behavior? That a reborn soul retains spiritual lessons from bygone lives? Yes, yes, and yes he was.

Over that forty-minute call, my father matter-of-factly upended most of my assumptions about karma, reincarnation, fate, and cosmic causation. I recorded the call, the better to review it later. In it, our voices layer upon each other’s, interrupting and qualifying and interjecting. My pressure cooker can be heard in the background, gathering steam, then whistling again and again, as if reflecting our conversation’s urgency.

Once we hang up, I shake my head, trying to knock loose the newly sown doubts. I unfurl my legs from their cross-legged position on the floor, groan as I creakily bring my young-but-aging body to a stand. I amble to the kitchen. Open my pressure cooker. I think about what Dad has said. The words, Sanskrit vocabulary old and new, swarm hazily through my mind—mukti, sanchita karma, agami karma, prarabdha karma. There is such a thing as bad karma? Souls can remember things from previous lives? There is a Hindu heaven? I’m flabbergasted by the incompleteness of my knowledge.

It takes weeks to realize that my bemusement was built on a foundation of arrogance. To be surprised when you learn something is to have assumed that you already knew it all. It’s all a bit embarrassing, really. How could a thirty-year-old presume to have the same theological mastery as her sixty-something father? And if my understanding of karma was so pocked with gaps, then what of my unshakeable trust in fate? Maybe I’ve been wrong to believe that every event is predestined, that suffering comes for a reason, that life is all one elaborate, unread novel. After all, most of the stories we tell ourselves as children aren’t true.

Santa doesn’t lay presents under the tree.

The tooth fairy isn’t in the dentition business.

Maybe there’s no such thing as fate.


There is a general understanding that medical professionals are intolerant of uncertainty. A 2018 study in Academic Pediatrics found that residents with more uncertainty-related stress had higher rates of depression and burnout. In non-academic speak, this means that doctors feel better when we are sure of ourselves. When you think about it, this makes perfect sense. Doctors carry the unbearably heavy responsibility of saving people from death. We respond by minimizing doubt at all possible turns.

In my training, nearly all medical decisions have been judged by one standard: has there been a study to prove that it is a good idea? If so, full steam ahead. If not, let’s think twice. This type of thinking can make medical care seem ponderous, needlessly intellectual, impersonal. I disagree. I think that physicians insist on certainty because it is the best way to cope with the massive uncertainty of caring for so many ultimately fragile lives. It is what we must do to go on with our work.

The trouble comes when no amount of evidence can keep a patient from succumbing. What do you do when there are no more guidelines to consult, no more textbooks to reference? What of the times I’ve diagnosed patients with impossibly rare diseases, born to parents who each had infinitesimally small chances of carrying mutations in the same gene and unknowable chances of meeting and mating? Or the times I’ve watched shining, beloved children die tragically, unexpectedly? In that space, where scientific evidence falls away, I have always turned to fate.

Since my father disabused me of my long-held notions, I’ve started to see the shortcomings of this belief system. I recognize now that I invoke fate inconsistently, conscripting it into action when it makes me feel better, and studiously ignoring it when it doesn’t. I’m beginning to understand how a steadfast trust in fate, soothing to me, seems callous to others. Perhaps there is no refuge from uncertainty.


Following a few months of missed connections, I finally made contact with Rick in late fall of my final year of residency. I took the bus across town on a crisp November morning to hear him speak at a conference, and scanned a sea of unfamiliar faces in a hotel ballroom. I sent a text message—I’m in the back, where are you? His reply directed me to the front of the room, far left, where I saw his upstretched arm waving me over. Rick smiled his irrepressible grin and welcomed me in a stage whisper as he was being introduced to the crowd. The speech he gave was largely unchanged from the one I had first heard almost exactly seven years ago, but it evoked a nearly identical emotional reaction. I laughed when I had laughed before, teared up at the same misty moments, felt my heart quicken in that familiar way.

Afterward, we ate breakfast together in the hotel restaurant. He talked about his childhood, his obsession with beauty, his hatred of injustice. As Rick told me about his journey, I saw in it a mirror image of mine: He began with one principle, beauty, and tried on careers until he found one that centered it. I began with one profession, physician, and explored specialties until I found one that arrested me with its principles of science and humanity, chance and fate, beauty in diversity.

My job is to figure out why children have medical problems. An errant nucleic acid, an extra chromosome, an untranslated gene. Catalog the differences, compare them to what we know, solve the puzzle, figure out what’s wrong. Now finished with my training, I have become confident in my ability to pinpoint the genetic diagnosis, if there is one. But simply identifying the causative variant leaves questions unanswered.

In our conversation, I drew inspiration from Rick’s unwavering sense of purpose: “My call to action here is to make sure that whoever’s sitting in front of me can look in the mirror, and say, ‘Wow. I fucking rock.’” He laughs. “That’s all I want to do.” This easy assuredness and genuine desire to help others is what drew me to Rick all those years ago. It’s what made me want to be his friend. It’s what makes me want to collaborate with him. Rick may not believe in fate, but a part of me still does. I still like to think that fate drew us both to genetics. Fate intertwined our stories.

I have a habit of starting new books by reading the last sentence first, a quirk born of a poorly timed library haul on a family vacation. Overeager, I had checked out far too many books, and the last day found me distraught at being unable to finish them. Logical to a fault, my father suggested I simply read the last page of each book. I took his advice, but reading the ending without the middle was disorienting. Instead, I discovered something unexpected: the final sentences were beautiful, even to my little girl’s brain. I continued this nontraditional approach—I still do it today—because knowing the ending casts the entire story in a shimmering light. The ending is out there, waiting for us to reach it. The writing is on our heads. Namma thalai ezhuthu. Let’s read.


Return to Spring Issue Volume 11.2


Chaya Nautiyal Murali


Chaya Nautiyal Murali is a pediatric geneticist and Pushcart Prize-nominated personal essayist living in Houston. Her work has appeared in Typehouse Literary Magazine, Aster(ix), Entropy, and Crack the Spine. She attended the Bread Loaf Writers’ Conference in 2018.  Chaya writes about family, inheritance, and identity and enjoys crocheting, cooking, and obsessing over her dog. She can be found Tweeting @ChayaSays and cooking on Instagram @AkkasHouse.