The day that my cousin died, I found out she was sick via text message. My father told me her oxygen saturation was 47% when the paramedics arrived. I knew what would happen next. My family teases me for being the constant naysayer, but none of them are doctors. They don’t know what it means to be at 47%. I imagined that when they found her, her lips were already blue.

The day that my cousin died, I spent the morning walking down brightly lit linoleum halls, crossing patients off my rounding list. I kept refreshing my phone for updates from my parents, but I didn’t respond to any of their questions. Unconsciously I held the answers ransom until someone could confirm what I already knew. The messages flashed on my phone: What is high-flow nasal cannula? What does it mean to be intubated?

This would be the day my cousin died. I held this preordained knowledge. Impulsively, I thought about flying to the other side of the world, 48 hours away, to find her. What would I do once I got there? I have never intubated anyone. I have never seen a cousin turn blue.

My cousin was 36 years old. She loved to draw. Her favorite movie was The Mask. When I visited her, she made me eggy French toast topped with brown sugar. She had strange anxieties I couldn’t understand. She had hypothyroidism but didn’t take her medication because she was afraid of doctors. Over time, I saw a small swelling around her neck in her Facebook pictures, growing until it formed the curve of a goiter. I had made a mental note that this was something I should bring up, the next time I went home. Ten long years- college, medical school, residency- had passed since I saw her last. During this time, I had learned how organs work, memorized drug names, learned a thousand abbreviations, taken marathon-like tests, learned the art-science of medicine.

At noon on the day my cousin died, my father texted me a picture of her lying in the ambulance. My mother told me she was waiting to be transferred to a medical center where they could perform intubations. I could see the goiter again extending from her neck, squeezing her airway like a serpent. Even in a picture, I could see her fighting to breathe. I bit back the questions that swirled in my mind. She hadn’t been intubated yet? Why did they take her to a clinic without ventilators? I felt my subconscious tingle with the knowledge of what had not yet occurred.

On my drive home, my parents sent me an X-ray over text message. A picture of a picture, from a hospital as far away from me as Mars. A constellation of stars in her lungs. On the mountain top, they call these conditions a whiteout.

That night, I heard confirmation of what I already knew twelve hours before it happened. Three thousand miles away, my cousin, an artist, a home chef, a Jim Carrey superfan, died of COVID pneumonia and an upper airway obstruction, a goiter-constricted neck that would not allow intubation. Like a poorly written murder mystery, the conclusion of her life, once revealed, seemed inevitable. Medications gathering dust. An infection, secretly spreading. A life not meant long for this world.

Sitting next to me in their living room, my parents cried into the phone with my uncle. “How?” they asked. Even the hourly updates had not been enough to assuage their shock. They assumed her body could fight back- but they did not know what I knew. They were not clairvoyant.

Every day, I walk into my patients’ rooms. I can predict that Room 8 will go home, Room 13 will likely transition to hospice, that Room 11 will get worse before he gets better. This is the culmination of our training: to recognize the patient dedicated to his kitten will want to discharge early to feed him, to see the woman sipping apple juice may very well aspirate on it tomorrow, to prophesy, to plan.

The day that my cousin died, I knew the news that I would be told 12 hours later. I was trained, after all, with lectures, book chapters, exams, and hospital rotations. I paid with time and money to learn to see the future. But that day, I would have traded the knowledge, the experience, the years of training- all of it, to say goodbye.