About six months ago, my daughter, Julia, became obsessed with all things princess, so it did not surprise me when she wanted a princess themed fourth birthday party. For me, an athletic, independent professional, these past four years of living with a daughter whose color palate ranges from pink to pinker, the frillier the better, have been quite an education. I have come to realize that tiaras are a necessity, and that we don't dare leave the house without a wand and at least two purses in tow.

With a coquettish tilt of her head and her well practiced pout, Julia begged "Mama, Dada, please, I have to have a beautiful sparkly dress for my party." Though as usual, I tried to explain how much more important compassion and intelligence are, and how beauty comes from within (blah, blah …), my husband, has fallen victim to this taffeta indoctrination. So, for her birthday, she got a lacy pink full length princess dress, complete with gold sparkles and diamond sequins. I rolled my eyes, but even I was up late the night before the birthday party making mini muffins and heart shaped tea sandwiches, because "princesses don't eat pizza," my husband, Julia's willing accomplice, had admonished me.

The next day, with great fanfare, they arrived -- the Cinderellas, Sleeping Beauties and Snow Whites, clad in frothy creations of pink, blue and yellow, each lacier, gauzier and more satin then the next. Under my breath, I muttered something about Disney's eventual world domination, and went about making sure there was enough pink lemonade and jelly beans for everyone.

But as the party wore on, something happened. I watched the girls, each pretty as a flower, as their faces glowed with excitement, and I noticed that the sunlight caught the jewels on their dresses and made them light up with multicolor radiance. Even my cynicism melted. It was magical -- all of a sudden, our garden had become filled with the laughter of a kaleidoscope of fairies as they limboed and twirled. I inhaled the fragrant joy in the air and watched, eyes wide with wonder, to imprint this into memory.

I cling tightly to moments like these because as a physician I have learned that everything can change in an instant.

Just the day after the party, a stunning young woman came in for a physical exam. An aspiring actress new to Los Angeles, she did not have the vivacity so common in Hollywood types. Something about her was different. She was wistful, more thoughtful, and though she smiled, her face was etched with sadness. She answered my typical questions softly, without elaboration, and when I asked if she were married, she paused, took a deep breath that caught in her throat and shook her head. I assumed she was just melancholy, until I examined her and noticed a symbol in the small of her back.

"That's an interesting tattoo," I mentioned.

"Oh that?" her eyes fixated on the ceiling, "that means regeneration." I watched her but she did not meet my gaze.

"After the accident," she continued shakily. "In 2000, my fiancé was driving me to school and we got hit by a drunk driver. My fiancé was paralyzed from the neck down, and though I was hospitalized for two months, I'm okay. I tried to stay, but his family blamed me, and it was too hard for him to see me. When I was there it was worse. I sorta like acting, so here I am."

She looked at me with a far away stare.

"Life is certainly not what I expected …" she sighed.

A few weeks ago a patient who I had not seen in about a year came in. A 45-year-old business executive, I remembered her as sharp, acerbic and confident. This time, I barely recognized her. Her face was sallow and gaunt, and she was wearing sweats that hung limply on her body.

"Oh, Dr. Yaris" she slumped in the chair, "please help me, I can't eat, I can't sleep …"

"What's going on?"

There is something extremely humbling about giving someone life-altering news.
"Eight months ago, my mother was diagnosed with pancreatic cancer, and died one month later. Two weeks after that, my twin sister got diagnosed with breast cancer, and she just died -- three weeks ago."

She shuddered and hugged herself. "We were all so close. I thought our family was charmed … I can't believe it …"

She looked at me with that same distant stare that I have come to recognize. In it, a mixture of utter disbelief, mourning and helplessness.

'Fate' had struck both of these women and sent them reeling, to confront pain and tragedy most of us dread, and dazed and broken, they were struggling to reemerge.

Occasionally, my job dictates that I be a conduit of 'fate' -- the God’s unwilling messenger -- and this is the hardest thing I have to do. There is something extremely humbling about giving someone life-altering news, and though many theories exist about how to give bad information, none explain how to avoid being deeply affected by having to do it.

Recently, I had to tell a single father of a ten-year-old boy that the lump in his neck was lymphoma. I watched as the light in his eyes faded to that same vacant stare, and though I tried multiple times to penetrate his thoughts by squeezing his hand and explaining promising treatment options, he was completely unreachable. Scientific possibility can not at all assuage the complete shock of mortality.

A few weeks ago, a prim 55-year-old woman with a faint European accent came in for a physical exam. A recently retired French teacher, she was thrilled that she was finally going to be able to spend time with her orchids. She spoke lovingly of her three-tiered garden, and how she and her husband were going to spend peaceful days tending to it. The only medical concern she could think of was two weeks of rectal bleeding, which she assumed was hemorrhoids, and I agreed. I suggested she see a gastroenterologist, really only for a screening colonoscopy. So I was completely surprised when the doctor I referred her to called and said, "It's cancer. I know its colon cancer, but I took a biopsy. I told her I'm very concerned, and she is coming to you tomorrow for the biopsy results."

I thought about that gentle woman, but for some reason it was the image of dying flowers in an untended three-tiered garden that made me shiver.

Life is so very fragile. Each jeweled, sunlit moment must be cherished.

The next day, when she came to see me, I could tell by her blank expression that she knew. I can't figure out, however, what I think is more sad -- her diagnosis, or that she leaned forward and whispered to me, "You know, doctor, my husband cried all night." She shook her head, "After 28 years of marriage, I never knew he cared so much …"

Each of these patients, and many others like them, weighs heavily on my soul. From their tears I have learned many lessons -- but mainly that life is so very fragile, and that each jeweled, sunlit moment must be cherished. I know that one event, diagnosis or phone call separates me, too, from having to face, eyes glazed, that empty abyss. This is why I keep pictures of Julia's princess party close by. Because if and when darkness falls, I want to look back and remember that beautiful late summer day when giggling cotton candy angels danced in my backyard. And my eyes will clear and I will again see God's light.