The weekend before last, my eldest son came home from college for a couple of days. Our home was in perfect harmony and rhythm. The duets (and quartets, if you count us parents) that had played over the prior month-and-a-half were once again trios and quintets. Five or six hands on the piano at a time. The clear brass joining in again with the bright woodwind and the deep bass. The voices in song with layers of harmony at the Friday night dinner table. The rhythmic click-click-click of the ping pong ball coming from the basement and the smooth, beautiful sounds of conversation and laughter late into the night. The sounds of a football being thrown as the three boys took over the street (and a few of our neighbors’ front lawns). Again, the laughter as they fake tackled one another both outside and inside the house. And inside the car. Believe it or not, you can tackle someone inside a car. I had almost forgotten that.

And then, less than 48 hours after we brought him home, we took him back to school, where he is developing his rhythms and harmonies that are separate from those of our family, yet undoubtedly still influenced by them. And the other four of us came back home, where we are adjusting our own time signatures and keys to reflect the change in our daily orchestration.

It’s funny. Of all my doctor skills, I really pride myself on being in-tune to my patients’ (and now my clients’) feelings, on my sense of empathy. But this is something I just didn’t get before – how something so good, something we’ve all worked for, can cause such an emotional upheaval. If I had been chatting with a patient a couple years ago, and she had told me her kid had just gone off to college an hour away from home, that he was doing great, that they communicated with him at least by text if not a phone call pretty much every day, and that they were able to visit with him for a couple hours on campus most weekends, I would have said, “that’s great!” and not given it much further thought, aside from being generally happy for her family’s general good fortune.

And it is good fortune. It is beautiful. It is as it should be. But it is a fundamental change. Rather than it’s being the exception that your child is away for a few hours, a few days, or a few weeks, it is now the exception that your child is home for a few days or that you see him for a few hours. And that thought can rock your world. It was very difficult walking back into the house after dropping him back at his dorm.

I now would take that conversation a lot farther with my patient. I would ask how she’s dealing with the changes in household dynamics, how her husband and other kids are adjusting, how she’s dealing with the stress of missing her child on a daily basis, whether she’s addressing the emptiness with cookies or channeling it into a daily walk. (Note: I’m walking. I have resisted the cookies.)

Our family’s song is developing. The instrumentation of our full ensemble is now the punctuation, the accent, rather than the underlying theme. It is our family’s first inversion. And our family will go through a similar second and third inversion over the next few years. The music is beautiful, yet in some ways a bit haunting. Melodious, yet profound. The beat changes and evolves, the lines harmonize and canonize as each musician conducts his own score through the blending and separations of the melodies. The music plays.