Everything All At Once

When life forces you to hold joy and terror in the very same breath, what do you do with that overload of feeling? In Everything All at Once, Steph Catudal argues that the only way through is not to choose between light and dark, but to learn to live inside their collision. She contends that love is the one constant roomy enough to hold grief, faith, fear, resilience, and mystery at once—and that healing comes when you allow the full spectrum of experience to move through you.

Catudal’s memoir orbits two defining illnesses: the slow, shattering death of her father from lung cancer when she was thirteen, and the near-death of her husband, elite marathoner Tommy “Rivs” Puzey, from an undiagnosed lung catastrophe in 2020 that was later revealed as NK/T-cell lymphoma. Between those bookends she tells a coming‑of‑age story—raised Mormon on promises of miracles and perfection, she loses her faith when prayer doesn’t save her father; for years she weaponizes anger to outrun sorrow; motherhood forces her to relearn how to feel; psychedelics crack her heart back open; and a global pandemic tests everything she believes about agency, surrender, and the meaning of miracles.

The Core Claim

The book’s core argument is deceptively simple: you do not have to choose between strength and surrender, hope and realism, science and spirit. You can hold (and be held by) all of it. Catudal frames life not as a linear passage from innocence to wisdom, but as a looping round—“time is round,” she writes—where lessons circle back until we are ready to hear them. Her father’s cough becomes her husband’s cough; the hallway between the ICU and the bone marrow unit becomes a private torii (a marker in Shinto tradition) between the mundane and the sacred; and the concept of God dissolves into the texture of love itself.

What You’ll Learn in This Summary

You’ll see how early loss trains a body and a mind to choose anger over sadness—and how to reverse that habit. You’ll follow the technical and human drama of a months‑long ICU fight: oxygen sats in the 70s at home, ECMO cannulas, tracheostomies, a rare lymphoma, and the exacting ballet of caregivers who keep a body alive while a soul decides. You’ll explore how faith can fracture and be reimagined (with a psilocybin journey as a pivot), how motherhood is the art of holding without carrying, and how advocacy, intuition, and community can tilt life’s odds when medicine stalls.

Along the way, Catudal reframes prayer as intention rather than transaction, miracles as harmonies of science and love rather than suspensions of nature, and strength as a willingness to be porous rather than armored. She does this not by preaching, but by story: a strawberry milk carton in a freezing minivan; a nurse named Tara who teaches her to corner doctors with questions; a housekeeper named Fringa who slips a tissue into her hand and rests her head on Steph’s shoulder; an ER transfer director named Craig who builds a cross‑disciplinary team when everyone else says no.

Why It Matters Now

If the last several years have taught you anything, it’s that uncertainty is not a temporary condition. Catudal models a way to metabolize it without hardening: feel your feelings in real time; ask for precise help; accept that “meaning” is something you make, not something meted out by fate; and let love’s very ordinariness—coffee, a head scratch, a scratched‑out note on the fridge—be the miracle. As in Joan Didion’s The Year of Magical Thinking, the memoir becomes a manual for surviving the unimaginable; as in Paul Kalanithi’s When Breath Becomes Air, the ICU is a classroom; as in Michael Pollan’s How to Change Your Mind, altered states expand what counts as “real.”

How This Summary Is Structured

We begin with grief’s apprenticeship and the cost of perfection. Then we turn to the body—Tommy’s athlete’s heart, his collapse, the choreography of machines and human hands—and to the reweaving of faith into love. We’ll look at motherhood as boundary and balm; advocacy and intuition as twin engines; and how to make meaning without invoking cosmic scorekeeping. Finally, we’ll translate Catudal’s lessons into practices you can use when life asks you to live everything all at once.

Steph Catudal learns grief early and badly. At six, she watches her three‑year‑old brother Phil undergo leukemia treatment. At thirteen, her father sits the family at the table and names the unnamable: stage IV lung cancer. Her Mormon ward promises miracles if she’s faithful enough. She prays, perfects, and pleads—until the day she touches her father’s cold hand and knows prayer will not spare anyone. The levee breaks; she chooses rage because sadness feels like drowning.

How Early Loss Shapes You

After the funeral, Steph turns toward the far edge—beer in a closet, a runaway night in a van with a former Mormon missionary, bondage lessons masquerading as love, and later a move to Los Angeles with a sweet, newly sober boyfriend named Dylan. She dumpster‑dives for a TV, goes to AA meetings she doesn’t need, and learns that the room’s two best gifts are donuts and a sentence: “Keep coming back—it works if you work it.” (Compare the grief‑to‑anger arc with Megan Devine’s It’s OK That You’re Not OK; also with Joan Didion’s insistence on grief’s irrational habits.)

What Anger Masks

Anger is easier to wear than vulnerability, especially for a teenager who was raised to equate worth with perfection. Steph weaponizes “I’m fine” into a personality, even as her body records another story. In Montreal, after snorting mystery drugs in a nightclub bathroom with her best friend Marc, she speeds to the hospital convinced she’s dying. She isn’t—at least not physiologically. But she sobs in the car and finally says the obvious: “I miss my dad.” Recognition is the first thaw.

The Cost of Perfection

Steph’s childhood church makes “perfect” sound like a staircase to wholeness. But the climb breeds shame. She forges a bishop’s endorsement by telling the truth—drinking, sex, Plan B—and the bishop signs anyway, saying, “I see your heart. And it is good.” It’s the first institutional crack in the lie that worthiness is a checklist. (This reframing echoes Richard Rohr’s shift from performance to participation.)

Relearning Sadness

Years later, when her husband Rivs goes down in the Grand Canyon and then into the ICU, sadness returns with its original force. But this time she lets it move through her. She cries on her daughter Harper’s lap while her ten‑year‑old strokes her hair and whispers, “It’s okay.” She learns what her mother could not model when Steph was fourteen—that strength is not the absence of tears, it’s the willingness to let them fall. As Didion chronicled, grief refuses tidy arcs; as Catudal adds, it is also a teacher that returns until you enroll.

Tommy “Rivs” Puzey is an improbable elite runner—six‑foot‑one, 170 pounds, a linebacker in split shorts—who races Boston in 2:18 and trains by climbing Humphreys Peak at dawn. He makes quiet, steady “deposits,” and his body returns the favor. Until it doesn’t. After a night descent into the Grand Canyon in June 2020, he can’t regulate his temperature. His heart bangs. He collapses on the asphalt outside their home, coughs blood, and shrugs off the ER because COVID wards feel like death. At home his pulse oximeter reads 71%.

Machines, Hands, and a Stubborn Will

At Flagstaff Medical Center, CT scans show “innumerable” lung nodules. Three negative COVID tests argue against the obvious. A fine‑needle biopsy collapses a lung. A chest tube goes in. Nurses type “undetermined lung injury; stable on high‑flow oxygen,” then upgrade to “max high‑flow; impending intubation.” At midnight an ICU doctor calls Steph: they have to ventilate now. On FaceTime, blue drapes encircle her husband’s face. He mouths, “I’m gonna be okay. I promise.” Then silence. (Readers of Atul Gawande’s Being Mortal will recognize the brutal compassion of such nights.)

When Advocacy Becomes Lifesaving

In a bedlam of alarms, a nurse named Tara tells Steph, “You’re his voice now.” She learns to call twice daily, demands explanations, and keeps a notebook. When Flagstaff delivers a diagnosis—stage IV extranodal NK/T‑cell lymphoma, a rare and deadly cancer—she pushes for ECMO, a heart‑lung bypass offered only at specialized centers. A Phoenix transfer director named Craig (himself a lymphoma survivor and ER doctor) cobbles together a receiving team: cardiac surgeons Riley and Piercecchi, pulmonologist Assar, oncologists Briggs and Fauble. Guardian Air flies Rivs through monsoon breaks to Scottsdale.

What the Body Remembers

There are near‑codes (an air bubble stalls the circuit; the team swaps machines in minutes), fungal sepsis, a femoral catheter for more oxygenated flow, and a liver wobbling toward failure. Steph sits in a plastic chair through it all and notices that even sedated, he “fights the ventilator.” When delirium later makes him unrecognize her, when he begs for his bike to ride home, she learns a second physiology: how the nervous system protects a mind from too much reality. If The Body Keeps the Score (Bessel van der Kolk) shows how bodies store trauma, Catudal shows how love and precision medicine can rewrite a body’s story—slowly, meticulously, through fifty‑three scars and a nine‑hour walk of the New York City Marathon sixteen months later.

Steph grows up Mormon on a diet of hymns, cookies, and a tidy doctrine: obey and you’ll be blessed; pray and the mountains move. When her father dies despite all that obedience, she boxes up God and labels the package “Rotten. Do Not Touch.” For years she won’t. And yet hunger remains—for meaning, connection, a frame big enough to hold her father’s absence and her husband’s ventilator. The bridge back into wonder is not a pulpit but a plant.

A Psychedelic Excavation

Under a guide’s watch in a forest home, she drinks five grams of psilocybin tea. Walls breathe, mandalas pulse, and an ivy plant becomes a goddess. Her ego dissolves into a field of love. “Time, space, birth, death” bend into a single, interwoven reality. She hears a sentence that feels like remembering, not learning: “All the power you’ll ever need is inside you.” (Michael Pollan’s How to Change Your Mind documents similar ego‑disrupting experiences and their clinical benefits for grief and depression.)

Prayer, Reframed

When Rivs is sedated, Steph begins to “pray” again—not to petition a cosmic vending machine, but to offer intention and attention. Sometimes she feels him answer. She learns to hear with closed lips: a warmth in her chest; a pull toward action; a phrase that arrives like weather (“This is not how he dies,” then later, “Don’t let it harden you”). She stops ranking miracles as suspensions of nature and starts seeing them as harmonies of science, grit, and love.

The Torii Between Worlds

In Japan, she’d noticed toriis—simple gates marking the passage into sacred space. The Scottsdale ICU doorway becomes hers. Inside, she chooses what to see: tubes, sores, and numbers, yes; but also the sanctity of a head scratch, a nurse’s massage oil, a respiratory therapist’s bad jokes. God is not a far throne; God is a tissue placed in your hand by a housekeeper named Fringa who rests her head on your shoulder and says, “I pray for you.” (Compare to Richard Rohr’s “the universal Christ” and to Kate Bowler’s insistence that blessings live inside limits, not beyond them.)

Motherhood, in Catudal’s telling, is the practice of creating a container that’s big enough for your children’s feelings but porous enough that you don’t claim them as your own. It’s the lesson her mother couldn’t model after her father died—too stoic to unravel in front of the kids, too strong to show she was breaking. Steph vows to do it differently when crisis returns.

Let Them See You Feel

One night, after a “collapsed lung” update and a lullaby that keeps catching in her throat, Steph sobs in Harper’s room. Her daughter, ten, reaches up and strokes her hair. “It’s okay, it’s okay,” she whispers—the same words Steph will later say to her daughters when they fall apart. The scene flips intergenerational roles and heals a fracture from Steph’s adolescence: emotions don’t poison children; secrecy does.

Hold Space, Not the Burden

The hardest sentence in the book for a parent might be this: “I cannot carry their grief.” She can make pancakes with extra sprinkles, yes, and set up adventures with both grandmothers. She can tell the truth in age‑scaled ways. But her girls must walk their own empty fields. Her job is not to intercept the pain; it’s to be the place they return to, still breathing. (This resonates with Dr. Shefali Tsabary’s The Conscious Parent on boundaries and presence.)

Women’s Invisible Strength

The caregiving coalition is almost entirely female: her mother Susan; her mother‑in‑law Julie; nurse Tara; oncologist Dr. Briggs; housekeeper Fringa; the online community of mostly women who cook, donate, and DM. Catudal sees both the ordinariness and the heroism of that labor. When she finally lets herself be carried—by women “holding worlds together in shadowed recognition”—she learns a second, quieter definition of strength.

Catudal places intuition and agency side by side: hear the voice, then do the next hard thing. The first time it roars, she’s on the way to a pine‑glade picnic. She’s done the “responsible” thing—left a smoothie by the bed, dimmed the lights, told herself he’s turning a corner. Halfway up Route 180 she feels it: Go home. Check on him. She U‑turns into a gas station, off‑loads the kids to her sister‑in‑law, races back, and finds Rivs cyanotic in a circle of blood. He argues from the bathroom floor; carbon dioxide poisoning has rewired his mind into obstinacy. She calls the shots—pulse ox 71; shower fall; trudge to the car; the last parking spot at the ER; one quick kiss because COVID rules say goodbye happens at the door.

Advocacy as Love

The second time it sounds, it’s a sentence: “This is not how he dies.” It’s not magical thinking; it’s marching orders. She writes down questions and corners doctors in the room (at nurse Tara’s insistence). She asks about open lung biopsies, antifungals, APRV ventilator modes, and Lasix drips. When Flagstaff says ECMO is unlikely and transfer “end of life,” she posts a plea. Within hours, the inbox fills with ECMO leads. A doctor named Craig secures bed space and a cross‑specialty team; a storm delays the helicopter until morning. She keeps steadying herself on sentences like handrails.

Signs in Human Clothing

A housekeeper slips her a tissue and rests her head on Steph’s shoulder. A perfusionist named Sam marvels at cardiac output he’s never seen. A surgeon texts fours in the morning. A respiratory therapist jokes her away from obsessing over numbers: “Eyes off the monitor.” Each encounter widens “voice” from inner whisper to relational web. (Kate Bowler’s Everything Happens observes similar graces inside limits—little kindnesses that are not “signs” in the superstitious sense so much as solidarity.)

“Everything happens for a reason” is the sentence that did the most harm to Steph as a teenager. She rejects it. What she embraces instead is Viktor Frankl’s more modest claim: meaning is something you make in response to reality, not something meted out by a cosmic accountant. In the ICU, this shift matters. It stops her from bargaining, and it frees her to love.

Miracles, Recast

Miracles aren’t loopholes in biology; they’re harmonies—ECMO and chemo carefully titrated; a surgeon who refuses to give up; a wife who learns to both advocate and surrender; a body trained by years of “small, steady deposits.” When someone calls Tommy’s survival a miracle, Steph can say yes without implying that those who died were less loved or less faithful. (Megan Devine makes a similar ethical distinction between meaning and explanation.)

Time Is Round

The story loops back on itself: her husband’s cough echoes her father’s; her daughter’s hand on her hair echoes the comfort she wanted at fourteen; the hallway between units turns from a chasm into a bridge. The point is not that fate scripted all this, but that love renders even the worst rooms spacious. “God is love and love is gray,” she writes—neither neat nor nihilistic, capacious enough to host contradictions.

A Practice of Meaning

Steph keeps “ECMO diaries” on Instagram. In them she refuses easy binaries: “Life is fragile, people are resilient.” “Pain is deep but love endures.” She names both the savage and the sacred with the same pen. Where reason would have asked “why?” and found nothing, meaning asks “what now?”—and finds community, ritual, and courage.

Catudal’s memoir reads like a field guide for how to stay human when everything breaks at once. You can borrow her moves now—before your own siren rings at midnight, before a sentence changes your life.

Feel, Name, Share

Let your body do what it knows. Cry in front of your kids and let them hold your head the way Harper held Steph’s. Name what you feel (“sad,” not just “angry”). Share without making anyone else carry it. Write your own “ICU diary”—public or private—as a way to metabolize experience in real time.

Build Your Circle

Identify your Taras (pragmatists who push you to advocate), your Craigs (systems people who open doors), your Brigg/Fauble/Piercecchi/Assar quartet (specialists who will take a chance), and your Fringas (quiet anchors of tenderness). Ask specifically for what you need: rides, food, ECMO leads, or simply someone to sit in a plastic chair while you sleep.

Advocate Like a Teammate

Bring a notebook. Learn acronyms (APRV, ECMO) and ask why a setting is chosen. Write questions and “corner the doctor in the room,” as Tara suggests. This is not antagonism; it’s partnership. And when a clinician shows up at 4 a.m., say thank you; you’re in a covenant of care, not a transaction.

Renegotiate Faith

If the old scaffolding fails you, let it fall. Borrow language that fits—love, intention, torii, prayer-as-presence. If a psychedelic journey feels right and safe, consider it with a guide; if not, find your version of the ivy goddess—trees, oceans, music—that reconnects you to something wider. (Note: clinical guidelines matter; see Pollan’s cautions.)

Create Rituals of Return

When the voice says “go home,” go. When it says “stay,” plant your bare feet and lay your palms on a beloved chest, the way Steph did when she repeated the names—“Iris, Poppy, Harper”—until Tommy smiled through sedation and a single tear slid down. Gather ordinary sacraments: head scratches, coffee, playlists, children’s voicemails, photos taped to salmon‑colored walls.