I Still Remember

Only once in my career has a parent asked me for my home address. After my patient's cancer relapsed, I knew it would be the last time I would see her. A few months later, a letter came from her mother. It held the card from my patient's memorial service and a photograph of the piglets she so loved on their farm. Since that first letter, we have written to each other several times a year. The subjects vary from gardening to the kids to the weather, but somewhere in each letter, there is a reference to “our dear one.” In pediatric oncology, many of us become attached to our patients or their caregivers, and we care deeply about their cancer journey. Yet, when our patients die, the relationship with the family often ends. If we are invited to ceremonies that honor the end of the child's life, we cannot always attend. It would also be foolish to think that by attending my patient's funeral, I am able to neatly compartmentalize my grief and close the book on the void my patient has left in my world. I also feel it's not my place to ask a family to stay in touch. On an institutional level, most children's hospitals hold a memorial service for the families of patients. Debriefs immediately after a traumatic death or rounding on the patient the day after their death in the hospital have been implemented to give providers space to talk about “the event.” Research has demonstrated that hospitals are aware that provider grief affects over 50% of physicians caring for critically and terminally ill patients and that interventions and research remain inadequate on this highly prevalent challenge in our field [1]. Similar to attending a funeral, I don't feel that these encounters are enough to address the grief providers feel at the loss of their patients. As the number of children who have died under my care has increased, I've found a ritual that allows me to remain connected to my patient and to acknowledge my grief, especially if I lose contact with the family: I write a poem for each of my patients who dies. Indeed, writing those letters back and forth with my patient's mother helped me recognize that we are all looking for a way to remember the person who died. For some of my families, I share that poem with their caregiver as a goodbye; others I keep, and some I publish. Writing each child's poem is cathartic, and I usually have a very good cry as I try to capture the essence of my patient. As I write a new poem, I often revisit my previous work and remember those children again and again. My poems often reflect a happy moment, an endearing trait, a wish, and revisiting them lessens the pain over time. Finding a ritual to help process our grief ultimately must be a conscious effort; we discover what works. I have a friend who presses a dried flower into a book and writes each child's name under it. Another physician dedicates a run to each patient. In our individual ways, these repetitive moments are able to connect us with our patients and allow us to develop a coping skill for the sadness and grief we feel when our patient dies. The most important note I write never makes it into the chart. More often than not, no one else reads it but me, and when I do, I still remember. The author declares no conflicts of interest. Data sharing does not apply to this article as no new data were created or analyzed in this study.