Recently, I have been thinking about patients whom I cared for when they died. A few of those occurred here in Grand Rapids where I have been a general pediatrician, but the majority happened during my pediatric training at the University of Iowa. I don’t believe that caring for grieving families was ever discussed in my training at all. I realize now, that everything I thought about how to deal with grieving families was wrong, and the one time that I thought I did everything wrong, was the only time that I truly did things right.

 Over those three years, there are 6-8 families whose children died that I truly remember. I remember some who wailed in the room and hallways and others who sat quietly with their newly deceased child, with tears flowing down their faces. Some families I barely remember at all, and instead can only picture their child in my mind. I wonder, now, is that because I disappeared, or because they did?

 By far, the most memorable death to me was of a little girl barely older than one, who had been in the Peds ICU for 12 months, the vast majority of her life. She had a heart transplant, but had never really recovered. All of the residents in my class knew her and her family so well. We did three months of training in the ICU during the day and took call every 4th night. During that fourth month, we did the call rotation only, while we did a clinical rotation during the day. We all loved this family, and even though she was medically complicated, when I came on for a new month, I always wanted to be the resident who was assigned to care for her.

 Although she was a very sick little girl, I don’t think I really thought about the fact that she could really die at any time. She had been there so long and she had gone through so much; she almost seemed like a permanent fixture of the ICU. One morning, however, I walked into the ICU and learned that about an hour or two before, she had died. I was devastated and emotional, but thought that I needed to ‘be professional’ and hold it together just as I had done with other families in the past.

 I know it took me a few minutes to gather myself up and walk into the room. When I did, I saw the mom sitting in the rocking chair holding her precious little girl, now without any of the tubes and lines that had become part of her. Almost immediately, I began crying, and quickly apologized. She then reached out to me for a hug. I bent over and hugged both her and her little girl as we both cried. I remember her saying to me then, ‘Marcy, you are going to be a great general pediatrician.’

 Until yesterday, I had completely misunderstood that statement. What I thought she meant was that it was good that I was planning to be a general pediatrician because I could never handle being an ICU doc or an oncologist or any specialty that would take care of dying patients. I certainly thought that my crying in that room was a sign of failure on my part and not the way a doctor should act after death.

 I now realize after having lost Andy that she likely loved the fact that I mourned her little girl with her. I showed that I truly cared for her and her entire family. That precious little girl mattered to me, and I demonstrated that to her. Her statement to me was not a reflection of what I should or should not do with my life. It was an affirmation that I was a caring compassionate doctor who would be able to be a blessing to many families as a general pediatrician, just as I was blessing her at that moment. She was giving me a gift that I had not been able to appreciate until now so many years later.