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For he shall give his angels charge over thee, to keep thee in all thy ways. They shall bear thee up in their hands. Psalm 91:11-12 (KJV)
My strategy of remaining emotionally detached from my patients simply did not work. Taking care of children is quite different from treating adults. Internists and surgeons may get away with keeping their distance, but for a pediatrician treating children with chronic diseases it is not a viable option. Whether atheists, agnostics, or firm believers, pediatricians must learn to listen to our young patients if we would gain their cooperation and practice something more communicative than veterinary medicine.
One of the bittersweet privileges of caring for children with cancer is that you grow to love them and bask in that love returned. We rarely see this form of love returned on this earth. It is unconditional. Part of that love entails, on occasion, the sharing of the road toward death.
As a young "post-Christian" doctor, I did not pretend to have any handy theological solutions to people's existential dilemmas, but I could be a friend on the way. Many times I listened politely to parents who groped for God in their most painful hour. I respected them all for their journeys, but I heard no convincing evidence in their revelations that challenged my way of thinking. I always assumed that if I were to believe, it would take the testimony of reliable witnesses. I mistrusted anyone who might have culturally determined expectations about death or an I-can't-afford-not-to-believe view of the hereafter.
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In the early years of the 1970s, brave parents helped me implement a home death program in a rural area of the South. As a cancer specialist for children at the time, I visited my patients at home. Sometimes they had physical pain but rarely did they seem afraid. In their homes, I was the guest and they were clearly the hosts. Children accurately reported their medical condition in this environment, since they felt in control. With encouragement and support, many families found they could manage pain and other dreaded complications of terminal cancer. If the children did need hospitalization for comfort, they themselves felt free to suggest it. If they preferred to die at home, we made it possible long before hospice services were more generally available.
In their homes, children would ceremoniously wipe the dust from my black doctor's bag and swear that they would not report me to the AMA for making house calls. My young patients and I would discuss what type of examination was appropriate, what tests might be useful, and they themselves determined the limits. I rarely used the syringes, needles, and blood test tubes in my bag. Tea in the kitchen with the rest of the family followed the visit to the patient's room, for the brothers and sisters-those who would live on-needed special attention as well.
Most children who die in this situation do not pass from this life without prior warning. Often parents of children at home or nursing staff of hospitalized patients could alert me in time to be at the bedside for that moment. The first time I sat by a child dying of cancer, I sat at her bed from a sense of duty rather than in anticipation of joy.
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Today many children with leukemia are cured, but this was not the case when Anna first became sick. There were periods of time that she was disease-free over the five years she received treatment, but she faced the end of her life at the age of seven. Before she died, Anna mustered the final energy to sit up in her hospital bed and say: "The angels-they're so beautiful! Mommy, can you see them? Do you hear their singing? I've never heard such beautiful singing!" Then she lay back on her pillow and died.
Her parents reacted as if they had received the most precious gift in the world. The hospital chaplain in attendance was more comfortable with the psychological than with the spiritual. He beat a hasty retreat to leave the existentialist doctor alone with the grieving family. Together we contemplated a spiritual mystery that transcended our combined understanding and experience. For weeks to follow, this thought stuck in my head: Have I found a reliable witness?
Everytime I hear the angel prologue to Boito's opera Mephistopheles, I think of Anna and the other "angels" who brought their oncologist back to the life of faith. My encounter with these children changed my life. Other stalled journeys of faith have been resumed. I write these stories as a witness to these children and their parents, just as they have been faithful witnesses to me.
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Several years ago, I had the opportunity to tell the story of Anna's vision of angels at a church conference. One participant was particularly overcome by the story and ran out of the room in tears. His reaction seemed to be a very personal one rather than generalized sadness about death in children. Later in the day, he returned and explained to the group why he had been so profoundly affected by Anna's story.
Twenty years before, Walter had personally witnessed a tragic accident. A driver parked a beer truck on an incline adjacent to a local pub while he made his delivery. The brakes of the truck were somehow faulty. Just as Walter walked out the barroom door and reached the street, the truck began to move unattended. It accelerated down a steep hill toward a mother and young child.
Walter anticipated what would happen to the child if the truck did not stop. He tried to catch it in time to put on the emergency brake but his efforts failed, in part, because the large amount of alcohol in his system impeded his reflexes. In fact, he was at that time an established alcoholic.
His worst fears were realized, and the child was fatally pinned against the wall. In his alcoholic stupor, he thought he saw the child's head surrounded by light and heard her last words to her mother: "Don't worry, Mommy. I'll be okay."
The shock and guilt he felt precipitated a two-week drinking binge, but his sense of a supernatural presence at the moment of her death led him to seek effective help for his alcoholism.
Can there be anything good about the death of a child? As Walter told his story, I remembered a comment that
Excerpted from Images of Grace by Diane M. Komp Copyright © 1996 by Zondervan. Excerpted by permission.
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