Thanksgiving: What a difference a letter can make
A recent article, published in the Journal of Clinical Oncology by our own Steve Duane M.D., brought tears to my eyes. Steve is a physician in the Park Nicollet Hospice Program. In his article, Steve movingly describes his experience with junior high students in the “Growing Through Grief” program sponsored by the Park Nicollet Foundation.
Growing Through Grief is a school based program that offers grief support and education to children who have experienced the death of a loved one. The program provides grief support groups, individual counseling and continuing education for staff and the community. (Click here if you would like more information about Park Nicollet’s Growing Through Grief program.)
In his article, Steve tells the story of a sixth grader reading a letter from his mother (which he keeps on his smartphone). The boy’s mother, who died of cancer when he was 5 years old, wrote the letter prior to her death.
The article prepared me for Thanksgiving as I consider the many Park Nicollet team members who have died this year and am aware of additional losses and tragedies suffered by co-workers. As I read Steve’s story, I feel grateful for my health and the health of those I love. Please feel free to use the comment box below to share your thoughts on the things for which you are grateful on Thanksgiving.
Here is Steve’s article.
What a Difference a Letter Can Make
by Steven F. Duane⇓
© 2012 by American Society of Clinical Oncology
I learned an important life lesson recently from a sixth-grade student: a letter from your mom can make all the difference.
All too often, oncologists find themselves in the difficult position of sitting across from a dying patient who is also the mother or father of young children, discussing end-of-life care. In my practice, such conversations usually involved young women with metastatic breast cancer. When the delicate topic of the patient’s children was broached, tears were inevitable. There is perhaps no greater sadness than that of a mother who is about to leave her children behind forever.
After allowing time for the patient to cry and to say whatever she felt up to saying, I often talked gently about ways that I hoped might help my patient and her children cope a little bit better with such an unthinkable loss. One idea that I sometimes suggested was for the patient to write letters to each of her children to open on special occasions in the future, after the patient was gone—letters for certain birthdays, graduation, or a wedding day. Despite making this recommendation, to me the act of writing such letters had always seemed impossible. And I also often wondered how these letters would be received by the child—would the communications from a long-gone parent be eagerly anticipated and prized, or would they instead be dreaded, summoning ghosts and painful memories of a desperately sad time? Whenever I imagined that future birthday or wedding day, I could see an image of the letter being opened and read, but my thoughts were unable to go any further.
Enter the sixth grader who taught me just how important those letters can be to the recipient.
I was asked to attend a support group for kids who had lost a loved one. This group is open to sixth through eighth graders and meets weekly in a local junior high school. The two group facilitators had been inundated with medical questions from the students, and the counselors asked me to attend one of the group meetings to help answer some of these queries. I accepted, but I had some reservations about talking with junior high school students, especially as it has been almost half a century since I was that age myself.
I arrived at the meeting early and was led to a room that was near the school principal’s office. The room was large and stark, making it seem more suited for detention than for baring one’s heart. The kids filed in slowly; eventually, six students comprised the group. They looked so young as they talked about band practice, compared homerooms, and speculated about this evening’s basketball game. “So, are you the doctor?” one boy eagerly asked. “Yes,” I said, knowing that my gray hair and necktie had likely already answered his question.
The facilitators began by asking each student to introduce themselves and briefly recount the story of their loved one’s death. Cancer was the common theme. Questions quickly followed. Initially, these questions were easy, straightforward ones that I had answered many times before. How did the cancer get to my mom’s brain? Why does chemotherapy make a person so sick? But soon the questions began to cover more uncomfortable matters. What does it mean that I dream about my dad? Is it OK that I am mad at God for taking my mom? It quickly became clear to me that these kids had been forced to grow up faster than children should, and they were demonstrating maturity and wisdom well beyond their years.
One young boy grew quiet, and the counselor noted his bowed head looking down. “Are you OK?” she asked. His soft response was, “It’s just not fair. Sometimes it makes me so angry that my mom had to die.” The counselor repositioned herself, now sitting next to the boy with her arm around him. (There are uncelebrated heroes on this earth, and I realized that I was witnessing one of them in action). “What do you do when you feel this way?” she asked him.
He looked up, paused briefly and said, “I read my mom’s letter. I was reading it just now.” He volunteered, “Would you like to see it?” After a few questions from the group leaders probing whether it would be OK, we collectively asked the boy to share the letter.
He explained that his mom died of cancer when he was 5 years old and she had written this letter just before her death. He had not been given the letter until he was 8. Now, he keeps a copy of his mother’s letter on his smart phone, along with her picture.
He showed us what the letter looked like and then started to read it. It was clear from the sound of his voice that he had read it many times before. The letter was brief, encouraging, sad, loving—and obviously deeply treasured by the boy. He shared with us that whenever he feels really down or angry, he rereads his mother’s letter. “Reading it always makes me feel better, more relaxed. I feel connected to my mom.” As he pocketed his phone, I could see a noticeable change in his expression and his posture—calmer and more settled. Fortified by his mom’s courageous letter, the young man now appeared ready to move ahead, both with the rest of his day and with the rest of his life.
A deep uneasiness stayed with me for days following this experience. My thoughts bounced back and forth between my previous conversations with dying parents and what I’d heard that afternoon from the group of young students. I felt a great sadness reflecting on the profound losses that they had experienced, and yet what kept resurfacing was appreciation of the courage and resilience that I had witnessed. So, bravo to that dying mother who somehow found the courage to write a critical letter to her 5-year-old son. Bravo, too, to that resilient young man, whose mother is now memory, but who is using her words to help him find his way in life, just as she had hoped he would. What a difference a letter can make.