A Letter to My Five-Year-Old Teacher

Dear F,

The pediatrics floor awakens at 7:30 this Tuesday morning, breakfast aromas and sounds of beeping monitors and Paw Patrol theme songs intermingling in the halls. As I search for my team on this first day of my pediatrics clerkship, I pass room number 8–30. I pause here, outside the room where I first met you. You probably do not remember me, a medical student shadowing your care teams, another stethoscope-sporting shape sliding in and out of your room. But I will always remember you. You were, in many ways, my first patient. Although we only met a few times in person, I like to think that our spirits are friends. Most importantly, though, you will always be my teacher. Five months have passed since I last saw you, but your impact on me only expands. So I write to you now to share what I wish I could have said in person, a sentiment that motivates and guides me every day: thank you.

Before I met you, I knew your medical history. Five-year-old female with malignant infantile osteopetrosis, read your one-liner. Osteopetrosis: a progressive genetic disorder in which bones become dense and fragile. Countless comorbidities, from blindness, to bone marrow failure, to pain, accumulated in your Problem List. Crimson ED-to-Hospital Admissions stained your Encounters log, cataloging the catastrophic nosebleeds that disrupted your weeks. Your medical treatments included morphine, total parenteral nutrition, and weekly blood transfusions. Days to weeks to months: your prognosis for the past three years.

I entered your hospital room with this clinical picture in mind, prepared with preemptive pity. But you immediately upended my expectations. Perched in your bed among pillows, toys, and books, you were vigorously shaking a rain stick to songs from Moana, a favorite movie of mine. As a smile broke out across your face, you started to dance, wiggling and laughing as the rhythm quickened. As the song reached its chorus, you sang. Although I could not understand your words, in this moment, I understood. I understood that your chart history was not and would never be your story. Your medical problems were a mere scaffolding for your personhood, an outline of the chapters that your strengths would write.

Throughout the fall, my admiration for you only deepened. From your clinicians, I learned that you adored dancing and sharing joy with your family. On Fridays—your transfusion days—I anxiously awaited your updates, astounded when your platelet count approached 1/L during one week, but you sang in clinic the next. The more I learned about you, the more I looked to you for guidance. You showed me to find strength in times of self-doubt. You reminded me to keep dancing, too.

Medicine emphasizes the concept of resilience. As medical students, we learn to appreciate the body's capacities to repair, regenerate, and rebound. We strive for personal strength and even stoicism as we train, hoping to enhance these capabilities to heal, to save lives. When a patient's condition precludes medical cure, however, we may question our notions of resilience. You, F, redefined resilience for me. Your condition compromised your ability to stand. But you responded by dancing. Your disease took away your hearing, but you felt music through the vibrations of drums, keyboards, and rain sticks.

You lost your ability to speak, but you expressed yourself through laughter. F, you showed me that resilience is not repairing and regenerating in response to difficulty but finding strength when repair and regeneration are not possible. Resilience is not steeling oneself against pain and emotion. Instead, it is discovering, in the depths of pain, room for joy, trust, and love—tools with which we both heal and connect with others, with which we build a network of strength. Resilience is living in this moment, regardless of how many more moments will come.

You died the weekend I turned 25 years old this past December, on a night when the sky darkened too early and the frost descended too soon. I did not cry when I learned that you had died, not right away. You had turned days to weeks to months into years, fighting, laughing, and living beyond expectation. But as I read and reread that 10:17 PM text, my body grew heavy, my fingers fumbling to find the rhythm of a reply. Staring at my half-eaten slice of leftover cake, I struggled to reconcile, as I still do, the fact that I have had 25 birthdays, 25 years of dancing, and you will ever only have 5 years.

As I continue in my medical training, I will strive to carry your legacy. Your lessons influence the areas I study, the questions I ask, the ways in which I care for and learn from my patients. F, thank you for sharing your laughter, cries, and dance moves with me. Thank you for showing me the meaning of resilience. And thank you for letting me be a part of your story. You will always be a part of mine.