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I want to introduce you to some
very wise kids that I've known,
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but first I want
to introduce you to a camel.
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This is Cassie, a therapy camel
visiting one of our young patients
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in her room,
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which is pretty magical.
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A friend of mine raises camels
at his ranch in the Santa Cruz Mountains.
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He has about eight of them,
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and he started 30 years ago
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because he thought
horses were too mundane.
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John is an out-of-the-box thinker,
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which explains why the two of us
have been such good friends
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all of our lives.
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Over the years, I've convinced him
to shuttle those sweet furry beasts
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up to hang out with our sick kids
from time to time.
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Talking to John, I was surprised to learn
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that camels have an average
life expectancy of 40 to 50 years.
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The life expectancy of many
of the children with whom I work
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is less than a year.
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This is a picture
of the George Mark Children's House,
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the first pediatric
palliative respite care center
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to open in the United States.
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I founded it in 2004,
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after years of working as a psychologist
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on pediatric intensive care units,
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frustrated with the undignified deaths
that so many children experienced
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and their families had to endure.
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As I sat with families whose children
were at the end of their lives,
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I was acutely aware of our surroundings.
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While the elevated train
rumbled overhead on its track,
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quite literally the room reverberated
with each passing train car.
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The lights on the ward
were fluorescent and too bright.
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Monitors beeped, as did the elevator,
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noisily announcing its arrival.
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These families were experiencing
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some of the most excruciating
moments of their lives,
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and I so wanted them
to have a more peaceful place
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in which to say a last goodbye
to their young daughters and sons.
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Surely, I thought,
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there must be a better spot
than a hospital intensive care unit
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for children at the end of their lives.
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Our children's house
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is calm and nurturing.
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It's a place where families
can stay together
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to enjoy quality time with their children,
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many of whom are there for respite stays,
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some with repeated visits
over a span of many years.
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We call those kids our frequent fliers.
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Rather than the bright,
noisy quarters of the hospital,
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their rooms are calm and comfortable,
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with actual living spaces
for the families,
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a sanctuary of gardens
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and a wonderful outdoor playground
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with special structures
for children with physical limitations.
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This sweet baby Lars
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came to us directly
from a hospital intensive care unit.
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Imagine hearing the heartbreaking news
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that none of us would ever want to hear.
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His parents had been told
that Lars had a brain anomaly
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that would keep him from ever swallowing,
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walking, talking,
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or developing mentally.
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Recognizing what little chance
he had for survival,
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his parents chose
to focus on the quality of time
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that they could spend together.
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They moved into
one of our family apartments
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and treasured each day that they had,
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which were far too few.
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Lars's life was brief, to be sure,
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mere weeks,
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but it was calm and comfortable.
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He went on hikes with his parents.
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The time that he spent in the pool
with our aquatic therapist
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lessened the seizures he was experiencing
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and helped him to sleep at night.
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His family had a peaceful place
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in which to both celebrate his life
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and mourn his death.
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It has been five years
since Lars was with us,
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and in that time,
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his family has welcomed
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a daughter and another son.
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They are such a powerful testament
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to the positive outcome that specialized
children's hospice care can create.
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Their baby's physical discomfort
was well managed,
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giving all of them the gift of time
to be together in a beautiful place.
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I'm going to talk to you now
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about the elephant
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rather than the camel in the room.
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Very few people want to talk about death,
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and even fewer about children's death.
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Loss of a child,
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especially for those of us
who have our own children,
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is frightening,
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more than frightening,
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paralyzing,
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debilitating,
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impossible.
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But what I've learned is this:
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children don't stop dying
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just because we the adults
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can't comprehend
the injustice of losing them.
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And what's more,
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if we can be brave enough
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to face the possibility of death,
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even among the most innocent,
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we gain an unparalleled kind of wisdom.
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Take Crystal, for example.
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She was one of the first children
to come for care
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after we opened our doors.
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She was nine when she arrived
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and her neurologist expected
that she might live another two weeks.
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She had an inoperable brain tumor,
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and her decline had really accelerated
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in the week before she came to us.
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After settling into her room,
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dressed entirely in pink and lavender,
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surrounded by the Hello Kitty
accessories that she loved,
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she spent the next several days
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winning over the hearts
of every staff member.
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Bit by bit, her condition stabilized,
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and then to our astonishment,
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she actually improved.
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There were a variety of factors
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that contributed to Crystal's improvement
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which we later came to call
the George Mark bump,
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a lovely, not uncommon phenomenon
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where children outlive
the prognoses of their illnesses
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if they're outside of the hospital.
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The calmer atmosphere of her surroundings,
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tasty meals that were fixed
often to accommodate her requests,
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The resident pets,
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the therapy dog and rabbit
spent lots of cozy time with Crystal.
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After she had been with us
for about a week,
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she called her grandmother,
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and she said,
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"Gee, I'm staying in a great big house,
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and there's room for you to come too.
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And guess what?
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You don't have to bring any quarters
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because the washer and dryer are free."
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(Laughter)
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Crystal's grandmother
soon arrived from out of town,
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and they spent the remaining
four months of Crystal's live
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enjoying very special days together.
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Some days were special because Crystal
was outside in her wheelchair
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sitting by the fountain.
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For a little girl who had spent most
of the year earlier in a hospital bed,
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being outside counting hummingbirds
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made for an amazing time with her grandma,
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and lots of laughter.
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Other days were special
because of the activities
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that our child life specialist
created for her.
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Crystal strung beads and made jewelry
for everybody in the house.
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She painted a pumpkin
to help decorate for Halloween.
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She spent many excited days
planning her tenth birthday,
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which of course none of us
thought she would ever see.
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All of us wore pink boas for the occasion,
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and Crystal, as you can see,
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queen for a day,
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wore a sparkly tiara.
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One hot morning, I arrived at work
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and Crystal and her partner
in crime Charlie greeted me.
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With some help, they had set up
a lemonade and cookie stand
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outside the front door,
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a very strategic location.
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I asked Crystal the price
of the cookie that I had selected,
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and she said, "Three dollars."
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(Laughter)
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I said that seemed a bit high
for one cookie.
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(Laughter)
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It was small.
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"I know," she acknowledged with a grin,
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"but I'm worth it."
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And therein lie the words of wisdom
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of a young girl whose brief life
forever impacted mine.
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Crystal was worth it,
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and shouldn't every child whose life
is shortened by a horrific illness
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be worth it?
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Together, all of us today
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can offer that same specialized care
that Crystal received
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by recognizing that children's
respite and hospice care
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is a critical component missing
from our healthcare landscape.
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It's also interesting to note
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that we are able to provide this care
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at about one third of the cost
of a hospital intensive care unit,
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and our families don't see a bill.
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We are ever grateful to the supporters
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who believe in this important work
that we're doing.
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The truth is that my colleagues and I
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and the parents and other family members
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who get to experience this special wisdom
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are in a unique position.
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There are only two freestanding
pediatric hospices in the United States,
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although I'm happy to report
that based on our model,
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there are 18 others
under various stages of development.
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(Applause)
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Still, most of the children
who die in the United States every year
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die in hospital rooms,
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surrounded by beeping machines
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and anxious, exhausted adults
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who have no other option
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but to say goodbye
under those harsh, institutional lights
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and among virtual strangers.
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For comparison's sake,
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the United Kingdom,
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which is a country with about one fifth
the population of the United States,
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and about half the size
of the state of California,
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has 54 hospice and respite centers.
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Why is that?
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I've asked myself that question
obviously many times.
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My best guess is that Americans,
with our positive can-do attitude
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hold the expectation
that our medical care system will fix it,
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even though it may be a childhood illness
for which there is no cure.
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We go to extraordinary measures
to keep children alive
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when in fact the greatest kindness
that we might give them
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would be a peaceful, pain-free
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end of life.
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The transition from cure to care
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remains a challenging one
for many hospital physicians
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whose training has really been
about saving lives,
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not about gently guiding the patient
to the end of life.
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The dad of a sweet baby
for whom we cared at the end of her life
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certainly captured this dichotomy
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when he reflected
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that there are a lot of people
to help you bring an infant into the world
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but very few to help you usher a baby out.
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So what is the magic ingredient
at George Mark?
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The complex medical diagnoses
that bring our young patients to us
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mean that their lives
have often been restricted,
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some to a hospital bed
for long periods of time,
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others to wheelchairs,
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still others to intensive courses
of chemotherapy or rehab.
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We make a practice
of ignoring those limitations.
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Our default answer is yes
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and our default question is why not?
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That's why we took a young boy
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who wasn't going to live
for another baseball season
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to Game 5 of the World Series.
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That's why we have a talent show
put on by the staff and kids
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for family and friends.
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Who wouldn't be enchanted by a young boy
playing the piano piece with his feet,
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because his arms are atrophied?
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That's why we have a prom every year.
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It's pretty magical.
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We started the prom
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after hearing a dad lament
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that he would never pin
a boutonniere on his son's tuxedo lapel.
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The weeks before the dance,
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the house is in a flurry,
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and I don't know who's more excited,
the staff or the kids.
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(Laughter)
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The night of the event
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involves rides in vintage cars,
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a walk on a red carpet
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into the great room,
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a terrific DJ
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and a photographer at the ready
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to capture pictures of these attendees
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and their families.
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At the end of the evening this year,
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one of our young,
delightful teenaged girls,
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Caitlin, said to her mom,
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"That was the best night
of my whole life."
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And that's just the point,
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to capture the best days and nights,
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to abolish limitations,
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to have your default answer be yes
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and your default question be why not.
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Ultimately life is too short,
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whether we live
to be 85 years or just eight.
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Trust me.
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Better yet, trust Sam.
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It's not by pretending
that death doesn't exist
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that we keep the people,
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especially the little people that we love,
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safe.
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In the end,
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we can't control how long any of us lives.
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What we can control
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is how we spend our days,
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the spaces we create,
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the meaning and joy that we make.
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We cannot change the outcome,
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but we can change the journey.
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Isn't it time
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to recognize that children deserve
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nothing less than our
most uncompromising [??]
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and our wildest imagination.
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Thank you.
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(Applause)