On an icy January morning when you were only eight years-old, you came into the school-based health center with a runny nose. “Miss Evelyn,” you said with big round eyes, rubbing your nose with a tissue. “My nose keeps running and running and I keep blowing it, but it won’t stop! Can you see if I need medicine?”
Our clinic office manager and I shared a laugh as I grabbed my stethoscope. “Of course! Come on back, Kevin!”
As we walked to the exam room, I asked you how your winter break was. “Happy to be back in school with your friends?” I said cheerfully.
“Uh huh,” you said, stepping onto the scale. I noticed that you’d gained 11 pounds since I saw you in August for your school-entry physical. Your school uniform did look a little more snug than I remembered.
“Have you been eating your fruits and veggies?” I asked, as I plotted your weight onto the growth chart.
“Well, um, not really because I mostly eat bread and chocolate every day.”
“Chocolate!? Kevin!” I groan. “Why?!”
“Because we have a lot of chocolate now,” you told me very matter-of-factly, climbing onto the exam table.
“And, why do you have so much chocolate?” I expected you to tell me that they were Christmas gifts.
But, then you explained that it was because your dad had died a week ago. Your family friends had brought over chocolates as condolence gifts.
I remember that day well, Kevin. I remember you telling me about a dream you had just had the night before. You said there was a big man who kept opening and closing a big box, and that this big man started to bleed a little… and then a lot, and he wouldn't stop bleeding, and there was blood all over the place, and the box kept opening and closing, and it just wouldn’t stop.
“Did the scary dreams start after your dad died?” I asked. You nodded, fingering the edges of the exam table paper while looking down into your lap. “Do you have anyone at home to talk to?” You fervently shook your head and told me your mother was too sad already and your sister was having a baby and you didn’t want to make her and the baby sad, too.
"So, I just keep my feelings inside,” you said. “I have to keep my feelings inside, because I don’t want to make everyone more sad.” A few seconds of silence passed before I told you it was okay to cry. You looked down at your hands and started rubbing an invisible stain on your pants.
“You must miss your dad,” I said. You sat very still and said nothing. Then, slowly, a tear. And then another. “What was your dad like?” I asked gently, softly.
You looked up at me with your round eyes and smiled. “My dad promised to build a house for me in Puerto Rico after I finished my school,” you began. “But, then, my Dad said he wanted me to stay here instead of going back to Puerto Rico, and he said it was because that was better since he might not always be here and then when I asked why, my dad didn’t say anything.”
You told me dad was in the hospital for two months. That every day, after school, you would go with your mom and sister to the hospital to see your dad. That on the last day of school before winter break you walked home in the slushy ice, as you always did, expecting to go to the hospital, as your family always did, but when you got home, no one was ready to go. “Everyone was sad so I just went into my room. Then my mom came and said it was time for me to know what happened.”
You never really stopped talking all that time, Kevin. Words came out of your mouth, one after another as if your thoughts and feelings were traveling faster than you could express them. You had so much on your mind, you had so much you wanted to say, you had so many feelings buried inside. And, so we just sat there in the exam room, me listening to you, you telling me your story.
You told me your dad had “a big straw” in his mouth and that’s why he couldn’t even talk to you. I knew this meant your dad was intubated and on a ventilator. You said that you would tell your dad about all the things at school and all that you were learning, but your dad could never say anything back, and that always made you sad. “And, miss,” you continued, “the people at the hospital just… didn’t… care about my dad… because they just kept coming to take blood from him and they didn't care that taking too much blood would kill him, and so that’s what they did—they killed him! They took too much blood!”
You were frustrated at this point, Kevin. You were spitting our your words and punching your leg with each breath you took.
Then, between angry and frustrated sobs, you started crying about the unfairness of it all. “I’m the only one who has to grow up without my dad! Because I’m the littlest and my sister and brother are all big and they all had a dad, but only I won't, and it’s just not fair! My dad’s never going to see me graduate and he can’t build me my house and he won’t know anything about me even though he’s my dad because he’s not here, and I … just... want... him... back!”
I gave you the tissue box and rubbed your back until you calmed down and could breathe again. I said something to you, I’m sure, but they’re words I no longer remember—perhaps because they felt so empty and futile to me at the time.
Once you stopped crying, you looked at me and said, “Did you know that my dad always knew what I wanted for Christmas? My dad always got me what I wanted because he always knew what I wanted. You know why? Because he’s my dad.” Your eyes filled with tears again. “And, this year, everyone else got what they wanted except for me and do you know what I got?”
“What did you get, Kevin?” I said, looking into your teary eyes.
“All I got was a toy police car.” And, then, Kevin, you began to cry again. Hard. Harder than before. You said between cries, gasps and heaves, “I... don’t... even… LIKE POLICE CARS! I don’t like them at all! And, you know what, miss? I even tried super hard this year to be a good boy.”
“I know you did, Kevin! You’re one of the best.” I started rubbing your back again.
“Then… how come I didn’t even get what I wanted for Christmas?”
I can still remember racking my brain for how to respond to all your big questions: death, hope, parental loss, and now…Christmas. I was trying to think of what to say. I didn’t know what to say. But, then, even before I opened my mouth, you answered your own question—a question I think I was too scared to ask out loud. "What did you want for Christmas?"
“All I wanted was for my dad to get better.”
I swallowed, took a deep breath and gave you a big hug. I would eventually have you come back and see me a few more times just so I could follow up with you as you navigated and processed your father’s death. We would talk about school, your friends, your family, your dad.
By mid-February, I would feel comfortable with how you were doing and our weekly sessions would end. I’d see you here and there in the hallways, and you would wave to me while standing in line with your class. And, each time I saw you, and every December since then, I would remember what you said to me after you finished crying, after you told me that your only Christmas wish was for your father to get better.
Do you remember? Do you remember what you said to me after I hugged you, after you were finished crying, after you hopped down from the exam room table?
I remember it so clearly. You gave me a big kind smile and said, while still sniffling, “Did you get any presents for Christmas, miss?”
Image: Artem Perevozchikov / gettyimages
All names and identifying information have been modified to protect patient privacy.
Evelyn Lai is a pediatric nurse practitioner as well as a 2018–2019 Doximity Author.