Entering my fourth decade, I was pleasantly surprised to find that I still find complete and absolute wonder while gazing at the sky. Daytime skies- I’m in awe of the different shades of blue and the infinite configuration of clouds and cloud types. Evening skies- how does all that blue transition before our very eyes to pink, orange, and purple? How can the clouds create such stunning shadow shapes?

I became hyperaware of this miracle of skies one afternoon in mid-September. A few weeks prior, I had bid farewell to a special soul, a young man who celebrated his 15th birthday, then fell asleep for the last time a week later. We had known each other for years, his parents bringing him to the Pediatric ICU every few months for pneumonia, complications related to his feeding tube, or seizures. Each time we greeted each other with rueful smiles: “Oh, you missed me, huh?” “You know it, Dr. Annie. You’re one of my faves and I just can’t stay away!” Conversations with my young friend were only verbal on my side; he communicated with us in his own way with his eyes and non-verbal connections. Maybe we were often guessing at what we were seeing, his parents included, but he went easy on us. That was just one way that he cared for us while we cared for him.

After a particularly grueling year marked by admission after admission, sometimes with only a few days at home in between, his parents and I started noticing that he was losing the light and sparkle in his eyes. In their words, “he’s just not...him anymore.” We chatted each day between rounds about how he’d been doing at home. His parents described in their usual jovial way about how he was postponing their family RV and camping trips, where he would trade his custom wheelchair for an ATV and have his trach capped while he and dad raced through sand dunes.

During a prolonged admission with an intensive surgical intervention that failed to give him relief from his struggles, mom and dad asked to talk about “next steps.” They were very clear: he can’t do this anymore. His life had become only suffering with none of his usual enjoyment. Most poignant to all of us at this point was that he was able to transition to a regular hospital bed. He was no longer trying to move around at all and didn’t need the enclosed sides to protect him. In fact, he appeared too uncomfortable to do much more than sleep.

We found a day that would work. How do you choose that? How do you choose the day when you say good-bye to your child? It’s impossible. By the grace of everything that is good, mom had the insight and love in her heart to say, “I want to celebrate his birthday. His 15th birthday is coming up and we always do something special for his birthday. We can do it after that.”

I wrote my friend a card. A birthday card was too specific, so I chose a card from the “Just Because” section that featured a pleasing cartoon of a rainbow, sunshine, and clouds. I told my friend Happy Birthday and thanked him for our years of friendship. I included a quote from a song that I wanted him to hear. I wrote my friend a card. A birthday card was too specific, so I chose a card from the “Just Because” section that featured a pleasing cartoon of a rainbow, sunshine, and clouds. I told my friend Happy Birthday and thanked him for our years of friendship. I included a quote from a song that I wanted him 

I feel lucky
To say that you’ve been
A friend of mine
Best believe me
You will see me

On the other side

Three weeks after my friend died, I went for a run to clear my mind of the sadness and grief that came in unexpected short waves, when I was least expecting it. My body felt weak and out-of-sorts and I questioned the wisdom of my choice as I set out on the road. I happened to glance up and saw the sky stretching out forever in front of me, the brightest blue, no clouds except a far-off suggestion of a wispy trail. I knew my friend was up there, running through fields of joy and skipping up waterfalls, finally free forever. The song that started in my headphones at that moment was the one I wrote in his card. “Thanks, bud,” I thought. “I needed that.”