I’ve worked with adults for my whole career in health care, but occasionally I will meet with the children of my cancer patients who have questions about what their parents are going through. On this particular day, I was looking into the big, brown eyes of an eight-year-old with her long black hair in pigtails rocking an outfit that I wish I could pull off: purple and pink tie-dye with purple sneakers accented with sequence and glitter. Her dad had been diagnosed with widely metastatic cancer when she was four and the last four years of her life, she had been watching him experience the symptoms of the disease and the side effects of the treatments that failed him one by one. She had worked with her counselor to write down a list of questions to ask me and the social worker, and articulately asked her first question, “Why do people get cancer?” I gave a basic explanation about cells mutating and forming tumors and our bodies not being able to recognize and destroy them, but what she really wanted to know was why this had happened to her dad and could this happen to her. It was heartbreaking to hear this sweet, little voice ask this big question.

When I reflected on this conversation later, I thought about how this question of “why did this happen?” is ubiquitous and central to human nature but rarely is there a satisfactory answer. As this little girl showed me, it is not only the patient looking for an explanation. A patient’s wife whose husband spent his life skiing, running marathons, road biking, and only put healthy food in his body wants to know why he has metastatic pancreatic cancer. A mother whose twenty-year-old ski racer is losing her battle with sarcoma wants to know why she won’t get to realize all the dreams she had for her life. A breast cancer survivor who did every aggressive treatment we asked her to do wants to know why she now has liver and bone metastases. As the health care provider, I am focused on what we’re going to do about the diagnosis but there is a feeling of “why” just under the surface of every diagnosis that I know will end with the patient losing their life, a spouse losing their partner, a parent losing their child, and a sweet little girl losing her dad way too soon.

Doing this work makes it imperative to me to find meaning in these diagnoses that can feel hopeless. I believe it is a privilege to work with patients and families as they are facing serious illness. I treasure the relationships I can form with my patients and their family members. I get the opportunity to learn many unique things about them that help me understand the diversity that makes up this ever-changing world. I watch in awe as a patient with metastatic colon cancer completes a standup paddle board competition. A patient and his wife delay chemotherapy for two weeks to go to the Galapagos. A patient reconnects with her father after years of not speaking. A little girl learns that reading a story to her dad and coloring a picture for him can be the best supportive medicine around. It may not be the answer we are looking for, but a cancer diagnosis often tells us why life is worth living and what is most important to do, to say, and to ask.