A child dies.

REATING CHILDREN with fatal hematologic disorders, and supporting their families, has been such a prominent part of my professional life that I have had to develop a philosophy of dealing with the dying child and his family. Although I have presented this philosophy to pediatric groups, I have never committed it to writing. When the Editor of this Journal asked me to do SO for its first number, I was most reluctant, because what can be expressed to the listening audience in a meaningful way may become flat and trite when written. I finally agreed to do so in the hope that my readers would make allowances for the discrepancies between the spoken and the written word and might perhaps benefit from some of the things that have impressed themselves upon me in caring for the dying child. 4 n i? Death is the inevitable end point for all of us, yet we accept this disturbing fact with equanimity for we know not when it will come. Our lack of knowledge of the time does much to allay our fears and apprehensions, but how different is the picture when the inevitable becomes imminent. Each individual physician must establish his own professional goals and strive to maintain them. Although there may be many variations on the theme, the cardinal points are the same: (1) to fight disease on every front, (2) to prevent untimely, unnecessary or avoidable death, (3) when death is inevitable-to make it bearable, (4) after death-to salvage the family. The first two goals are accomplished by diligent, never-ending study of all parameters of medical knowledge. The latter two reflect the physician’s empathy and compassion. However, they are not innate skills but are tools which he must learn to handle if he is to fulfill his professional responsibilities. No one enjoys the heartbreak and emotional chaos associated with impending death; no physician enjoys visiting the death room, talking with the family, making appropriate but unsatisfactory small talk. In fact, most physicians run away from it and salve their conscience by working inordinately hard in areas other than the one where understandably they feel so helpless. Nevertheless, the physician must face up to his role in handling the dying patient. Physicians are not ministers, and yet in our profession if we minister to a person’s body we must minister to all of him. We can serve a patient fully only by caring for him when he is dying as well as when he is living. There is nothing right or good or bearable about the death of a child. It seems morally wrong to have life taken away almost before it has been lived, but one of the facts of life is that death comes-and to all ages. Contact with a dying child and his family can strain the emotions of the physician as