Writing about dying youngsters is a near-impossible activity. The topic indicators, instantly, that this won’t be a straightforward learn, and that the terrain forward is steeped in grief and concern and helplessness.

And but, in As a result of I Knew You: How Some Outstanding Sick Children Healed a Physician’s Soul (Chehalem Press, 2025), Dr. Robert Macauley does one thing reassuring: he neither flinches from that actuality nor burdens the reader with unrelenting sorrow. As an alternative, he reveals the quiet, radical truths of pediatric palliative care: its heartbreak, sure, but additionally its fierce love, its magnificence, and its grace. This can be a ebook that insists we glance intently at what most individuals would fairly not see. In doing so, it upends each assumption about what it means to witness a baby and their household navigate an expertise that, for most individuals, feels unimaginable.

In As a result of I Knew You, Dr. Macauley provides a young, clear-eyed, and in the end redemptive take a look at the world of pediatric palliative care. Macauley’s personal journey via medical faculty, seminary, and years at sufferers’ bedsides mirrors the trail walked by the households he serves: marked by uncertainty, braveness, and deep presence. His lived expertise– together with a childhood marked by abuse– coupled with profound empathy makes him not solely a talented doctor however a rare information via considered one of life’s most troublesome landscapes.

The ebook’s title comes from a line within the tune “For Good” from the musical Depraved: “However as a result of I knew you, I’ve been modified for good.” And certainly, the central thesis of the ebook may be this: that the act of bearing witness to a different’s struggling shouldn’t be passive. It modifications you. It calls for one thing of you. Dr. Macauley rises to that demand many times, and in doing so, challenges the remainder of us— healthcare suppliers, dad and mom, readers— to do the identical.

What’s exceptional is the mild, nearly meditative pacing of the ebook. Macauley resists the temptation to supply linear options or tidy endings. As an alternative, he permits uncertainty and grief to be what they’re: usually unresolvable. The ebook strikes between scientific expertise and religious reflection with grace.

Dr. Macauley’s prose is lucid and spare, sometimes poetic however by no means indulgent. He attracts from literature, philosophy, and even popular culture, however all the time in service of the story at hand. There’s a profound respect for the youngsters themselves all through the ebook, not simply as sufferers, however as entire folks. They’re by no means used as classes or metaphors. They’re seen.

One of many ebook’s core strengths is its moral humility. Dr. Macauley doesn’t fake to have the appropriate solutions in each case— simply higher questions. How do you clarify to oldsters of a dying baby that the remedies that can delay their baby’s life may even delay their struggling? When, if ever, is it okay to cease making an attempt to save lots of your baby’s life? How does a health care provider steadiness empathy for his or her sufferers whereas additionally sustaining skilled decorum and preserving their potential to proceed to indicate up within the long-term? And maybe most poignantly: why do horrible issues like terminal childhood sicknesses and genetic ailments occur below the attention of an all-knowing and loving God?

These should not summary philosophical puzzles for him— they’re each day observe. He shares the story of a youngster who wished to die “at residence, comfy,” and the way that want steered selections round his end-of-life care. One other part recounts the story of a household that pursued a dangerous coronary heart surgical procedure for his or her daughter– figuring out her underlying situation was terminal– as a result of it will purchase them a couple of extra months collectively. In each case, Dr. Macauley provides households company with out romanticizing their selections.

For me, this steadiness was what made the ebook such a balm. It additionally took me on a stroll via acquainted floor: in Could 2020, when my daughter was 8 years outdated, she was identified with Acute Lymphoblastic Leukemia. She spent the subsequent three years in remedy, critically unwell, combating to outlive. Throughout that point I usually felt as if we had been suspended in a merciless type of in-between. My baby was steady however not protected, by no means removed from a brand new complication, and struggling immensely. Medical professionals similar to Dr. Macauley had been our lifeline. They offered steering, perception, and assist at each harrowing flip. Studying As a result of I Knew You jogged my memory that there are folks on the market who always remember the gravity of what households like mine endure.

Even when your baby survives a severe sickness, you carry the shadow of what may have been.  The ache Dr. Macauley describes dad and mom enduring all through the ebook– dropping their youngsters to horrible sicknesses– was by no means mine to expertise, however for years my household stood on the precipice of it, hovering close to the sting of a cliff we had been terrified to look down. Dr. Macauley doesn’t sensationalize this terrain. He merely lives in it with compassion and ethical readability after which invitations us in.

As a result of I Knew You is important studying, not only for medical professionals, however for anybody who has ever beloved a baby via struggling. It’s a quiet ebook, however its affect is seismic. In a world so usually uncomfortable with dying, Dr. Macauley invitations us to remain current in life— all the way in which to the tip, after which, mercifully, past it.