When I walked through the front door of my house as a new mom, I felt that I was given a different pair of glasses. I had to refocus and readjust my lens because I was “a mom.”  With these new glasses, I view things differently. When I inspect my dental insurance, I focus on the orthodontic benefits; when I go walking, I notice the sidewalk hazards; and when I enter a patient’s room, I focus on their family, their children and their relationships.

As a palliative care physician, my view is often from the bedside of a dying person, witnessing the recounting and reappraisal of a life.  As a mom, my view is often watching my children move through the world, appraising their environment and recounting their adventures. From these vantage points, I realize that the lessons the dying teach us are often the same lessons our kids teach us.  These lessons, described by Dr. Ira Byock in The Four Things that Matter Most, are four simple phrases (“I love you,” “I forgive you”, “Please forgive me” and “Thank you”) that have unique powers to heal and nurture relationships especially at the end of life.  Since becoming a physician mother, I realize that these phrases, which guide people through their final days, are lessons in humility and love that my children teach me every day.

I forgive you. Please forgive me.

Mr. C is dying from an inoperable bowel obstruction and though his physical pain improves, he continues to have a deep level of distress unresponsive to opioids.  When I ask how I can help, he tells me of the estranged son he has not contacted in thirty years and the existential pain of the unhealed wound.  With amazing humility, Mr. C places a call that spans the largest human chasm.  His son answers. Mr. C invites him to his bedside in a humble gesture to ask for and to give forgiveness.

My son fancies himself a construction worker and has dug a series of holes in the backyard. He has dug up my perennials and laid waste to our grass. I run out of the door, yelling, “Stop! Put down the shovel! Go to timeout!” He runs upstairs in a flurry of anger, fear and hurt.  After tempers subside, he comes out of his room, lower lip quivering, apologizes and asks for forgiveness.  My anger melts, his apology accepted and I ask him for forgiveness for getting mad and yelling over a patch of grass.

While thirty years of hurt and thirty holes in the backyard are on different levels, the lessons of asking for, receiving and giving forgiveness are the same.  In asking for forgiveness and in honoring my children’s requests for the same, I realize these small moments of grace steady us for those larger experiences when we are asked to humble ourselves and dig deep into a root of love that may have laid dormant for years.

Thank you.

My three-year old daughter sits mesmerized as I read her favorite book for the thousandth time.  As I finish, she looks at me and says, “Thank you, mommy.” Mr. K, dying of AML, looks at his wife of 60 years and, in between labored breaths, says, “Thank you for being by my side.” After a long day of work, my son hands me a homemade Valentine card and, as tears well in my eyes, I hug him and cry “Thank you.”

These moments of gratitude for gestures both little—a glittered Valentine—and large—a lifetime of unwavering love—can be conveyed with two simple words.  The seemingly simple act of truly thanking someone encompasses acceptance of the other person and acknowledges a shared understanding and experiences that transcends words. Through gratitude, I acknowledge my son, daughter and spouse as a person, honor their gift and express how their presence has become a vital part of me.

I Love You.

Walking out the door, I kiss my kids’ sweet heads and say, “I love you.”  I watch through the ICU window as a mother lays next to her 14-year old son, declared brain dead from a bicycle accident, and she repeats, “I love you. I love you.” A daughter sits next to her father’s bed as his breathing becomes apneic. She leans closer and whispers, “I love you so much.”

The words of love spill much easier from my mouth since becoming a mom. I strive to be as quick with an “I love you” as I am with a tissue.  As a physician, expressions of love do as much healing and comforting at the end of life as any morphine. These words offer a plain, simple and deep acceptance of one another.  “I love you,” offers a home in my heart and in my life, whether your body is down the street playing tag or gone from this world. These three words open myself to your jokes, your tears and your presence in life.

Since entering motherhood, I realize that the lessons learned from patients and children are similar. They teach me to appreciate and enrich the relationships around and within me. These relationships are nurtured and healed by simple, meaningful phrases of “I love you,” “Thank you,” “Please forgive me,” and “I forgive you.” My children teach me to say these phrases nearly every day and my dying patients show me the graceful power of these words.

Byock, Ira. (2004) Four Things That Matter Most: A Book About Living. New York, NY: Atria.