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Dear Keisha,

This letter is going to seem very odd, and somewhat strange to you.  You probably wouldn’t remember me, nor should you really. You see, we met some twenty-seven years ago when you were just ten years old. That’t right, you were only ten the first time you came to seen me for physical therapy for a hip injury. We only had the pleasure of working with each other a few times, but in those few treatments, you made a very big impression on me. How big you ask? Well, I have been a therapist for a very long time and have seen tens of thousands of people in that span of a career.

And I still remember every bit of our time together. Even after all those years.

You wouldn’t have known this, but you were one of my very first patients at my first job when I was fresh out of physical therapy school. I had just moved to Waco. I was young, I eager to save the world, but also very stupid and incredibly naive. Everything a young man probably should be at that stage of their lives. 

I thought I was superman. Little did I know that I would soon meet my kryptonite. 

First things first, I remember your hair. It was freshly braided and you had little beads hanging off the ends of each strand. You were short and squatty, no offense, and you had to scoot yourself forward and almost fell down out of the very large chair in the waiting room that you were sitting in. You had your momma, (as you called her) with you, and your littler brother Kenny. I only say littler because he was literally smaller than you, but come to find out, Kenny was actually your twin brother. I told you and Kenny that I had a twin brother too, and unlike the two of you, we looked just alike. Kenny thought it was cool, you just seemed to not care, you didn’t seem to care about a lot of things I said that day. Oh, and there was one thing that I remember the most about that first meeting.

You had the saddest eyes.

First impressions are a big thing when getting to know someone, so the sadness in your eyes made a big impression on me. Kids shouldn’t have sad eyes, they shouldn’t have an ounce of sadness in their tiny little bodies at all, so your sad eyes made my normally joyful heart sad.  

It was going to take a lot of work to make them big brown eyes happy.

Your momma told me that today was meant to be a big “adventure”. She said it the way most parents say things when they are trying to get their children excited about something that children don’t get excited about normally.  Like going to the doctor’s office.  

I remember her saying that today was a big “treat” because you and Kenny got to skip school and you went to a fun breakfast place for pancakes. I think Kenny said he had pancakes with sprinkles, I don’t remember if you even told my what you had.

I also remember her saying that today was a big treat because she was actually in town. She mentioned she had to live with your Auntie in Dallas most days of the week because of her work, and that you and Kenny lived with your grandma (NaNa) back here in Waco. 

I can see where not having your momma around would make you sad, but I felt there was something more to the story behind your sad eyes.

I asked you about your hip and why you were limping so bad. I asked you to show me where it hurt and was a little confused that you really didn’t have a “show me with one finger” spot, that you used more of a hand. Your momma told me that you were running in your classroom at school and hit the edge of a table. At least that is what she was told. 

But was that what really happened? Is that why you were hurting so bad?

Of course we did all the silly and annoying tests we therapists do to assess a hip that has been injured. I laid you down on you back and  moved your hip around. I then checked to see how big and strong you were. We even got Kenny involved because it was the only way to keep him from running around the entire clinic acting like it was one big playground. 

I asked you about the bruises. 

You didn’t really seem to know where they came from and your momma said that you had been falling a lot because of your hip. Or that’s what your NaNa told her. I didn’t think a whole lot about them at the time. You were a little kid and to my knowledge, a pretty active one at that, well, before the “accident” at school. All I assessed at the time was you had normal motion in your hips, were very weak in the left one as compared to the right one, and you walked, or better yet, shuffled. 

You also fatigued rather easily. I wasn’t sure if you truly got tired and wanted to quit the exercises you were asked to do, or if you were simply bored. None the less, you said you needed to quit, a lot. Actually, those were about the only few words you said to me. 

It was the same the next week on your second visit.  Kenny was still crazy, your momma was still as lovely and sweet as she could be. And you were merely still. You didn’t seem to want to do any of the exercises, and when we did, you didn’t seem to want to do them for very long. 

And you still had the sad eyes.

You looked at me in more of a “why are you punishing me” kinda of way rather than a “this is boring way”. I know that look.  I have seen that look dozens of times over my career. I just wasn’t sure what it was then. I do now.

I chalked it up as loss that day. 

The third time you came in was no different than the first two. We had fun, well, Kenny and I had fun trying to get you do the “fun activities” this rookie therapist had planned, but again, you really weren’t excited about any of it. Of course your momma raised you to be kind, and you tried all the things, but you just tired easily or started to “hurt”.  

You don’t know this part, the part when I asked to talk to your momma alone, the part when I really just had the weird feeling and finally had to say the thing out loud. Your momma and I spoke in private for a few minutes while you and Kenny, I mean Kenny, continued to play. I told her about my hunch, that something wasn’t adding up, that you seemed to be dealing with something greater than a bruised hip. I didn’t know if it was a cry for attention seeing that your momma was out of town a lot working, or if something was going on at school. Or at home. Whatever the case, I told her that I really didn’t know what was going on, that she needed to take you back to the doctor or even talk to a counselor. I just didn’t know what was happening.

Until I made the phone call. 

About a three weeks after that last therapy session, I found a red folder on my desk with a sticky note on it that simply read “D/C ?”.  It was your folder, the one that had all my notes and lists of the exercises I tried to get you to do. The front office lady had pulled your chart for me to discharge (along with several others) because you had not been back to therapy in several weeks. 

Normally I would have just written what we call a discharge summery, saying we had completed therapy and you were told to go see your doctor, and there was nothing more we could do therapy wise. Normally it would have taken me a few minutes to finish that task, and then I would have taken the chart back to the front, and moved on with my day. 

I decided to call your momma. 

I searched the chart and found the emergency contact number, your momma’s phone number. Now remember, this was in 1999, and cell phones weren’t as popular as they are today, so the number was actually to your NaNa’s house.  

A lady answered the phone that didn’t sound like the voice of your momma, or the voice I remembered your momma having. I told the lady who I was and that I was calling to check on you, to find out if you had been back to the doctor, and truth be told, find out what I just couldn’t put my finger on .

The lady was sweet and very soft spoken. She introduced herself as your Auntie, and she remembers hearing about me. And thanked me for calling and then she told me the news that I had never in a million years would have guessed when I dialed that number just seconds before.

She told me you were dead.

She told me it was cancer, she told me something about fluid around your heart, and she told me it happened so fast.

I told her I was sorry. 

I couldn’t think of anything else to say. Looking back I had so many more questions, so many more words, but in that moment, I froze, I could’t move and I couldn’t come up with anything better or more comforting to say other than, I’m sorry. 

So we finally come to the part of this long letter Keisha, the part that has taken me twenty-seven years to write. The part that I wish I would have said then if I had the time to think, but more importantly if I had the wisdom that twenty-seven years has given me. 

I’m sorry Keisha, I am so very sorry. 

I’m sorry that I didn’t catch it from day one. I’m not sure if three weeks would have made a big difference, but I would like to think it may have. I would like to think that doctors could have come up with a plan, and that plan worked and that working plan kept you alive long enough for the next plan to work, and the treatment cured you. 

I’m sorry the entire healthcare system failed you. We were all so focused on a tree that we didn’t notice the forrest, that the forest was burning and you were caught up in it, trying to escape. Any you couldn’t escape because you couldn’t run. 

I’m sorry that none of us were listening hard enough to hear what your eyes were trying to say.

Three weeks ago I found a sticky note on my computer that simply read “Call Bill” and had a phone number.

Bill is patient of mine that I had inherited from someone else. He is in his mid 60’s, super nice guy, retired and living what most of us would call “the dream life”. He had neck pain that traveled down to his left shoulder and down his left arm. X-ray and MRI show some pretty significant degenerative changes in his neck, changes that were consistent with the pain he was having. Consistent with what all the medical experts would say is cervical radiculopathy.

Except something didn’t feel right.

I thought it was not right how he described the pain. I thought his whole situation seemed a little different than the hundreds of cervical radiculopathies I have seen in the past. I thought of a lot of things. 

I thought of you.

When I called him, he told me that he went to the ER the next day after our last therapy session like we had talked about if he was till in significant pain. He told me that they gave him medication for the pain and ran more tests and took more X-rays, and that they had discovered something

Bill has cancer.

It is too early to tell, but the cancer is in his lungs and he was being referred to a place, a place that deals with cancer. A place that can help him the way we couldn’t help you. Bill is getting the care that we should have been able to get to you, but we didn’t.

We caught the fire before the forest began to burn.

So you see, the other point of this letter is to say thank you. You may have helped save a person’s life. Your memory, your story that lives with me, may have just been enough to help someone get treatment early enough to get the right treatment.

I know that you were only ten years old when you passed, but you made a mark in this world. You should now that. Most people go through this great big world without feeling significant, feeling less than, feeling like their lives didn’t matter.

Yours did. 

And still does today. In your short time here, you made people happy, you made people smile, even though we weren’t able to make you smile. 

These days I still think about you, and they are more often than you think. I like to imagine you would have grown up to be someone important, someone that was able to capture the hearts and minds of the people around them. That you would go on to make wonderful discoveries and change the world. That you would have made a difference in people’s lives. 

And then I remember you did, even at ten years old, even if you didn’t know it.

I love you

Thank you

I forgive you

Please forgive me

May I one day see the happiness in your eyes,

Mark

*names of patients were changed to protect their identity