To every thing there is a season, and a time to every purpose under the heaven.

—Ecclesiastes 3:1


I step into the exam room carrying a small plastic tray on which rests a syringe filled with influenza vaccine, a cotton ball saturated with alcohol, and a Band-Aid dot. The little boy is sitting in his grandmother's lap, looking at a book. Her face brightens when she sees me.


"Well, hello!" I say, sliding the tray onto the countertop and extending my hand in greeting. "You've got the duty today, I see."


"Yes," she says. "Tuesdays are my day off from work. I get to stay home and take care of my grandson. He just turned 3 years old."


"Those early years zip by in a flash," I say. "They don't stay little long."


"No, they don't. It seems like just yesterday I brought my own babies to see you, and now I'm bringing my grandson."


"How are things with you?"


A fleeting smile flashes across her face. "It's been a tough year," she says. "I've got my mother living with me now. I didn't think it would be quite like it turned out. She's 85, and with frontal lobe dementia, she requires constant care. But what can I do? She's my mother. And then there's Meg—I've still got Meg at home. You remember Meg—"


"Of course I do."


I think back to the days when Meg was a small child: happy, healthy, developmentally sound. I recall the onset of the headaches, the consultations, the initial imaging study that revealed the astrocytoma. I think back to the first in a series of surgeries, the post-op care, the grueling periods of chemo and radiation therapy, the recurrence. I thought for sure she would succumb to these therapeutic punches, but somehow she survived.


I remember watching her blossom into adolescence—that day her mother brought her to see me. One breast had begun to develop, the other lagged behind. She was worried. What should we do? Wait, I advised; give it time. How long? Three months, six months. We waited. The laggard finally caught up. Meg was pleased. She no longer felt like a freak, even though she still lost her train of thought when she spoke to you.


She made it to her 18th birthday. Then she turned 21 and transferred to an internal medicine practice. Kids eventually grow up and become adults. Adults mature. Some get married 
and have children of their own, like Meg's older sister, the mother of the 3-year-old boy who is here today for his flu shot.


"How is Meg doing these days?"


"Actually, she's a big help," the grandmother tells me. "She likes to spend time with my mother. She keeps her company when I'm at work. She even does her laundry. My mother calls Meg her little treasure."


Slowly, I nod my head. Then I say, "Well, let's have you give your grandson a little hug, and we'll get this pinch out of the way."


She tightens her arms around his small body and whispers something to him as I slip the hypodermic needle into his arm. Like a tiny puppy, he lets out a yelp and buries his face in his grandmother's arms.


"My daughter needs something in writing saying that he got his flu shot," she tells me as she rises to her feet. "This year the daycare is requiring it."


I reach into the overhead cabinet, pull out a notepad, and begin to write, whispering the words as I jot them down on the paper. The grandmother watches my pen strokes intently. I tear off the sheet of paper and hand it to her.


"Oh," she says, "it's the title of a book!"


"Yes—The Summer of the Great Grandmother by Madeleine L'Engle. Do you know it?"


"No, but we'll look for it in the library. Is it good?"


"It's about how a family of four generations commits to caring for the 90-year-old great-grandmother in their home the last summer of her life. I think you'd like it."


"Thank you so much," the grandmother says. "It's always nice to have a recommendation for a good book. Maybe Meg would like to read it as well."


I watch them walk down the hallway, this woman I have known for the past 23 years as a mother, now as a grandmother, whose grandson still has a great-grandmother of his own.


L'Engle writes: 


I hold [my mother] as I held my children when they were small and afraid in the night; as this summer, I hold my grandchildren. I hold her as she, once upon a time and long ago, held me. And I say the same words, the classic, maternal, instinctive words of reassurance. "Don't be afraid. I'm here. It's all right."


During this summer of dying, Crosswicks becomes a refuge.... But even Crosswicks cannot hold out death—for, indeed, a refuge is not a defense against death but the place where we prepare to meet it. Nor is it, at the end, a place at all, but a Person in whose arms we securely rest and to whom we return at last, 
at home. 

JAAPA 

Brian T. Maurer, PA-C, practices pediatrics at Enfield Pediatric Associates, Enfield, Connecticut. He is the author of Patients Are a Virtue and a member of the JAAPA editorial board. Visit the author at http://briantmaurer.wordpress.com/.