Yitgadal

Children will lead and awaken our senses if we let them.

Yitgadal¹

Ms. Cornwall died at 4:25 in the afternoon. My son and daughter are by my side when I receive the phone call from my hospice nurse. Ms. Cornwall’s son and daughter-in-law are at her side. Everyone knew this moment was fast approaching, yet not one of us is ready for it when it finally comes to pass—especially not my daughter.

When I put the phone down and look up, my eyes flood with tears which seem to pass from my face to hers in one smooth stream, streaking past my nose and lips and onto her warm soft cheeks. Isabell bites her lower lip trying to stifle a cry, but her trembling chin gives her away. No use, a wave of sadness sweeps us up, and together we fold in each other’s arms and curl onto the floor. Joshua comes near and puts his arms around us both as we huddle and remember. My pain is magnified in the wake of my daughter’s. How can this young girl, who has argued with me only moments earlier in her most angry, righteous and defensive tone, denying any sort of hostile or bullying behavior, denying how she has just attacked her brother, now be so soft, so consumed with sorrow?

We met Ms. Cornwall nearly a year ago. During my first visit, I learned of many of her passions including her insatiable love of backgammon.

Entering her room is unlike entering a room of any other patient I have ever encountered in a residential facility. It is as if the very walls are alive, beckoning me to come and listen to their stories. Her walls are adorned with collages, each with colorful symbols and Asian influences. Each collage is crafted using any image she can get her hands on, with old JAL² calendars being her favorite.

Her hardwood floor is covered with handwoven carpets layered on top of one another, precariously balancing carved chairs from East Asia. The chests along the sides of her room are also clearly from Asia and are covered with brass statues and wooden boxes, each with a story all their own waiting to be retold. In the far right corner of the room sits the ever-droning oxygen compressor with tendrils of clear tubing coiled like a lasso with one end of the rope always leading to Ms. Cornwall. In the far left corner lay a very tall bed with Ms. Cornwall sitting regally as if perched on an elegant throne. Her sleeveless nightgown exposes her thin wrinkly arms covered in shiny, clanky silver bangle bracelets with rings to match on most of her fingers. Only the noise of her jewelry can match the energy with which she flings herself in and out of bed as if to defy the ever-failing state of her lungs and body.

Her backgammon board is set in mid-play on her bedside table. As she has no one to play with at the facility where she now lives, she resorts to playing herself the way many passionate chess players fill their gaming hours. She is beside herself when she learns I know the game. In a strong German accent laden with a heavy lisp, she replies hostilely, only half-joking “No you don’t!” Her cunning mind and infectious zest for life force an even quicker “Prove it!” on the heels of her disbelief.  

Throwing this gauntlet is a bigger challenge than she realizes. My love for this game runs deep. My father taught it to me when I was about Isabell’s age. He was always ready to play, and though backgammon had given way to cribbage as I grew older, these remained games I exclusively played with my father. I have not played since he died, until this day.  

Nearly every subsequent visit I make involves several mini-backgammon tournaments. It feels wonderful to play. I want to play with my kids, yet the memory of my father teaching me is too haunting to allow me to take on teaching my own children. So, I ask Ms. Cornwall if she might be willing to be their instructor. She is elated with the notion, and I set about bringing my children to meet her on their next school holiday.

Many visits with Ms. Cornwall pass before I am able to bring Joshua and Isabell. Most include rounds of backgammon. During our games, we do not distract ourselves with conversation. We play. It is only between games, as we reset the board and she takes sips of her half regular, half hot water Starbucks Grande coffee I routinely deliver, that I learn how she, a Jewish girl of 12, escaped Germany on the Kindertransport³ just at the start of the war. Oddly, this does not seem to define her as a person. She does not look on being separated from her parents or moving to a strange country on her own with any remorse, anger or hostility. In fact, her most frequent reply to such questions on my part is, “I am really blethssst. I have truly lived a wuunderful life!” With her magnetic personality radiating strong at 90, it is easy to imagine how she was able to make friends and create a community for herself in England. Even so, her competitive nature was clearly in full swing at a young age. She brightly smiles as she recalls her greatest victory soon after her move. “We were playing a game, all together, and I won three eggths! Three! You have to understhand, you were lucky to have one egg a week at that time.” She looks like she has just won the keys to a candy store. I can only imagine how she must have appeared 75 years earlier….

She once shared with me the worst moment of her life. Given all that she can conceivably choose from, not to mention her current failing health, I am startled by her reply. She describes watching in disbelief as her son, only five years old at the time, climbed the railings on the side of the ship they were sailing from England to Japan. As she remembers the image of him hanging over the balustrade, she shakes her head with her hand over her heaving chest, “I thssstill feel thsssick just thinking about it now!”  

I share all these stories with Isabell and Joshua. As toddlers, my children had heard about many of my patients over the years, yet they had rarely met any. Most of their encounters were with my hospitalized patients while I was rounding, but in these instances, Isabell and Joshua were always in tow on the sidelines, never visiting by intent. They were curious, as children will be and would ask why so-and-so had this pole attached to them or why were they acting a certain way. They never seemed frightened by the hospital smell or the beeps of the equipment. Children aren't born afraid of death. Children are born inherently curious about everything, including death. It's how grown-ups around them react that shapes children's responses to death. Though Isabell and Joshua had never been formally introduced to any of my patients, the stories they heard were usually about their illnesses, not their lives.  

Ms. Cornwall is different. Her life is the story, a mesmerizing story, a story that always has more that wants to be told. So even before their first meeting, Isabell and Joshua are already asking, “Did you see Ms. Cornwall today? How is she?” 

Finally, on Rosh Hashanah⁴, Isabell, Joshua and Ms. Cornwall meet face-to-face. Although they creep into her room rather slowly and shyly at first, (a behavior likely learned from observing their introverted mother), the intrigue of Ms. Cornwall's walls, knick-knacks and jewels quickly breaks the silence. The backgammon set is hastily broken out, and the game is on. Ms. Cornwall is not intimidated by their bold desire to play even though they don’t know how. “We know! We get it! Let’s just play!” is the repeated interruption of youth’s impatience as their new teacher attempts to articulate the rules of the game. The kids are equally nonplussed by Ms. Cornwall’s thin frame and tangles of tubing covering her bed and floor. They are just as curious about the wooden red bird by her lamp as they are about the oxygen tanks. It quickly becomes clear that this is a win-win proposition regardless of how the die fall.  

Ms. Cornwall’s eyesight is far from perfect, even with her many pairs of glasses to choose from on her nightstand. Furthermore, her hearing is hindered at times, whether by the constant drone of the oxygen compressor or by the soft-spoken voices of my suddenly angelic children. Fortunately, accuracy is not a point of contention when playing this game. So, when Ms. Cornwall begins moving multiple pieces thinking she has rolled a double and she can’t make out what the kids are trying to tell her over their uncontrolled laughter as she shouts out, “Oh, that was thsssooo thsssstupid” with scattered spittle from her ever-moistened mouth sending the smell of Starbucks coffee into the air, any hint of death lurking is enigmatically veiled. She plays the kids ferociously, never playing down to them and always trying to teach them the skill of the game. “Pay attention to your teacher!” she jabs, grabbing Josh’s hand as he reaches for a piece across the board, her bracelets banging away and rings flashing in the sunlight, making the entire scene a sensation for all the senses. “Now, look. Alwaythss prlotect your piethes! You never want to be alone.” We are all hopelessly in love.

Ms. Cornwall gives the kids one of her own backgammon sets after their first lesson. They immediately come home to practice and corral me with little effort into a match. They create elaborate “thank you cards” for her that are received with sincere adoration and appreciation, “Your kidths are really thsomething. I mean it!” She treats them like adults, not like children or grandchildren, and Isabell and Joshua eat it up and long for more. They have become friends. The age differences vanish.  

Ms. Cornwall never lets on she is getting weaker or sicker in any way. Her game board is either already out and in the middle of a set or just at the side of her bed. And no matter how out of breath or fatigued she might seem, “Oh, I’ll get it!” is her emphatic plea for independence and joy. So, when Ms. Cornwall’s health takes a very sudden turn, my children need to know.   

Isabell’s first attempt at understanding how sick Ms. Cornwall has become is by asking me if we played backgammon during my visit. When I shake my head, she becomes amazed, “You mean she couldn’t even play one game with you?” A look of utter disbelief consumes her, and she drops her head in silence, trying to imagine the unimaginable. Joshua, much like with the death of my father three years earlier, is practical and clear in his articulation. “Isabell, everyone has to die sometime, even us. I’m just grateful we got to know her. Can we go visit her and play?”

Somehow, the evening of Ms. Cornwall’s death, we manage to get back into our night’s routine. We have dinner and read stories and get ready for bed. When I enter my daughter’s room to tuck her in, I am startled to find her standing at her doorway. Figuring it is her usual delay tactics of “I’m thirsty” or “Mom, my knee is hurting,” I am slightly annoyed and impatient with what I expect to be a feeble justification for her being out of bed.

“Mom?”

[Constrained] “Yes, Isabell.”

“I was wondering…”

[Less constrained and more aggravated] “Yes, Isabell!”

“Could we say the Mourner’s Kaddish for Ms. Cornwall tonight?”

I was taught early on in my medical training to remain detached from my patients and have a professional boundary set for my own emotional well-being. I eventually decided that, for good or bad, I was not going to be that kind of doctor. Or, as Ms. Cornwall would say, “To hell wittth tthat!”             

1. Hebrew for magnified, it is the first word of the Jewish prayer, The Mourner's Kaddish. As the name implies, it is a prayer recited in honor of a person who has died. A version of this story originally appeared in JAMA and is being shared with permission.

2. Japan Airlines still makes these though distribution has changed— you can find JAL calendars for sale here!

3. Kindertransport was a “rescue” orchestrated by many European countries to relocate a total of 10,000 Jewish children under the age of 17 residing in nazi-controlled countries. Most did not speak the language of their new homes. Most did not have the opportunity to see their parents again. For firsthand knowledge, please explore the stories and voices which have been curated in a variety of learning formats from the USC Shoah Foundation here and Kindertransport.org here.

4. Hebrew name for the Jewish New Year, Rosh Hashanah is considered a High Holiday, an especially important day for many Jews which warrants missing work or school in order to observe the holiday by attending synagogue and enjoying a celebration meal that begins with dipping apples and a special bread called challah, in honey to create a sweet new year. Challah is typically braided except on Rosh Hashanah when it is shaped into a winding circle marking the cycle of life and beginning of a new year.