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The children I write with die, no matter how much I love them, no matter how creative they are, no matter how many poems they have written, or how much they want to live. They die of diseases with unpronounceable names, of rhabdomyosarcoma or pilocytic astrocytoma, of cancers rarely heard of in the world at large, of cancers that are often cured once, but then turn up again somewhere else: in their lungs, their stomachs, their sinuses, their bones, their brains. While undergoing their own treatments, my students watch one friend after another lose legs, cough up blood, and enter a hospital room they never come out of again.

The M. D. Anderson Cancer Center in Houston, Texas, where I have taught poetry and prose for nearly ten years, is a world-renowned research institution. I have met the sickest children in the world there—children who have been treated already, somewhere else, and who have come for one last experimental treatment, who have one last chance at survival. In this capacity, my students often take part in studies. The treatments they receive are often groundbreaking, innovative ones that, with time, are perfected and standardized. This means their experiences, whether their disease is successfully eradicated or not, serve to build treatment protocols that eventually cure children throughout the world. But only a small percentage of the students I work with in the center’s classrooms live. Less than half, maybe less than a third, and I think less than that: I am just one of the writers in residence there. The numbers aren’t available to me.





As part of my job I write a yearly reflective journal. In the first one, I wrote that while I had been an agnostic before working there, my experiences at M. D. Anderson made me understand that whether or not there is a Supreme Being, there is an afterlife. My proof was an eleven-year-old boy named Gio, who was a thin, shiny-eyed boy from Mexico. He was simultaneously firmly planted in the world of the living and the world of the hereafter. Up until the day his doctors informed him he wouldn’t live another two months, he had behaved like any other little boy: like he was too cooped up, like he was ready to tear the hospital apart in an adventure game. Once he received news of his impending death, he changed. He wasn’t afraid of dying and he wasn’t angry at the hospital the way he had seemed to be before. It was as if the news of his cancer’s progression opened something inside of him so that he could clearly see into another world, another place he was on his way to. Whatever it was he saw endowed him with an overwhelming generosity of spirit and the most intense humanity I had ever witnessed. I don’t mean he wandered around performing good deeds; it was something more internal. He was overtaken by something like joy. Not a giggling and hysterical one, but a calming joy that infected every room he entered.

Gio’s was the first death I witnessed as a writer, as an outsider who enters into the intimate world of struggling children. I assumed that his death was a template of sorts: this is how the very young die; they become almost holy. Unlike older people, who die scared and uncertain, dying children are endowed with grace. They are able to peek ahead into the world they are about to enter, and so they feel assured it’s there. They know it’s okay to transcend.

For two years after Gio’s death I clung to this vision. But there wasn’t another death like his. He was an exception. Most of the teens I regularly worked with when I started at the hospital died within two years of my meeting them: Oso, a big teddy bear of a boy, a Mexican immigrant who was so sweet it rubbed off on the edgier teens around him; Kile, an angry teen from Guam who had watched his two sisters die of the same cancer that was taking his life; Dolma, a pretty Turkish girl whose family ran out of money to pay for more treatments and who tried to sell books of her poems to raise the money they needed. None of these kids blossomed sweetly into death the way Gio seemed to: Oso was so scared I could barely breathe looking at him, Kile became too furious to speak, and Dolma died with her family in Turkey, always believing a miracle was possible.





How horrible to be able to catalogue the deaths of children in this way. I don’t know what else to do with what I’ve seen. These former students, these young, beautiful friends of mine were just the ones I met in my first weeks at the hospital, and the truth is that I could name at least a dozen more off the top of my head. After that I could read through my catalogue of student work, which I have saved, and come up with countless more. Names of lives I have forgotten because I didn’t teach them first or last.

Working in a classroom whose currency is the eventual death of most of the students runs contrary to the way anybody wants to think about life. People don’t mind being reminded that ten-year-olds die so long as they get to hear the story of that child’s life, so long as it is a story of resilience, a story about a soul raging on long after the funeral because it touched so many peoples’ lives and changed them for the better. From my current perspective, demanding so much of a dead child is sick. I also understand it is one of the only ways the people left behind have to make sense of these most enormous of losses. However consciously or unconsciously, they want to look in at the life of a young death and say: see, God had pity on these children because in the end, even though this baby died, she knew something we adults don’t comprehend. Her death has meaning that changes my life.

More than a decade into my teaching at the hospital, I no longer say I found faith there. I feel stupid for ever having suggested it. I was, like everybody else, trying to make sense of what is nonsensical. What I can say now is that there is something very special about being one of the people in a dying child’s life. When you know somebody with less than six months to live and that person agrees to spend any moment of it with you at all, the immensity of that generosity does change you, undeniably.





Some children I know for two weeks, some I know for half a decade. That means that I grow much closer to certain patients than to others. I grow too close. I say: if Khalil dies, I won’t be able to continue working here. Since I have known him since he was seven and he’s twelve now, his death is the line over which my presence in this institution cannot cross. Khalil is too full of life. He has written half a stream-of-conscious novel full of food fights and basketball games, has written one hundred and fifty poems. He is too crazy to die, he is whacko, he is nuts—or, as my coworker, Jeff, used to say before he left the job and moved to California to be a social worker: Khalil is crackers, an arrival straight from the cracker factory. Why would the world endow this young boy with such wackiness, with the young Johnny Cash’s lopsided gait and pool-ball eyes, with the right amount of kindness to soothe the youngest children in the room and the right amount of self-assurance not to be intimidated by the presence of the older children, if he were not meant to live? I know that Khalil will be famous one day—a rock star, a basketball hero, a politician who will become the first Arab American President of the United States because he is so beautiful, and he knows suffering, and he will be cured, and I know for sure: he will live long enough to enter a presidential election, he will live long past thirty-five.





The classrooms I work out of, with my coworker Evan, two teachers from the Houston Independent School District, and sometimes volunteers, are hospital rooms that have been fitted with a few computers, textbooks, and a table large enough for about ten people to fit around. There are two classrooms: one for kids younger than twelve, one for teenagers. Usually Evan and I bring the young students together with the older—mixing age groups is useful in writing: the different energies of the different ages of children inspire each other. When we have more than ten students we move into the Pedi-Dome, a giant indoor playground fitted with a basketball hoop, countless balls, and a dozen or so little fire engines and cars for the preschoolers to ride around on. Its roof is painted with stars, there is a yellow brick road painted on the floor, and an entire wall is made up of windows. Even though the view is terrible—we see the top of the building next door—the windows are so big that the room is full of sunlight.

Some kids arrive in class sailing down the hallway on their IV poles, some in wheelchairs or on crutches. Headscarves and baseball caps are the preferred bare head covering—wigs have been universally proclaimed too itchy and too weird. Some days we have one student, some days we have over a dozen. Writers’ class, as they dub it, is filled with poems, stories, blogging, Scrabble or Taboo game playing, arts and puppetry projects, and This American Life. We enjoy ourselves in Writers’. Tell Michael you’re three thousand and ten years old, tell Darrian you left your sweet talking mouth at home so he better get to work, and they’ll giggle. They’ll start making up jokes of their own. They’ll start goading each other.

One of the most meaningful days I had in Writers’ was after a particularly raucous class in which I think we laughed uncontrollably for three or four minutes straight at one point. We collectively got the giggles. Afterwards, an old woman stopped me on my way to the elevators.

“I stood outside and listened to your class today,” she said in the halting English that is common in M. D. Anderson’s corridors, “I just stood outside the door and listened to Umberto laughing, because he doesn’t laugh in the hospital room. He never laughs anymore, and I thought I’d never hear him laughing again,” she said, and she was crying.

I hadn’t realized before then how much the fellowship of kids being around kids changed my students’ personalities. Umberto laughed all the time in Writers’, he always looked forward to it. Our classes are usually jolly. Even when there’s one student who annoys the others, or when students don’t want to work, they all pull together to have a good time. To write, to joke, to be children. But the old woman, Umberto’s grandma, made me see how important it is for the children to not just be in Writers’, but to be in school. To forget, just for awhile, the pain, the nausea, the uncertainty, the boredom of hospital life.

Of course, there are sad days. We can go plowing through months and months with a regular group of about ten children, and then something terrible will happen. Then, unimaginably, after six years of living with a cancer that can only be contained by active chemotherapy, after the doctors tell his parents he will die of the chemotherapy if they don’t try a more aggressive treatment, and then, after the doctors fail to successfully remove the almost three hundred tumors in Khalil Al-Almoudi’s stomach in an experimental surgery, Khalil dies. Nine students are left in the classroom, students who have known him as long as they have been hospitalized, because nobody has been in and out of the hospital as long as Khalil.

The week after his death, two more children enter the hospital classrooms. Oblivious to reasons behind the sadness the schoolteachers, the writers, and the other children can’t shake, they assume those first weeks that there is just a pall in a cancer center’s classroom.





Students don’t often address their cancer directly, in the day-to-day of the classrooms. They write about thunderstorms, or animals, or when they’re being more serious, about family and the homes they left behind. However, conquering insurmountable odds and tricking fate are common themes. When they do write directly about their cancer, they don’t write poems, they write essays detailing their experience. Except when a child is about to die. Then they often choose poetry, they often speak directly to God. These poems are angry or they are hopeful. One nine-year-old boy who had spent two years writing whacked-out adventure stories wrote to God in this last poem of his life, which was untitled:

What thoughts I have of You tonight, God. You protect me and You make giant waves and wash people away. You owe me. You make the tornados that suck Up the people and move them to another dimension. You lift every rock in the whole wide universe and throw them At the people who try to hit me. God, I see You playing my videogames in my room. You’re young, with shiny eyes like mine. You have a little beard and You play the Games without using controls Because You can. Because You Can fly without wings. You Can use magic and make balls of fire and lightening. God, You are powerful and I am a cell Compared to you.

If you were a teacher, and you loved a boy who died, you might quit because you always knew you couldn’t keep going after that death. You could quit any day, knowing his wouldn’t be the last death, knowing your employers would understand because really, they have been expecting you’d quit suddenly, one day, all along. It is a hard job you have, after all.

The week before Khalil died, I didn’t think he would really die. It had been predicted at least a year beforehand, and I had ignored the prediction. I always knew I couldn’t work there any longer if he didn’t live.

But a month before Khalil’s death, his best friend, Darrian, who was newly cancer free, lost his mother. His perfectly-healthy-seeming, thirty-five-year-old mom just collapsed and died on the floor at home, in front of Darrian and his two younger brothers. Darrian called 911, but it was too late. After moving in with his grandmother, arrangements were made for Darrian to have one more semester in the hospital, in a place with people he loved and was familiar with, instead of starting junior high in the public school as he had been scheduled to do. In Writers’ class, Darrian only spoke cryptically about his mom. “You know what’s weird,” he said, just a month after she died, “My mother’s birthday and the day she died have all the same numbers in them. I noticed at the funeral.” And then he wouldn’t say any more.

When Khalil died I thought, on one level, I can’t go back. But in the world of the living the reality is that I can’t leave just yet. I can’t leave Darrian. Or Amirah. Especially Amirah, because she is eight, a little girl from Egypt who loves the Disney princesses and the color pink, but who is one of the most strange and grave little souls I have ever met. I can’t step away from her steady, stoic gaze. And when I imagine my own two-year-old daughter in six years I see Amirah’s face, awaiting me haughtily at the end of the hallway every Monday and Thursday. I can’t leave the hospital just yet, I say to myself. I say, instead: But if Amirah dies, then I can’t come back anymore.





Nicole is the elementary school teacher, and she’s worked at the hospital a year longer than I have. In her midforties, she is a silver-haired, pretty, no-nonsense Jewish lesbian who adopted a child from China seven years ago.

“The teacher I took over from said we are supposed to take lessons from all this,” she says shaking her head, “Take lessons? If one child has to suffer so that I can learn a lesson, I’ll skip it thank you. Learn a lesson! We’re not here to learn, we’re here because we can be here, and because the kids need people here with them. We are here. End of story.”

How it is we all stay at the hospital, or why some people come for a couple months and leave while others of us stay for years I don’t know. I wonder about it often, though.

Mr. Nicholas, the secondary school teacher who has only taught a couple of years in the hospital, jokes around with his students the whole day, sneaking in algebra and biology lessons as he goes. After hearing about the death of Darrian’s mom, I found Mr. Nicholas, who I know has a particularly close bond with Darrian.

“I feel so sad for Darrian,” I said, “I feel so sorry for what he’s gone through.”

Mr. Nicholas looked me in the eye in a way that told me he wasn’t going there, and said, “Who you ought to feel sorry for is me, because Ms. Evie retired and now I have triple the paperwork to get through.”

Mr. Nicholas takes night classes to be an undertaker. Sometimes he leaves weird pamphlets around the classroom or he talks about corpses nobody has come to claim. He is a smooth-talking, African American man in his early fifties and one of the best regular teachers I’ve seen cycling through the system. His love for the children is obvious and unstated. Still, I was shocked by what I considered the callousness of his statement. But only for about six seconds: he was telling me, I knew, that his capacity for discussing his feelings was used up. That he could work among so much sadness, but he wouldn’t broach the reality of it right there in the classroom, and then get through to the end of the day. He, like everybody who stays in the hospital, fights hard, every day, to keep coming in the next day.





There is no floor to the sadnesses I have entered into at M. D. Anderson, there is no dimension that could contain the horrors of watching so many young people suffer and then not survive. I spent a long time, in the first years of my teaching, trying to figure out what makes me able to sustain. At first, it seemed there must be an inherent flaw in the personality of people who can work with dying children without breaking down. I can do it, I thought, because my mother abandoned me as a child, because my sister was sick when I was a teenager, because my father emotionally abandoned me when I was a young adult. I am calloused. I don’t let people into my heart, and so these children, whose situations should have broken me long ago, don’t affect me the way they should. The way they would if I were a fuller person.

I looked critically at the people working alongside me in the same way: this man likes inflicting pain on himself, this woman doesn’t connect to anybody and isn’t in danger, this woman is unfeeling, this man is just doing his job, that woman is a ditz. We were fakers, I thought. These children need more intense presence than any other children I have known, and we fake that presence. We fake and we fake, I thought, and the children are too young to know we’re not here.

Looking so harshly, judging so cruelly, doesn’t get a person very far, and I’m much easier on all of us now than I used to be. Instead of focusing on a flaw inside me that retains me unnaturally, I focus on the pull of the children themselves—because, of course the reason I have worked so long with children fighting cancer is that they have drawn me in, they have invited me, they have accepted me into their fierce and fragile worlds. I feel proud because they have. For some reason that I realize, finally, doesn’t matter much at all, I stagger under the weight of the losses I have encountered with these children, but, miraculously, I haven’t fallen. I am a Dixie cup, and these children’s lives and needs are hundreds of oceans, and by some incredible grace I have been able to contain them.





Khalil went home to Saudi Arabia the summer before he died, and he came back in the fall. Evan and I went to his room because he didn’t come to class the first week he came back. The doctors had told him he didn’t have two weeks to live, which I knew, but I still didn’t believe.

We poked our heads into his room, where he was watching cartoons on television from his hospital bed. He was skinnier than when we’d seen him in the spring. He was sadder. I told him I’d missed him and he asked what we did in class that day. We had written poems about photographs the students had taken of themselves and then painted over. The art teacher, Jonie, was going to enter it all into Houston’s Photofest show. I asked if he was going to make a photograph. Maybe, he said. I didn’t know what else to say, and his mother came down the hall. A pretty woman who dresses in Western clothes, unlike most of the other Muslim mothers in the hospital. She had a baby the same time I had my little girl.

“If you let Jonie take a photograph, I’ll come to your room and we can write. Or you can come to the classroom. Or we can write something else. Whatever you want,” I said.

He searched his head, and gave his signature, crooked nod: “You’ll be back on Thursday. Mondays and Thursdays.”

So simple, the clock of my presence in his life, the presence I could see him measuring alongside the other information he had: you will be here Mondays and Thursdays just the same as always, and I am not expected to live through the weekend.

His mother began asking me about my daughter, and I asked her about her youngest son. Two year olds. All over the place. Except, I couldn’t help thinking, you have a two year old and a twelve year old who is dying in the bed in front of us. I couldn’t look her in the eyes and I fled, ashamed, full of tears that I didn’t let out in front of Evan, I didn’t let them out until I was in my car in the parking lot. I was aghast I didn’t tell Khalil how much I loved him. I didn’t know what to say to the boy I had watched grow from a child into a young man, who died late that next Thursday night while I was out at dinner with friends. I thought if I left without saying more, it would guarantee me a next time to say them.





Some parents ask that nobody tell their fifteen-year-old son about the death of his friend, some parents demand their seven-year-old daughter be present when the social workers sit all the children down and give the news. For this reason, we can’t discuss deaths openly in class—because even when the uninformed child secretly knows, or even when their parents break down and admit the death they were hiding, then the parent doesn’t want them to discuss the death with anybody but family members. We work in a hospital with divergent cultural beliefs—Christian Scientists, liberal Christians, Muslims, Hindus, and Catholics. Death means dramatically different things to different kids, and we are asked not to tread in that territory unless a child chooses, of her own accord, to enter it in writing.

Only the social workers are allowed into the meetings. After they told the students about Khalil’s death, the social worker told Jonie and me how the meeting went: Abdul didn’t believe Khalil died, Darrian was too afraid of crying to speak, Bianca, who was new to the school, talked about the many friends she’d lost since being treated for cancer. Amirah left the room when she caught wind of what was about to be discussed, or maybe, she just left because her friend walked by . . . it wasn’t clear.

A few weeks after Khalil died, Abdul was scheduled to have a surgery in which his leg might be removed. He had told his parents to do what they thought was right—he trusted them. He referred to the upcoming surgery as, “The big day.”

“I remember Khalil’s big day,” Darrian whispered, referring to the unsuccessful tumor removals. Abdul pretended not to hear, and Darrian kept his eyes on the binder in front of him.





Once, I found Khalil himself, sifting through the files of the poems we typed on the computer. They were on a password protected computer drive whose codes he had weaseled out of Jeff, years before. He liked having the access because he was the first student who demanded to write his poems on the computer, and he liked saving them into his file by himself. But the day I found him on the computer he wasn’t looking at his own poems.

“I found poems by Katie and Michael,” he told me. Khalil, Katie, and Michael were all seven when they entered the hospital, in the same school year. But Katie died when she was eight, Michael when he was nine, and Khalil was eleven when he was searching through their poems. He was still certain he was going to beat his cancer. Both his friends had died while he was on a trip home to Saudi Arabia and he’d never gotten to say goodbye.

Michael Hendrix looked like a birdling. He had huge brown eyes, clothes that were always one or two sizes too big for him—and his smile was like that, too, almost falling from his face. He was the first person I worked with whose death I was sure would be an end to my teaching—a tiny, African American boy from Houston, who told wild stories, who was the poster boy for the greeting cards the Children’s Art Project sells every year to raise money for children’s programs. He loved critiquing poems after a couple months of working with us: This could have used more details, that poem I didn’t really see. You need to be able to feel a poem deep inside for it to be any good.

Like we thought with Khalil, we believed Michael was cured after a year of treatments. But he didn’t make it through a semester of regular school before he was back with us. He was skinnier than ever before, weak, and mourning the loss of Katie, who had died over the summer. He was scared too: he was going to lose a leg. When he came back to the hospital, he would crawl into my lap at the beginning of every lesson, without asking if he could sit there. He’s the only child who has ever done that.

Michael weighed almost nothing, his bones, in my mind, were dried out honeycombs. His legs were skinny and dry. It scared me when he was on my lap, it scared me to touch him because he was dying and I knew, already, I loved him way too much. But when he sat in my lap, I tried to be the steady warmth he needed from me. We would write out a poem and I knew that what he wanted, what he needed, was the feeling of my shoulders wrapped on either side of his own shoulders. I helped him write—a loose hug that lasted at least the length of a single poem, but often, towards the end of his life, a hug that lasted the entire class. Though there were other kids I should have gone around to help more, I couldn’t send Michael from my lap. Like I would feel with Khalil, years later, I believed Michael couldn’t die if he were sitting there with me. He felt the same way, I think. He’s the boy who wrote that God owed him, he dictated the line to me, and I wrote it down, trembling, because he was right.





The rules of teaching sick children: you don’t imagine any of them will die. You are teaching living children with living futures. You notice their missing legs, the tumors on their faces, the poles attached to their chests through IV tubes. You don’t avert your eyes, but then you forget that you see all that. The second you look around and begin imagining which five or six out of the ten children in front of you won’t make it, you are no good as a teacher.

No teacher I know at the hospital has ever cried over the death of a child, not in front of the others. After Khalil died, I tried to get the teachers and Jonie together over lunch, one day, so we could talk. As Mr. Nicholas had made clear before, though, it turned out none of them wanted to say anything. Nicole said she felt him in her room the day he died, Jonie said there is so much sadness, that opening the door to any of it would obliterate her. That was as much as people were able to hear, or willing to share.

A few weeks after that meeting, though, Evan and I were teaching in the Secondary Classroom. We were expecting Amirah’s best friend to arrive from Egypt any time. Amirah had been looking forward to this moment for weeks; it was all she talked about. There was no way not to be caught up in her excitement.

Since Amirah is usually in the Elementary classroom, her mother brought her friend to that room. Nicole was grading there, and as soon as she saw the girl, she grabbed her by the hand and ran across the hall to the room we were in.

“She’s here!” she said, breathlessly, dragging the poor child alongside her. “Everybody, this is Amirah’s best friend in the whole world,” Nicole said, and then she was sobbing. Nicole, who is always so solid and so unflappable, was sobbing so hard from happiness for Amirah she couldn’t finish the introductions. The only time I have ever seen a coworker cry.





When people ask me about working at the hospital, no matter where the argument about whether or not I will be able to keep working longer is in my head, I say it is the most important thing I have ever done, it is the one job I cannot quit. That, so far, has proven to be the truth. Few people want to hear much more than this about my job, though. Some people actually scowl when they hear what I do, whether it is because they’re upset or don’t know what to say, or just feel bad, I don’t know.

Once my friend Sarah told a guy named Nathaniel, whom I had gone to college with, about my job at M. D. Anderson. “Working with dying kids! It’s the kind of thing contestants in beauty pageants say they want to do. It is too good to talk about,” he told her, “It’s not even interesting.”

When I worked at a food bank for people with AIDS, as a teenager, friends thought that was cool. It was edgy, the disease was still new, its back story involved sex, drugs, homosexuality—maybe even adultery. There is a hierarchy of the dying created by the world at large—and people won’t talk about stories that don’t have apparent moral meaning. Even with AIDS, the patients who got it through transfusions were often the least acknowledged, or at the least, the least memorialized by our culture at large. The tragedy was harder to name.

We prefer to assign morality to death, we prefer a world in which we take risks—we rebel, we resist, we transgress, we love, we gamble—and sometimes we lose. That makes sense, that is tragedy. One of the reasons I can’t stop going to the hospital: the kids don’t avert their eyes when they see each other.





A while back, I walked into the Pedi-Dome and was greeted by Amirah, her nose, chin, and mouth entirely covered in scabs.

“Excuse me,” I said. I sucked my whole being inside my lungs, and I walked back out into the hallway where I was nearly bowled over by my tears. After gathering myself up in the stale, pink hallway, I summoned enough courage to find somebody to tell me what was going on. It took gaining courage, too: I have worked with kids with faces blown up twice their normal size, with boys whose physique resembles young colts and who lose the ability to move or to speak as I watch, with girls with amputated limbs. These things I know to expect. But I wasn’t ready for Amirah, for my little Amirah, to begin on a downturn. Not so soon after Khalil’s death. Not ever.

It was Jonie whom I found a minute or two later. She told me what I never expect: Amirah had fallen on some steps at the Kemah Boardwalks and skinned her face. Just like any little girl could.