This reflection on her own losses, practice, and learning was written by Dr Lauren O’Brien after completing the PatchSA 9-month Comprehensive Course on Paediatric Palliative Care in 2025. 

I have had a few losses in my life. The most significant was that my beloved father died of Colon Cancer when I was 22 yrs old. I also have a very close family member who has a life-threatening condition, where there is no clear or safe treatment option available.

My father’s death was too tragic for words to describe. The second is a potential loss and it is sore, more complicated and devastating.

I had anticipated and delayed grief with my dad and have anticipatory and disenfranchised feelings of grief with my family member’s diagnosis.  I understand this now after doing this course.

We have three children, now young adults. Just writing this makes me cry. The thought of anything happening to any of them is too unthinkable to comprehend. And this is what the parents of our patients have to face in harsh reality.  In this Paediatric field of Palliative Care, we have the responsibility and privilege to meet the child and family where they are at. We could, with God’s help, try make this journey just a little less overwhelming for them.

We are friends with a couple who lost their 16-year-old son to Leukaemia about 18 yrs ago. The amazing thing about our friends is that their grief has propelled them to care for the sick and dying. The empathy they have resonates with people who are suffering with a similar loss. I have been humbled by the parents who have shared their story on the Courageous Parents Network. What a blessing they are to other parents and health care workers.

My intention was to help and do better
I was a GP for 25 years.  I never had to counsel any parent of a terminally ill child. I had many adults whom I diagnosed with a life limiting or life-threatening illness, and I walked their journey with them from diagnosis through to bereavement. From doing the UCT Introduction to Palliative Care course, and this PatchSA course, I understand that I got so many things wrong – I didn’t know how to treat pain properly, I didn’t understand the concept of total pain. I didn’t know how to break bad news according to the chunk method, but I also got some things right. I have been told that I have compassion, kindness and empathy – these attributes go a long way. I could be there for them. My INTENTION was to help and do better (Mary Angelou).

“Palliative Care Doctors can learn all the skills and correct way of doing things which has been wonderful to learn. But if you don’t have the soft skills of compassion and empathy, or lack the intention to do better, you do your patients a disservice.”

What I have learned about children’s grief
Back to what I have learned about children’s grief. I have learned how to hold space, how to be comfortable in silence, how to actively listen and to encourage questions. I have realised that children of different ages, and adults, grieve differently.

I have seen a mother who could not cope with the impending death of her baby, and she left the hospital to go back to her mother who lived a good few hours away despite me explaining that her baby could die within hours or days. She was adamant. I was appalled that a mother could leave her baby to die on his own – which he did the following day.  What I have learnt in doing this course is that she was grieving in her own way, and that it is NEVER my/our place to judge! I am concerned for that mother because it is possible that she will have complicated grieving.

Invaluable skills I have learned
I have also learned about Advanced and Terminal Care planning, and how it helps us as caregivers to appropriately treat a child. However, I think it has as much benefit to the parents if it is done well. By this I mean that it opens up an opportunity to discuss important decisions and wishes regarding the child’s death, if it has not been done thus far. Even if it has been discussed, it gives the child and/or parents pause to reflect on those decisions. This has been an invaluable skill to learn.

I have also learned how to treat symptoms towards end of life.  I now understand the value of morphine and other opioids and the use of co-analgesics and anxiolytics. It was interesting to me how active the medical management is towards end of life in a child.  This course has been brilliant.

This poignant, beautiful poem was written by William Wordworth (first published in the year 1815). He composed this poem in memory of his daughter Catherine, who was 4 years old when she died in 1812. This poem expresses Mr Wordworth’s sudden painful return of sorrow when a moment of unexpected happiness triggers the memory of his daughter.

Surprised by Joy
By William Wordsworth

Surprised by joy – impatient as the Wind
I turned to share the transport – Oh! with whom
But Thee, long buried in the silent Tomb,
That spot which no vicissitude can find?
Love, faithful love, recalled thee to my mind –
But how could I forget thee? Through what power,
Even for the least division of an hour,
Have I been so beguiled as to be blind
To my most grievous loss! – That thought’s return
Was the worst pang that sorrow ever bore,
Save one, one only, when I stood forlorn,
Knowing my heart’s best treasure was no more
That neither present time, nor years unborn
Could to my sight that heavenly face restore.

This poem so perfectly describes grief and bereavement. In the last stanza, it reminded me of a child’s deepening understanding of the concept of death as they grow– that death is irreversible, universal and inevitable.

I have been so grateful for what I have learned in this course – thank you!

You can learn more about the 2026 comprehensive course here.

About the author

Dr Lauren O’Brien
In my 5th year of Medical School, I was the only person who chose to work at St Lukes’ Hospice, Cape Town. I ran my own successful Community GP Practice for 25 years. In July 2024, I made the decision to step away from my Practice. Partly because I wanted to be 100% available for my daughter’s very busy Matric year, and also to assess what I wanted to do for the rest of my working life. It became very clear that this was Palliative Care. I also have an interest and work experience in Mental Health. I am foremost passionate about our children: Dale (24), Megs (21) and Amy (18) I am married to Matt Young (a Retinal Ophthalmologist). We live In Durban. We enjoy (occasional) travel. I love cooking, baking and entertaining. I have been doing Pottery, am very bad at it, but love the sessions. I do believe that God directs my life and work.