1. Ferrell, Betty PhD, MA, FAAN, FPCN, CHPN

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Every issue of JHPN tells the stories of patients whose lives have been improved by palliative care. Case studies, qualitative research, and clinical trials capture the many benefits of our field for patients' physical, psychosocial, and spiritual needs. I am also often reminded as I read the journal about the profound grief experienced by families through the loss of a loved one through illness or injury and also of the great privilege we have to support them in their grief.


I recently had the honor of participating as a faculty member at a conference sponsored by the Jewish Hospice and Chaplaincy Network in Michigan ( This is a phenomenal annual conference and a model of community partnership. One of the speakers at the conference was a bereaved parent, Sherri Mandell. I was so moved by her story, and I then read a book she has written about her loss. In the book, The Blessing of a Broken Heart, she recounts how her 13-year-old son, Koby, and a 14-year-old friend, skipped school on May 8, 2001; hiked to a cave 100 yards from their home in Tekoa, an Israeli West Bank settlement; and were brutally stoned to death by terrorists. Ms Mandell painfully recounts the discovery of the children's bodies, her anguish, the stages of her mourning and her spiritual journey, and finding "redemption." That redemption resulted in the creation by Sherri Mandel and her husband, Rabbi Seth Mandel, of "Camp Koby and Yosef," which has served thousands of bereaved children and orphans whose parents or siblings have been killed by terrorists. Mandell comments that the camps are "a combination of fun and healing, with camps during the summer and school holidays and a 'Big Brother-Big Sister' follow-up program."


Sherri Mandell eloquently describes her grief:


[horizontal ellipsis]I am part of a story that is larger than myself. Koby's death reaches past the length of my arms and legs; it snakes out toward the world and demands to be explored[horizontal ellipsis]


My purpose now is to hold Koby's death in my hands, to cradle his life and death, and turn it like a quartz crystal to reveal each facet of light within, each particle of holiness, each ray of hope[horizontal ellipsis] I falter at times, I fall into grief. I despair at meaning. What is meaning with my son gone? And then the wave of pain passes. I swim toward his life and death, reaching again for meaning, a raft that will keep me from drowning.


Her description of her son's funeral procession is an intense reminder of not only the loss of her son but also the loss of her relationship with her son:


[horizontal ellipsis]This is the last day I will see my son, and this is the last touch I will give him. I lay my face on top of his body and wonder where is his head; where are his legs? He is so tightly wrapped I can't tell. I hold him and try to hug him and remember how the nurses swaddled him tightly when he was born, bound him so he would feel secure. And now he is swaddled again, and I hold him and feel nothing, and suddenly I understand death. He is a body without a spirit. I know his soul has gone somewhere else; is no longer with us. There is a huge throng of people but I am alone with my son's death.


As I spoke with Sherri Mandell at the conference and later read her words, I was reminded of our work in palliative care to be present witnesses of the very painful process of grieving. She writes:


Some people tell me to be strong. They want me to reassure them that there is hope in the world. Keep going so that we can see that life is possible after your child is dead[horizontal ellipsis]


But what they mean by being strong is not what I mean. I believe that being strong means feeling pain, letting my body mourn, letting my mind mourn, letting my soul mourn-entering the pain, not fleeing it.


The work that the Mandells have done through their foundation over the years since their son Koby's death is a testament to their love and dedication to supporting others through loss. She writes about those who supported her:


The people who helped me aren't real angels. I know that. But it is said that God sends angels to help you when you are about to stumble[horizontal ellipsis] Angels can come to us anywhere, but we have to be willing to recognize the divine message that each person can give us. Many of us are angels but we balk at our jobs. Because to be an angel, you also have to believe you have something to give. Sometimes I feel that each moment is an opportunity to encounter an angel[horizontal ellipsis] Because of my angels, I can bear my pain. I can walk with it. I see that even in suffering, there is love. The pain can be so overwhelming that it is too hard to carry alone. But my angels help me carry it.


Palliative care is a commitment to witness the suffering of those who live beyond a loved one's death. It is the daily work of palliative care to be there for those who live beyond, to let them know they are not alone in their pain, to be the angel that helps them carry the burden and the pain. Like so many aspects of our work in palliative care, it is sacred work, as we are afforded an opportunity to support others as they experience profound grief-as Sherri Mandel explains, "entering the pain, not fleeing from it." Palliative care is a privilege, and we are honored by the opportunity to accompany others on this life's journey.


Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN




[email protected]


The author has no conflicts of interest to disclose




Mandell S. The Blessing of a Broken Heart. Milford, CT: Toby Press; 2003.