Because I Knew You: How Some Remarkable Sick Kids Healed a Doctor's Soul

5 Star Review

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Editorial Book Review:

By Antonia Garret

Most people, when they learn what Robert Macauley does for a living, say some version of the same thing: I'm so glad I don't have your job. He has heard it thousands of times, and he has a ready answer about how palliative care is really more about living than dying. What he has never told anyone, until this book, is the real reason he chose this particular path: he didn't want anyone else to hurt the way he hurt as a child.

That revelation, held back for so long and released with such quiet deliberateness, is the key that unlocks Because I Knew You. Macauley attended medical school and divinity school simultaneously at Yale, completed his pediatric residency at Johns Hopkins, and became one of only a few hundred physicians in the country board certified in both hospice and palliative medicine. He is also an Episcopal priest. The combination of those identities is not incidental. It is the whole apparatus he has built to do a job that most people cannot look at directly, and the book is his honest account of what that apparatus cost him and what it ultimately gave back.

The children at the center of each chapter are rendered with the kind of specific, loving attention that refuses to turn them into symbols. Cora, born with trisomy 18 and given no chance by conventional medicine, who outlived every prognosis. The others whose names and faces and particular ways of being brave in unbearable circumstances are preserved here with the care of someone who understood that bearing witness was itself a form of medicine. Their courage did not merely move him. It changed him in ways that the book traces with remarkable honesty.

Hippocampus Magazine described it as insisting we look closely at what most people would rather not see, and doing so in a way that upends every assumption about witnessing a child navigate the unimaginable. Connie May Fowler called it an instant classic. Both assessments feel right.

For anyone in healthcare, and for anyone who has ever sat beside someone suffering and wondered whether their presence was enough, this book is the most honest and most healing answer currently available.

About the Author

Robert C. Macauley MD

Robert Macauley is the Cambia Foundation Endowed Chair in Pediatric Palliative Care at Oregon Health & Science University. After earning both medical and divinity degrees at Yale, he completed a pediatric residency at Johns Hopkins, then joined the faculty at the University of Vermont College of Medicine in 2002. At UVM he directed the Department of Clinical Ethics and also founded the Pediatric Advanced Care Team. In 2017 he moved to Oregon to join the faculty at OHSU.

He holds degrees in theology from Oxford and fiction writing from Vermont College of Fine Arts. In addition to being a pediatric palliative care physician, he's also an Episcopal priest. He and his wife live with their four kids and two rescue dogs in Portland, Oregon.