“Because I Knew You” by Robert Macauley Chehalem Press – 370 pp — $33  

Robert Macauley has worked in pediatric palliative care for decades, beginning on the East Coast before landing in Portland at Oregon Health and Science University in 2017.

His new memoir, “Because I Knew You,” shares the stories of how his young patients, all of them dealing with life-threatening medical conditions, asserted their personalities and pursued their aspirations while navigating the health care system and their own mortality.

These true-life stories, of course, involve their parents, too.

There’s no getting beyond the fact that these are heart-wrenching tales.

Macauley notes that “Initially, I’d felt uniquely equipped to practice pediatric palliative care, insulated from intense suffering by my soul calluses.”

The calluses he refers to are an allusion to the dissociative defense mechanism that he’d developed after being sexually abused as a child himself.

As he grew up, Macauley tried to put the childhood trauma of what he dubbed “Bizarro World” in his rearview mirror by excelling in his academic career. He earned an MFA in writing, became a certified instructor for the National Outdoor Leadership School, and simultaneously attended both medical school and divinity school when he was at Yale.

Since then, even while advancing his career in medicine, he has served as an Episcopal priest in parishes in Oregon and four other states.

But instead of entering into some high-profile line of medicine, this go-getter chose palliative care which, he concedes, is “something that the rest of the world prefers not to think about.”

Often associated with end-of-life medical care, palliative treatment takes both physical and emotional needs into account, and strives to coordinate treatments to improve the quality of life for patients and their families.

Even so, there is a bit of flippancy in the behind-the-scenes jargon that comes with the territory. In this book, Macauley talks about “filling the rapport bucket” – a recognized strategy by palliative care specialists to build up the trust of patients during non-stressful (and often non-billable) interactions so that they can “cash in good will when heavy discussions are necessary.”

And the author seems rather brisk when noting about one of his patients, a teen with cystic fibrosis who developed cancer after scoring a long-awaited lung transplant, that “We weren’t talking about prolonging life anymore… we were talking about prolonging his death.”

But Macauley gradually begins to experience a softening of the guardedness that had shielded him from others’ pain as well as his own.

And this, he realizes, is beneficial overall. While only some of his patients are able to grasp that “happily ever after” brass ring and live many more years, Macauley becomes better at listening to his patients and the patients’ families. He becomes more creative in offering more customized end-of-life care.

“Because I Knew You” offers up poignant life lessons in courage and generosity and abiding love. It celebrates defying predictions, but it also honors the difficult but sacred journey from grief into acceptance.

I recommend this book. But keep a hanky close by.

The Bookmonger is Barbara Lloyd McMichael, who writes this weekly column focusing on the books, authors and publishers of the Pacific Northwest. Contact her at bkmonger@nwlink.com