Last of the Spirit Bears: the Greatest Hits (2014-2019): Paediatric Palliative Care & Complex Care Anthology

By R R Pravin

Celebrating two hundred poems over six years (2014 to 2019), Dr. R. R. Pravin returns with the definitive Paediatric Palliative Care & Complex Care Anthology in Last of the Spirit Bears: The Greatest Hits (2014-2019), written in memory of all the children and their families he was fortunate to have met and worked with around the world since he was a medical student and as a paediatric resident. This timeless read showcases all four of his collections with bonus tracks as a personal tribute and a humble thank-you to his faithful fans and followers through the years.

“For anyone who has lost a child, a family member, or a loved one, this collection will help you get through life. And to the fans, this is a culmination of all our years together. You will cry, you will laugh, but most of all, you will gain a newfound outlook on life. May this book always serve as your guide and a shoulder to lean on through the most difficult times as it did for many who have read it. Peace and much love always.”

• Language: English
• Publisher: AuthorHouse
• Release date: May 23, 2019
• ISBN: 9781728310862

R R Pravin

R R Pravin is an avid author who loves writing about contemporary issues near and dear to his heart. During this COVID-19 pandemic, he wrote a groundbreaking anthology to define these unprecedented times. He also pays homage to his hometown and to the ordinary people for their hard work.

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Copyright © 2019 R. R. Pravin. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse  05/22/2019

ISBN: 978-1-7283-1081-7 (sc)

ISBN: 978-1-7283-1086-2 (e)

Any people depicted in stock imagery provided by Getty Images are models,

and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

In loving

memory of Professor Tan Cheng Lim, my biggest fan and avid supporter through the years, I remember how you used to always ask me whenever he saw me along the corridor, ‘When is your next book coming out? Can’t wait to read it!’ Miss you Prof.

Contents

Foreword by An Inspiration

Preface: An Open Letter

Caught in the Mo(u)rning Rain

Dreamcatcher Le Capteur de Rêves

Do They Have Telephones Up In Heaven?

Fire, Faith & Glory Le Feu, La Foi et La Gloire

Bonus Track    Postcards

Bonus Track    Outer Space

Bonus Track    Winter’s Wreaths

Bonus Track    Last of the Spirit Bears

Bonus Track    A Second Forever Too Short

Bonus Track    Sunflower

Bonus Track    When It Comes to My Turn

A Tribute to the Children

Dedications

About the Author

Foreword by An Inspiration

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It is with great pleasure and privilege that I pen this foreword for a most exceptional junior colleague on his latest outing in mainstream literature. When Pravin said it is a greatest hits compilation of his previous anthologies of poems on palliative and complex care, Madonna’s Immaculate Collection immediately sprang to mind. Revealing that generation I belong with this expose notwithstanding, whenever one learns about the release of a greatest hits album, excitement soars; followed by a dash to the CD store after school to pick up the treasured disc containing every hit that for various reasons one did not manage to own before, always with bonus tracks that add to the cheer.

On another equally serious note however, I have witnessed Pravin’s growth as a doctor, poet and person (in no particular order) since he started volunteering with the Star PALS team at third year medical school. In some ways, his journey is almost similar to mine, as he tracked almost the same locations in search of experiences and ways to hone his craft – to serve sick children better. It is apparent from these poems written over the years that he has learnt much from the wisdom of children and families he met. His writings developed even greater depth and richness, yet not losing their simplicity and authenticity. Only one who has experienced those raw emotions that prevail in situations that these children and families face can such empathic understanding arise. In spite of the hurt involved, he revisits that space again and again, consistently producing new poems in reflection. As a closeted activist (now outed obviously) for paediatric palliative care, I am proud to see a future champion who proclaims in the first edition of these anthologies Caught in the Mo(u)rning Rain: I believe that Paediatric Palliative Care has a long way to go and needs a captain at its helm. I am not going to rest till this ship sees shore.

Enjoy the hot hits and new material readers (thank you Pravin for gifting the most evocative poem ‘Postcards’ to our parents at the last Star PALS memorial!) and I look forward to the next Billboard number one.

All is well.

Dr Poh Heng Chong

Medical Director, HCA Hospice Care

(Star PALS is a specialist paediatric palliative care service by HCA Hospice Care)

Preface: An Open Letter

First of all, I can’t believe it is time for a greatest hits! Have we been on this journey long enough? Well 6 years is an incredibly long time. Back when it all started with Caught in the Mo(u)rning Rain in 2014, who knew where this would take us? By us, I mean the paediatric palliative and complex care kids and their families (y’all know who you are!). Though sometimes it may seem that life is full of more downs than ups, I hope you all realise that it is human nature to overcome. You all have done so in your respective ways and I couldn’t be more proud. It is not easy and the memories flood back at times of our loved ones but we need to stay strong as they would have wished for us to. Looking back at all these collections, I fondly recall all the smiles I left on the faces of all these children both as a medical student and now as a paediatric resident during my internships and postings around the world.

Paediatric Palliative Care and Complex Care is a field that is growing in relevance every day, be it in a first world or third world country. The care, both medical and non-medical, given to a child who is in extreme pain, short of breath or bed-bound matters in more ways than one. Though they may not be able to verbalise what or how they feel, they recognise the kindness shown to them and will forever carry it with them even after they move on. Children are delicate and innocent. They know not what suffering means and I am always amazed at their intense resilience to fight till the end with a quiet optimism. These poems celebrate all these children and their stories. They are living, breathing miracles and though some of them may no longer be with us today, they are solid examples of what making the best of life is all about.

Besides children, this collection also celebrates the remarkable parents behind these kids! Can we give a thunderous round of applause for the parents and the siblings who tirelessly support these kids despite all odds being against them. These parents and siblings live to tell and they are living embodiments of loyalty, dedication and faith because they are 200 percent dedicated to the cause 24/7 and there can be no substitute for their unfathomable love and devotion to their child. Seeing them at the annual local paediatric palliative care team, Star PALS (Paediatric Advanced Life Support) Memorial Service or along hospital corridors, it takes me back to the last moments we shared together with their children and to see them on their journey to overcome the sadness is inspiring beyond words.

Each of these anthologies represent a milestone in our journey to make paediatric palliative care and complex care better known and to increase awareness that there is a need for specialised care in this domain, both in medical and non-medical domains from the dedicated doctors to the amazing nurses to the awesome medical social workers who make it happen! The teams I have seen across the world can’t do without any of these key people who make such a colossal difference in the lives of the children and their families, tirelessly working behind the scenes.

I am also so grateful for the opportunity to have been able to share all these books with so many fellow paediatric palliative care believers across the world and my fans have been unparalleled especially the children who are the reason I do this. I still fondly remember the terrific reception to 2014’s Caught in the Mo(u)rning Rain – the first paediatric palliative anthology and the awareness it raised through local media and it was selected as a finalist in the International Best Book Awards (Health: Death & Dying Category). It was my first time combining my love for writing with what meant the most to me in medicine. This passion followed through the years with 2015’s Dreamcatcher: Le Capteur de Rêves which featured children & families from both local and international paediatric centres. 2017’s Do They Have Telephones Up in Heaven? was released with an unforgettable book launch with a charity single and music video, ‘Face the Fight’ we did to raise funds for Star PALS, our local paediatric palliative care organisation. As my paediatric residency continued through various rotations such as neonatology & intensive care, I penned 2018’s Fire, Faith & Glory: Le Feu, La Foi et La Gloire. 4 indelible collections to last a lifetime, encompassing all the wonderful stories of the children and their families in the form of poetry and the short contextual explanations that followed suit after in the form of #inspiration.

To the families who have lost their children, I hope you know that you are not alone on this journey. We remember your beautiful children with you every day and it is in the memories that we keep them alive.

As I go through these pages, I can’t help but be grateful for all that I have learnt from these little angels and their families. I have also added 5 poems to this anthology, completing 200 paediatric palliative care and complex care poems over 6 remarkable years from 2014 to 2019 with all of you. There is a poem for every possible occasion, celebrating the highs and lows during all of our journeys together. I couldn’t have done it without all of you who have supported this dream, the books, the charity single and the Children’s Palliative Care page on Facebook. Thank you. Merci beaucoup. I appreciate it from the bottom of my heart. To all the paediatric palliative care and complex care children and families, I have you in my heart all the time and I hope you will always know that.

Thank you for giving me the chance to do what I do. This anthology is my thank you & tribute to you.

God bless. Peace & love always, Dr Pravin

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This is Misha, a dear oncology patient of mine who was one of my biggest fans. She suggested renaming my anthology ‘Do They Have Telephones Up in Heaven?’ ‘Do They Have Toilet Bowls Up in Heaven?’ instead because she said that was more important – talk about the sense of humour children have even in the darkest of times. She will forever be one of the many special princesses I am a fan of because of her incredible fighting spirit to the end. It was beyond heartbreaking to lose her end 2018 shortly after the photo on the right was taken with ‘Fire, Faith & Glory: Le Feu, La Foi et La Gloire’ and her mum said she waited for the book to be released before she passed. I recall spending the last few moments with her and Dr Heidi, a friend from our local oncology department who knew Misha when she was first diagnosed. We miss you Misha xx.

Caught in the Mo(u)rning Rain

I was caught in the mourning rain No where to run no where to hide Thought I had nowhere to go

Till you came along & saved me

Caught in the Mo(u)rning Rain is a compilation dedicated to all children in the palliative care programme. It was inspired by a teenager (to whom I dedicated the title poem) who was initially apprehensive to meet me but eventually warmed up to me. We became real good friends during that session and planned to meet again. Unfortunately, he passed on a couple of days later. It was tough and pretty rough but I decided to express myself honestly through my poetry. The collection was inspired by all the children I have met during my Paediatrics/Haematology-Oncology/Palliative Postings in both the KK Women’s & Children’s Hospital & the National University Hospital in Singapore.

Paediatric Palliative Care has a very special place in my heart. I’ve experienced loss and I know how it feels – the alienation, the anguish, the injustice, I’ve been through it all before, therefore I know. I believe that Paediatric Palliative Care has a long way to go and needs a captain at its helm. I am not going to rest till this ship sees shore.

This book isn’t only meant for children with cancer or in palliative care. It applies to children with special needs such as those with Down’s Syndrome (Trisomy 21), the autistic children and even children whose parents or loved ones have cancer! This book does not discriminate and is all-encompassing filled with words to comfort, words of kindness and immeasurable compassion – something really special about this book and if you look hard enough, you may just find some magic that’ll make all your sorrows go away & make every day a better & brighter day!

Every punctuation, every capital letter is intentional to evoke an emotion, to bring back a memory and to paint a portrait in the minds of the reader. Accompanying each poem is a short paragraph on my inspiration for writing the poem labelled with #Inspiration so that readers will be able to gain a deeper understanding into the thought process (pretty much like a live newsfeed) and the personas I adopted while crafting the various poems. All the words are from my heart to yours. May they make you laugh, cry or inspire you!

This is my gift to all the children of the world.

Especially the Paediatric Palliative

Kids & their loving families.

Contents

Foreword

The Aftermath

Mercy

Caught in the Mo(u)rning Rain

Cookie Jar

Repeat Offender

Hold Me

Vanity

Waterfall

Creep!

Un-Impossible

Dead

Cocoon

Walk Beside Me

Spare Change (Two Pennies Worth…)

Tattoo

Overcast

Ward 1.4.3

Disney Princess

Summer Fashion

Girl Talk

Rain, Rain Go Away

One More Time

Sleepless

Blinded

A Melody, A Memory

Tin Kids

B.M.A

Hey Mr Sandman?

A Child’s Play

Peter Pan (to Neverland)

Still Waiting (for my angel)

Octopus (whatchalookinat?)

Who in the world cares but me?

The Final Remembrance

Kerosene Lamp

Papa, Papa

The Homecoming

Free My Soul

if I could live one more day

Just You & Me

Magic

I don’t know

Morning Glory, Evening Sunset

Built A Little Different

If Only God Could Save All the Children On this Earth

Blame Me Not

Everybody hurts

I’ve Got A Dream

Angel

Never Let Go

Swan Song

Let Me Be

A Quiet Place

Anew

Foreword

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This is a special anthology of heartfelt poetry inspired by the author’s privileged time befriending children and their families who faced the trials and tribulations of the greatest test in life. It provided snapshot glimpses of the hope, the despair and the courage of living life to its fullest in the journeys through the valley of the shadow of death. Even as it is said that when a parent dies one loses part of the past; when a spouse dies one loses part of the present; when a child dies, one loses part of the past, present and future; here words immortalize many the precious moments life gifted to these brave young warriors; their memories live forever.

Dr Tan Poh Lin, Senior Consultant,

National University Hospital of Singapore Division of

Paediatric Haematology & Oncology

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WHO Definition of Paediatric Palliative Care

Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO’s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

• Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.

• It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.

• Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.

• Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.

• It can be provided in tertiary care facilities, in community health centres and even in children’s homes.

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‘Strike A Pose Little One’ – give me a prop & I’ll make it work. As always, birthdays were special milestones my family never missed celebrating. It is a festive occasion & all children, I mean ALL, should have a chance to see a cake (& even if they can’t blow candles as I know some special kids have weak muscles or tracheostomies) to understand how special they are on their birthday. I remember helping out with a home birthday surprise for a special needs child who was around five or six years old. He had a tracheostomy. It was the first time the family celebrated his birthday & it really moved me. He was really excited & you know that glimmer of joy in a child’s eyes when you see one, especially with the candles, the balloons and the singing. Really lovely moment there.

The Aftermath

Out in a quiet meadow

I lay praying silently

In my heart seeking

The cure for all the woes

Which plague my once-upon-a-time

Peaceful being

Opening an old glass window

Coated with cakes of dust

Butterflies sprinkled across

Sparkling golden fields

Greet my cataract-laden eyes

Which yearn to see one last time

Free me of all sorrow

Won’t you sweet love?

I say to the old tombstone

Lying lifelessly in my courtyard

With the remains of a friend

Who was my reason to live

Till he died 1st January1984.

A sweet sparrow

Sings to comfort

A tortured soul

Hoping for an answer

To end this loneliness

Once & for all

Save me, help me.

#Inspiration:

The Aftermath was the first poem I penned for this compilation. For me, writing has always been therapeutic. This poem reflects the sadness someone encounters during one of those quiet moments we all have when we can reflect and reminisce friends or family we have lost. Natural feelings of regret & loneliness are usually the aftermath of someone’s passing – it is only human to cry out once in a while.

Mercy

Mercy sweet mercy

Can’t you feel

This pain of mine

Not even love can cure

Been through the lies

They call protocols

Stealing my life away

Even quicker than the tumour

No more treatments for me

I’ve begged

But nobody listened

Not even you mercy.

Mercy have mercy

Can’t you hear

My pleas for salvation

Which never came

Despite enduring humiliation

For having lost all my hair

Through no fault of my own

Fighting my tears

Amidst the laughter

When all I asked for

Was a teaspoon of mercy.

Mercy show mercy

Can’t you remember

What sympathy means to me

Or has your heart hardened

Till it feels no more

While time runs out for me

Draining my life

Day by day without

A tinge of your mercy.

Teacher, doctor,

Daddy, mummy,

Brother, sister,

At the end of the day,

What does it matter

When mercy itself

Has failed to pardon

My only life

Which I lost

Without your mercy.

Mercy O Mercy

Please don’t do this

To any other

Who may need you

Have mercy

For mercy begets mercy.

#Inspiration:

Mercy was a poem which came to mind when a friend recounted her experience while she was in the treatment room in the Paediatric Haematology & Oncology Ward. The child was about to have a procedure done on him and he looked sadly at his father, asking if the procedure was going to be painful. The father reassured his son that there would be no pain, trying his hardest to fight back any tears that were forming. It was a tough moment but I imagined what the child was thinking and hence Mercy was born.

Mercy is a figment of the child’s imagination – someone the child talks to & negotiates with especially when the child is about to receive really painful injections or chemotherapy. When I was eleven, I acted as Princess Portia in the Merchant of Venice (it was a school which only had male students) & I remember reciting the famous ‘Mercy is like the gentle rain…’ monologue when I disguised as the male judge to save my fiancé’s best friend. I learnt a life lesson & till today, I learnt the importance of having mercy in any and every context possible, especially in the medical world.

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During my term in the 65th Medical Society as the Publications Director, I decided to work with Star Pals (the Paediatric Palliative Organisation in Singapore). We organised storytelling sessions cum cheer squads for kids in the palliative care programme. Haikal Anwar suffered from cerebral palsy. When we entered the house, his family warmly welcomed us & they were so thankful for everything we did for Haikal. We read him stories, had a little birthday party and we sang for him. It was Christmas & we promised that we’ll visit him next Christmas. In this picture, we have myself, Haikal & his lovely family in the background and our dedicated Star Pals social worker Ms Geraldine (one of the most A+mazing people I’ve ever known – she would always go the extra mile to update me on a sick child or inform me when a child passes on even if it’s in the middle of the night!).

Unfortunately, the next Christmas never came. Haikal suffered from a bad episode of pneumonia. His condition deteriorated acutely and he passed on. I was really heart- broken when I received the news cause I was planning a second visit during Christmas. I thought about his loving family who worked really hard to support him even though they weren’t the youngest of parents. But I’m glad we did what we could for him & hopefully made that little difference, no matter how small.

Caught in the Mo(u)rning Rain

My heart’s too sad to drive

Down this road called life

Heavier than a cannonball

How much further must I travel

Alone in the morning rain.

Colliding into dilemmas

On this slippery slope

No hand to hold onto

Just my tiny umbrella