We have never met and are unlikely to do so but I wanted you to know this. Your mother has been my patient for the past several years. You might recall that her cancer diagnosis really shook her, coming so close after your father died unexpectedly and robbed her of her greatest support.  Fortunately, her early detection meant she was cured and over time cancer just became an addition to her charts. Most patients can’t wait to see the back of us doctors – not for them the reminder of illness, the interminable waits and the apprehension that clings to you as soon as you set foot in the hospital. But your mother was different – each time I broached a discharge she would look crestfallen and ask if she could come back just one more time because she felt safe. I have lost track of all her visits but I know that at some point her fear of cancer receded and it was hardly a topic of conversation. Instead, I remember other things.  Related: Want to be happy? Join a choir  One year, her arthritic shoulder froze and I arranged for a steroid injection and physiotherapy. She couldn’t believe that a cancer doctor could or would treat her shoulder and wrote me a wonderful note that I kept. The next year she developed a slipped disc and I found her the kindest neurosurgeon who took her hand and told her an operation wouldn’t fix her but time would. He did all the work but she gave me the credit.  Some years ago, she came in for her annual visit and I asked how she was spending her Christmas, causing her to burst into tears. Through her sobs she said the hardest part was not being able to see you. I innocently replied that I didn’t know you had moved, which is when she haltingly shared her story.  She was an industrious migrant who brought you up with the best of what she could afford. She cleaned floors and waited tables while encouraging you to a scholarship at school and university. You became an academic and gained international repute. You met a lovely man, married and had children. But when your father died you suddenly disengaged from your mother. You stopped visiting or returning calls. Your young children wouldn’t speak to their grandmother and soon lost interest in her. Your relationship dried up.  Here was your mother, cured of cancer, her shoulder rehabilitated and her back pain resolved but what she was really suffering from was a broken heart. And there wasn’t anything the health system could do to fix it. She spent sleepless nights over the reason for your behaviour, figuring that she could start all over again if you only told her what was wrong. I watched her feelings turn from disbelief to dismay to resignation but never once anger. She loved you too much.  One year she remarked that she was glad your father had been spared this humiliation because he had always suspected your education had led you to disown your humble beginnings. She can’t show us off, your mother would lament. I’d point out that she was a model mother who had sacrificed greatly for her family. She thanked me but never believed it.  Witness to her piercing grief, I tried to imagine your life. With a new marriage, a demanding job and the care of young children, your loyalties must be scattered. How I wished you’d reconnect with your mother but it wasn’t my job to interfere. I couldn’t judge you. For all I knew, you owned the dark half of a story I wasn’t privy to.  Every Christmas, accounts of soaring humanity compete with sorry laments. A daughter bans her mother from lunch by text message. A son puts his reluctant father into a nursing home so the family can go to Europe. An adult locates his father and turns his back on his adoptive parents.  Your mother’s story isn’t the worst of them but I have never told her this. Each year she has lived in hope and then Christmas arrives and I am listening to your lonely mother curse the destiny of her final years. We have discussed the presents she might have bought your children and cherished recipes she might have cooked for lunch. With a lump in my throat I accept her affection towards me, knowing I am no substitute for her greatest loss.  Related: How do you tell your children you have cancer?  This year when your mother came back with months left to her appointment, I was immediately concerned for her health. But no, she was well. She walked in with such lightness in her step and I rejoiced that she had finally moved on from her disappointments. But after the routine questions she told me something I never expected to hear – that one day, after too many years of silence, you had suddenly returned with the children. They hugged you and demanded ice cream. The little girl scolded her brothers and said they must remember to wait for two minutes before asking for a treat, everyone had laughed, and just like that, it felt like family again.  Your mother was the happiest I have ever seen her. Happier than when I said the cancer was gone, happier than when she could move her shoulder again, happier than when she could walk straight. Then she surprised me again. Thanking me for keeping her company all these years, she said she was ready to say a final goodbye because her life felt whole again. Frankly, I never thought I’d see that day. Her eyes were dancing at the thought of indulging your children. Her mind was working overtime trying to recall dusty recipes. She had never been afraid of dying from cancer but now asked if it was possible to die from happiness!  She might make light of it but I want you to know that this Christmas there will be no one filled with delight and wonderment more than than your 86-year-old mother. You have given her the best gift of her life and in doing so you have also completed the missing link in my care. My handover feels complete, thank you.  I hope that this is the first of many holidays you spend together and you can make up for missing time. Your mother is an exceptional woman. I will miss her but nowhere near as much as she has missed you all these years.
This Christmas I’d like to write a letter to the daughter of one of my patients – because I could cure her mother’s cancer but only she could ease the greatest pain