By the end of my fifth month of internship at Concordia Hospital, I had noticed already that death comes for a child either terribly swift or terribly slow; rarely does the pace of death allow the minds and emotions of parents and physicians to arrive naturally at some compensated equilibrium. Accelerating perhaps as a blur of devastating image, like an onrushing view of the ground to someone who has slipped and is falling from on high; or fading as a still-life photograph, turning yellow faintly over the years until not even the slimmest outline remains—hectic or lingering was the experience of watching someone die, and not much in between.

For Amanda, the 6-year-old member of the circus troop, death chose the dilatory route—indeed, she seemed almost to be dying from the moment that the acrobat had found her as an infant, inexplicably, on the trapeze platform nearly 70 feet in the air, perched in the highest reaches of the tent. No one could figure how she had arrived in such an unlikely place. The only way up to this particular platform was a single slender rope, one that would have been quite difficult, if not impossible, to climb with a small baby in tow. Doubting that she came by that upward route, many—the acrobat especially—believed that she had actually come down from higher reaches, ones that extended far beyond the tent and its domain; Amanda, the circus members felt, had descended into the realm of their lives; and although she remained there for 6 years, they always shared the sense—never spoken—that she was destined, sooner or later, to reascend beyond the trapeze platform, beyond the tent, beyond anyone's grasp or gaze.

I should let you know now that Amanda was blind, and had been so when the acrobat found her and carried her down to the ground. Perhaps consequent to being blind, Amanda had developed the peculiar habit of talking with her head tilted downward, as though examining some secret object that she cradled in her lap, the loose curls of her auburn hair pitched forward, spilling down from her forehead and screening her face from view.

But this was not the first thing that I noticed when I knocked on the door and then walked into her hospital room and saw her sitting in bed. For even more striking, to this intern and to everyone else who met her, was that Amanda never spoke for herself; rather, with her hands raised side-by-side above the stage of her curls, two puppets—a plain brown dog and a cream-colored rabbit, each with tremendous floppy ears—spoke about her.

In fact, it was as a puppeteer that Amanda, even as a babbling 2-year-old, had first begun to astonish private audiences, as she bestowed upon her simple cast of characters an otherworldly imagination—detailed, intense, fantastical. By the time she was 4 years old, Amanda had become the central attraction wherever the circus traveled; she was a natural performer, who sought out public attention from her earliest age. Since she was allowed to act for only half an hour twice a week (the strongman and clown would not hear of longer hours), her show was forever the one that sold out. Even when her heart started to fail in a grievous manner, and the energy of her arms and voice waned, she still kept the audiences enthralled, concentrating the spiritedness of her puppets into the smallest gestures and briefest remarks. All of this I learned later—much later, too much later—but I could readily believe everything after even our first encounter.

Unfamiliar with the details of Amanda's case, but well aware of her remarkable reputation and precocious abilities, I had spent several minutes in the hallway glancing at Amanda's thick chart before turning at her doorway, eager to meet this child who had been admitted several days before in the final stages of heart failure.

“Who's there?” barked the dog as soon as I crossed the threshold to the room. “Stand fast and identify yourself by rank and personal merit.”

Admittedly, I was taken quite aback. “Ahh—it's me …”

“Speak up! Speak up now! Who's me?” the dog inquired sharply before I could get another word in.

“Ahh—I'm Gregor Thompson, the pediatric intern who is taking over the care …”

“What's that you say, a pediatric intern?” the rabbit asked, likewise interrupting, but in a less confrontational tone.

Misunderstanding her, I replied straightforwardly, “Oh—ahh—that's a young doctor who takes care of children such as you …”

“Of course, of course!” the dog shot back with military precision. “Do you not know how much time we've spent here with pediatric interns mucking about? And besides, Doctor Young Doctor, there are no ‘such-as-you’ children here. Rabbit, although now slightly hard of hearing, has pursued a distinguished stage career; while I, soldierly-speaking, have been amply decorated in my youth for faithful service to this nation. We both are on in years. As far as Amanda, she may be a child by age but not by experience—or, I might add, personal merit.”

“Oh, well—ahh—I'm sorry if I offended anyone here. I was just coming in to see how you are feeling, Amanda.”

“She's quite ill, you know,” replied the dog curtly, “and although the ache in her legs or the pain in her chest isn't terrible now, the coughing keeps us all awake through the night.”

Then, in a near whisper, the rabbit added: “Doggie and I are afraid that she might die this time.”

Bam. I would have sworn that I heard the room start to hum loudly.

“Oh—well, I don't know about that at all. Why don't you tell Amanda,” for I was now addressing the rabbit, “that I am going to work with the other doctors here to help her get better so that she can go home …”

“Humph.” The dog was then silent for a moment, as though sulking. “That's what all young doctors say …”

Since in my mind the room was only humming louder and more insistently, and thinking it might be possible to slip out undetected, shielded by Amanda's blindness and cloaked in my own desire to disappear, I stepped backward gingerly.

But these three, propped up in bed, saw more clearly than I did.

“Oh, you are leaving us,” Rabbit and Doggie said in unison, waving gently. “Thanks for stopping in. Goodbye! Goodbye!”

As fate would have it, this admission was not quite the time when Amanda died—although in truth I can not tell you why, for her heart, I soon discovered, was hardly working at all. “Idiopathic cardiomyopathy” the senior doctors called the mysterious unraveling of the muscular fibers in her heart—and naïve though I was (and still am), I suspected that this label did little for us as physicians and even less for Amanda as a patient. Her heart, that beleaguered pump in the middle of her body, no longer moved blood with bold and commanding strokes but rather with rapidly repeated squeezes, each tremulous and faint, leaving more and more blood to pool behind the heart, flooding the lungs, while sending less and less to the rest of the body. Her legs were edematous and chilled beyond her knees; when I pressed lightly on her fingernails, the underlying flesh remained pale and bloodless long enough for me to grow anxious; she liked best to sleep in nearly a sitting position. Putting a name on this process and its signs would do nothing to alter its course: her heart, no matter how faithful to her enchanting soul, was failing her body.

We limited Amanda's diet carefully and plied her with drugs to get the most from each half-hearted squeeze. Over the course of a week, she rallied. As the backlog of blood made its way slowly forward, the burden on her breathing eased. Feeling better, Amanda (through the loyal advocacy of Doggie and Rabbit) made her case for going home, back to the circus, in all the most irresistible ways. And, much to my innocent surprise, her heart seemed to heed their arguments and comply.

On the day of Amanda's discharge, the sun slipped in and out of the clouds, uncertain of what mood to appropriately cast. The acrobat arrived with the dancer, the clown, and the strongman, who hoisted Amanda up onto his shoulders, refusing the wheelchair. Then, with the dancer prancing gently in the lead from one room to the next, the elevated Amanda and Doggie and Rabbit said goodbye to each and every child on the ward, by name, as the acrobat and clown passed out flowers to all. Finished with their tour, the quintet—with the two puppets reigning high above everyone in a kingdom of their own design—strolled down the hall, out the door, and into the sunlight.

Later the following night, back in her own bed, while the acrobat held her cold puppetless hands, Amanda died. Her death had indeed come slowly, but then arrived too fast. Although many would keep the memory of Amanda like a burnished and fragile photograph, the acrobat would remember most—and forevermore—the feel of plummeting.

We learned of Amanda's death by telephone. The duty to call fell to the clown, as the rest of the circus felt dumb-struck. He spoke with the head nurse on the floor where Amanda had just resided; she said subsequently that in the tone of his voice alone she could see the image of his face, without makeup, lined, ashen, hollow. She told three other nurses and one of the residents. The word quickly spread. I found out when I encountered a nurse, whom I knew well, walking along one of the long hallways toward me. She was crying. When we drew near, I stopped and asked her why. She told me that Amanda had died, and that was why she was crying; she said that she did not want the other children and parents to see her, or the nurses and doctors, and that was why she was leaving. She looked at me briefly, her eyes red and puffy, her nose moist, then continued on down the hall to a more vacant end of the hospital.

This nurse displayed the only manifest act of grief I would see expressed by the hospital staff. Even I kept my feelings to myself. Yet who knows what tears wetted which cheeks in the bathrooms and quiet corners of the hospital, or were wiped dry in the dark on bedsheets and pillowcases later that night, or flowed in dreams not remembered the following morning. All I can attest to is, for the rest of that day and the next, I marveled at all the sorrow that surrounded me but was held in check, subdued, as the duties of our healing profession held sway over the pained whispering of our hearts.

Seven days after Amanda died, the circus troop made a pilgrimage to the ward on which Amanda had spent so much of her life. They arrived at the front door of the hospital, crammed into an elevator, rose to the fifth floor, and then walked solemnly down the hallway as though in procession, passing the entryways of darkened rooms, until they entered a large open space in one of the children's wards. They were 17 in number, garbed in all manner of black dress: light black and dark black, hats and veils and cloaks and scarves, threaded with red and gold and sapphire, strong and angry and sad. A dozen players carried in their bare hands each a different herb, all rising from dirt-encased roots along delicate stems and shafts to the terminal leaves and seeds and even flowers: marigold and lady's mantle, bergamot and periwinkle, myrtle and angelica. Their redolent odor immediately pervaded the ward.

The assembled lot stood silently in their ranks for a dramatic, dizzying moment. Then the barker, decked out in a midnight blue suit trimmed with sequins of gold, his moon-shaped cufflinks sparkling at the ends of his sleeves, took three steps forward and then firmly planted his feet right next to each other.

“We want to thank you all,” he exclaimed, “for the care that you gave Amanda over the years, and to show our affection and our grief.”

With this, most members of the troop settled downward until they were sitting on the carpeted floor. The barker held his ground, bolt upright. The other four who remained standing—the acrobat and strongman, dancer and clown—paired off two and two, clearing their own private space amidst the crowd of spectators that had gathered from throughout the hospital. Little patients and their parents, nurses and physicians, secretaries and orderlies stood back, so that for a moment silence was all.

Then the four began to perform simultaneously, guided by some extrasensory cue from the barker.

The acrobat dropped to his side on the floor and swiftly folded himself into a ball, curling his trunk, tucking his head between his knees, grasping his ankles and pulling all of himself into a compact and remarkably round mass, like a flesh-made medicine ball. The strongman stooped over and picked him up, placing him on his shoulders, assuming the duty of a modern-day Atlas, supporting the world. Then the strongman jumped, as high as he could, time after time, his face etched with effort and with pain—as if wishing to escape the weight of memory and grief—until, scores of leaps later, he collapsed in exhaustion and the acrobat unfolded into a bruised limp mass and both lay on the carpet, panting and nearly unconscious.

Meanwhile, the slender dancer rose upon her toes, extended her arms outward, and flung back her head and silver-blonde hair. Standing behind her, the stocky clown—much shorter than she—reached his arms forward and grasped the dancer with his hands, his fingers on either side of her waist, his thumbs and palms pressed against the small of her back, supporting her weight. Then he proceeded to walk slowly in a circle, causing her to pirouette around like a tiny doll atop a music box. Only here, there was no music, and this dancer-doll had tears cascading down her cheeks—and the clown, weeping himself, caught the limpid drops tenderly in his mouth, the grief of one flowing into the other perhaps augmenting, perhaps consoling. When the other two performers fell to the ground, the dancer turned in place, faced the clown, and both embraced in a manner to shut out the world.

A minute passed, maybe two. The barker gradually withdrew from his coat sleeve a white wand, which he proceeded to wave about in the air, inscribing interconnected circles. A dense vapor emanated from the tip of the wand, engulfing within seconds the entire room, moistening every face, obscuring the four performers. Then the barker stopped, the mist cleared, and these four were gone. The remaining 12 witnesses, after arranging their herbs in a small pile in the middle of the ward's lobby, turned about and, with the barker in the lead, recessed from view.

Now the circus group had been gone for several hours. In my body, I felt the chill of long sleepless hours arising in the early morning. Circling through that particular ward for one last check before heading for bed myself, I observed the overnight cleaning lady trying to remove the pile of herbs from the carpeted floor; but already the plants had each taken root and would not be gently removed. I knew, as I looked on—and it subsequently came to pass—that these roots would defy all trimming of stems and pulling of runners. After several months of futile attempts at eradication, the hospital administration (never quick to fathom the deeper under-life in the hospital) would concede defeat and erect a sensible, knee-high wall of gray stone around the indomitable patch of greenery, allowing the herbs to flourish as they would have regardless—only now contained, safer, and with a polished brass plate affixed to the largest stone proclaiming: For the Children of Concordia Hospital.

Trouble was, in my view, the herbs were never meant for the children. The clary sage and rosemary, the foxglove and poppies, the tarragon and fennel, the coriander and forget-me-nots, with their medicinal allusions and evocative aromas, they were left by grievers for grievers, for survivors left to make something of their losses, for the sad and often lonely process that is given little space or freedom in the forcefully cheerful confines of a children's hospital. How often, during the following years of training, I would look at that wild profusion of plants, breathe in their pungent odor, and be flung backwards to see myself, watching the four performers from the half-lit recesses of an empty room. How palpable and bewildering their grief had been. I had never seen anything like their act—not only in form, of course, but more so in bluntness: these people had suffered a rending of their hearts, and came here not to hide that pain but to proclaim it, to play it out in their own manner for all to see and to feel. I, for one, certainly had felt it—and it mystified me, then as now, for there was something greater in what they were doing than a simple act. They had been touched by someone precious, a person of grace, and somehow this performance was one expression of how they carried the light gravity of her memory with them, how they lived with the weight of its feeling. For a momentary spell, they had with their performance clarified my vision on this entwined burden and blessing, so that now, with each flash of those colorful leaves and petals or the unexpected waft of their aroma, I am reminded of the necessity, the pain, the vitality of grief.