Author: Maria Balhara, Philosophy student at University of Pennsylvania

 

Maria Balhara is a student at the University of Pennsylvania studying philosophy. She provides spiritual care in paediatric intensive care units through Clinical Pastoral Education at the Children’s Hospital of Philadelphia and writes about medicine, ethics, moral distress, and decision-making during serious illness.

 

A footprint can only be taken once. The same is true of many of the rituals that surround serious illness and death. A blessing can only be offered before the moment has passed. A final song can only accompany a goodbye while the goodbye is still taking place. By the time a family knows which moments will matter most, those moments are often gone.

One of the first things I noticed during chaplaincy training at a children’s hospital was how much attention people devoted to things that would not change the outcome.

I watched child life specialists press an infant’s hands and feet into clay, creating keepsakes for a mother who would leave the hospital without her baby hours later. I saw chaplains prepare for emergency baptisms. These actions would not alter a diagnosis. They would not change the course of events.

At first, I saw them as acts of comfort. But the longer I spent in the hospital, the more I wondered whether they were doing something more crucial.

They seemed to be preserving something before it was gone.

I began to notice how much of medicine is oriented toward the future. Physicians order tests to predict what might happen next. Nurses monitor patients for signs of improvement or deterioration. Entire teams work to prevent complications, extend life, and improve outcomes.

Yet some moments in the hospital resist that future-oriented logic.

A parent saying goodbye to a child. A family learning that treatment options have run out. A clinician recognizing that a patient will not recover.

The medical questions are important, but they are no longer the only questions.

Who should be here?

What should be said?

How are we going to remember this?

Hospitals answer these questions more often than many people realize. Clinicians pause while explaining the withdrawal of life support. Chaplains remain beside a family for hours. Nurses and child life specialists create mementos for grieving families. Teams gather quietly before difficult conversations.

The more I noticed these practices, the more they seemed connected.

Understanding often arrives after events have already unfolded. We rarely know, in the moment, what will matter most to us later.

Hospitals confront a practical version of this problem every day.

No parent knows which memory will be precious years from now. No clinician knows which conversation a family will remember long after they leave the hospital. The significance of a moment often becomes clear only in retrospect.

By then, however, it is too late to preserve it.

A footprint can only be taken once.

Perhaps this helps explain why rituals persist even in some of the most technologically advanced places in society. They are not alternatives to medicine. They exist alongside it.

A ventilator can support breathing. It cannot create a memory.

A medication can prolong life. It cannot tell a family how to spend their final afternoon together.

Ritual does not change what happens, but it is often the only remaining option to help people move through what happens.

As a chaplaincy trainee, I expected to encounter ritual mostly in explicitly religious settings. Instead, I found it woven throughout ordinary hospital life, often among people who would not describe themselves as religious at all.

I found it in handprints and footprints.

I found it in moments of silence.

I found it in the instinct to stop, acknowledge, and preserve something before it disappeared forever.

Hospitals, for all their focus on the future, seem to understand something that many of us learn only later: moments acquire their meaning in retrospect, but they must be honored in the present.

Declarations of Interest
None