Some days, I catch myself holding back a smile—not because there’s nothing to smile about, but because joy can feel almost out of place in the shadow of cancer. It’s a strange emotional math we do: weighing the goodness in our own lives against the grief we witness at work. I know I’m not alone in this—colleagues have told me they, too, wrestle with guilt for feeling happy when so many of our patients and their families are hurting.
Being a pediatric oncologist means bearing witness to profound pain. It also means absorbing unspoken blame when medicine doesn’t offer the miracle we all hope for. When cancer doesn’t respond—or when it comes back—it’s not uncommon for grief to curl itself into anger. And sometimes, that anger has nowhere to go but us. Rationally, I understand this. Emotionally, it stays with me.
This emotional residue doesn’t clock out when we leave the clinic. It follows us home, lingers at dinner tables, and sometimes sits heavy in our beds at night. It can sap the energy to return texts, to show up to social events, engage with our families, to share a picture of a joyful moment on Instagram. Because what if a grieving parent sees that post? What if it feels insensitive, no matter how true it is?
And yet… we are still human. We love. We laugh. We crave lightness.
What I’m learning is that this conflict—between grief and joy, sorrow and celebration—isn’t something to “solve.” It’s something to hold. Psychologists sometimes call this “emotional dissonance” or “compassion fatigue,” but more recently, a framework called moral injury has helped me understand it more clearly. Originally coined in military medicine, moral injury refers to the inner distress that happens when our actions—or inactions—clash with our deep values or sense of rightness.
In our world, moral injury might look like this: Wanting to save every child but knowing we can’t. Feeling blamed for outcomes beyond our control. Wishing we could grieve fully, but needing to move on to the next room, the next family, the next decision. It’s a psychological reckoning between what is and what should be.
So how do we keep going?
For me, part of the answer lies in allowing space for both things to be true: that our patients’ stories break our hearts, and that our lives contain beauty too. That we ache for our families, and still deserve moments of levity. That a good laugh over dinner does not dishonor the tears shed at bedside.
We are not less compassionate for needing joy. Many of us feel that we will seem unfeeling for posting a photo of a hike, a meal, a wedding dance. These glimmers of life don’t make us callous—they help make us whole. If anything, our joy honors the lives that have taught us just how sacred joy really is.
To my patients and families: Please know that we carry your stories with us—long after the clinic doors close and the charts are filed away. Your strength, your tears, your laughter in the most impossible moments—these shape us. If you ever wonder whether your doctor cares, I can promise you: we do, deeply. Sometimes that care sits quietly behind a composed face, but it’s there. And when we smile or celebrate in our own lives, it’s not because we’ve forgotten your pain—it’s because your courage reminds us how precious joy is, and why it’s worth holding onto.
To my fellow clinicians, especially those deep in the work of healing and hoping and hurting alongside your patients: It’s okay to feel everything. It’s okay to grieve and to laugh in the same day. To post that happy photo. To cry between patients. To need support. We are not superheroes. We are human. And that, in itself, is enough.
