Not giving your child a flu shot? Read this letter from a grieving pediatrician first.

As of September 15, 85 children from 33 states, the District of Columbia and Puerto Rico have died due to infection with the flu during the 2015-2016 season.

Piper Lowery, who was a healthy and vibrant 12-year-old girl died from H1N1 Influenza almost one year ago. Her mother, Pegy Lowery, has gone public with her daughters’ story, to urge more parents to get flu shots for their children. I would like to help her spread this message, because I was devastated by the death of Piper and I miss her beyond words. Below is my reflection on my own grief as her pediatrician.

My dearest Piper,

I remember the day you were born like it was yesterday as I gowned up to go into the OR and attend your delivery. The OB placed you in my arms, and you were so beautiful. I loved you from the moment you took your first breath. You were feisty, and had a good, strong cry. I knew we were going to be special to each other.

Over the last twelve and half years, I had the great privilege of watching you grow into a beautiful young lady. Whenever your name appeared on my schedule, it always put a smile on my face. You brought sunshine along no matter the reason you were visiting me. Occasionally, I bribed you with chocolate from my personal stash to assuage my guilt at having given you immunizations. I loved your hugs and your quiet smile. I miss those things most of all.

Being your pediatrician was priceless. I expected to take care of your children someday and knew you would make a wonderful mother by watching you care for your little brother. There would be many stories to tell your children about you as a little girl. I never thought it would end.

You are the first and only patient in 16 years of practice for whom I have signed the birth certificate and the death certificate. 100 years ago, country doctors did this sort of thing more frequently, but today, I suspect it is a rarer experience. It is one of the hardest things I have ever done. The last time I saw you, I knew you did not feel well. You kept asking to go home; you were pale but still had your sparkle. I repeated your vitals myself and spent extra time with you to ensure nothing was missed. I treasure our hug as you left; not knowing it would be our last.

You were ill with influenza, and I was so worried you might worsen over the weekend. Your mom knew to take you to the hospital if you deteriorated and she sent me a message the following morning that you were headed there. I told her I would be concerned all day until I heard back on your condition. She messaged back that you had said you loved me. Thank you for those final words dear child; they will be etched on my heart forever. “I love you too, my little friend,” I thought to myself.

You hated the thought of going anywhere but my clinic; you had never been to the hospital before. You asked your mother if I would be there by your side in the ER. You were disappointed when she told you I would not. Upon arrival, you collapsed in the hospital parking lot and had to be carried into the ER by strangers. I wish I had been there, though the outcome would have been no different. The doctors started trying desperately to save you. I could hear the word ‘epinephrine’ in the background while on the phone with your mother during your resuscitation; I knew we might lose you.

You were not mine to lose in the parental way, but you see, that is how I always thought of you. My own daughter was not born until you were eight, so you were one of my “first” daughters. I had two sons already when I became pregnant for the third time. I assumed it would be yet another male child. Do you remember telling me you absolutely knew in your heart it was a girl this time? I can recall that conversation like it was yesterday. You were right, my sweet friend.

When I received the call from your mother that you died, I was overcome with disbelief and wanted so desperately for the outcome to be different. As I drove to your home afterward, I did not know what to say to your grieving family. We sat together and cried for what felt like hours. Your parents and brother felt more of a comfort to me than I was to them; though we were undoubtedly a comfort to each other. We told so many stories about you and your shenanigans. We laughed and cried that day. I sobbed the entire drive home.

At your funeral, I sat next to a mother of four whose children attended your school. They kept handing me tissues as I sobbed uncontrollably while taking in each picture of your smiling face over the years. I had known you at EVERY stage of your brief lifetime. Halfway through the service, the mother leaned over and said: “I wish my children had a relationship with their pediatrician like Piper had with hers.”

I thought to myself that I was the lucky one; to know you and to love you. I am so thankful to your parents for sharing you with me all these years and allowing me care for you. Not one day has gone by since your passing that I have not thought of you and longed to see your smiling face one more time. I will miss you more than you will ever know.

With love,