For About and By Caregivers
A Caregiver’s Lesson

By Iris Graville


From the time we say our first words, most of us receive instruction in manners. We’re told, “Say please” when we ask for more milk. Or we hear, “Tell Grandma thank you for that cookie.” But it was my friend, David, who taught me, as an adult, how to say, “You’re welcome.”

One day in early July, David had a seizure, lost consciousness, and was airlifted to Seattle from our rural island community in the Pacific Northwest. Then came the terrifying diagnosis—glioblastoma—an aggressive, invasive brain cancer. David and sickness seemed inconceivable. Despite the gray sprinkled in his blonde hair and beard, he had the muscle tone and strength of people half his age. At 56, he was still an avid skier and mountain-climber. He thought nothing of paddling his kayak a couple of hours to work on a neighboring island, spending the day doing carpentry and painting, then paddling home.

Not surprisingly, David, his wife Barbara, and their two grown sons brought that same kind of strength and endurance to the treatment plan for David’s cancer. They moved with grace and courage through brain surgery, chemotherapy, radiation implants, and gamma knife surgery. They followed intensive yoga practice, changed their diets, prayed, and sang. And, as is typical in our community, dozens of us prepared meals, washed laundry, and did grocery shopping. We also dug a septic system for David and Barbara’s straw bale house, built a peace garden, and took shifts at David’s bedside around-the-clock so he could remain at home when it was evident none of the treatments could eliminate the growing cancer.

Some people stopped by regularly to sing with David. Others stayed for several-hour stretches during the day to be sure he was never alone while his family took naps or walks or just got a break from caregiving. And some spent the night, at first when David got his days and nights confused and was awake when his family needed to sleep, then later when he was restless and anxious about nighttime, and finally when he could no longer get out of bed and needed to be turned often so his skin didn’t break down.

I was one of those friends who took some day shifts with David, and I often felt anxious as the time for my afternoon visits to his home grew near. It was emotionally demanding seeing a friend just a few years older than I decline mentally and physically. I never knew what to expect when I arrived. Sometimes David dozed during much of my visit and said little more than hello and asked for something to eat or drink. Other times, often when he had slept well the night before, he was alert and asked about my kids. On those days, he’d talk about rock-climbing in Mexico and skiing at Mt. Baker.

Caring for him was hard work, too. David’s legs and torso remained strong, but they didn’t always move the way he wanted them to. It was a workout for both of us to transfer him from the couch to his wheelchair, then to the commode, and then back to the wheelchair and couch. As David’s sense of balance deteriorated and his left side weakened, positioning him required constant rearranging of pillows to overcome gravity and keep him upright so he could eat, drink, and watch videos.

“You know what one of my pet peeves is?” David asked me on one of his good days. “When someone says, ‘Thank you,’ and the other person says, ‘Thank you’ back. You hear it on NPR all the time,” he went on, his usually hoarse voice getting stronger with each word. “The interviewer says, ‘Thank you’ to the person being interviewed, and then that person says, ‘Thank you.’ They’re intelligent people. Don’t they know when someone says, ‘Thank you’ you should respond with ‘You’re welcome’?”

I had noticed the thank you reply, too, and although it hadn’t risen to the level of a pet peeve for me, I shared David’s annoyance. However, up until then, I was as guilty as many of answering someone’s “Thank you” with “Thank you.”

That day as I was leaving, David, as he always did, said, “Thank you, Iris.”

“Thank, er, you’re welcome,” I said. We both smiled.

Every time after that conversation, David and I went through a ritual of saying, “Thank you” and “You’re welcome” amidst chuckles. Once I attempted to convince him that people were trying to express their gratitude and pleasure doing or giving something that someone else appreciated. He didn’t buy it. He remained peeved.

One chilly spring day, I couldn’t wait to tell David something I’d heard on the radio.

“David,” I said, as I pushed his wheelchair to a warm spot in front of the wood stove, “I heard a great interview on NPR with some archbishop today.”


“And at the end of the piece, the interviewer said, ‘Thank you.’”


“And then the archbishop said, ‘You’re welcome,’” I announced triumphantly.

David smiled, nodded his head, and said, “I’m so glad you told me.”

As the days went on and David became less responsive, I missed his thank yous. But I knew he felt them. And even though I always said, “You’re welcome” to Barbara or one of the boys when they thanked me for spending time with David, inwardly I was saying, “Thank you.” Despite the weariness in my back and the ache in my heart when I left his house, I felt deep gratitude to be able to care for David and to be with him and his family during one of life’s most intimate experiences. Caring for him was a gift, and despite his insistence on good manners, I came to believe “Thank you” was the more accurate response to his appreciation for the care I gave him.

You’re welcome, David. And thank you.

Iris Graville is a former home health and hospice nurse and now a school nurse and writer. Her first book, Hands at Work—Portraits and Profiles of People Who Work with Their Hands, includes stories and photographs of caregivers as well as artisans, musicians, and others passionate about work with their hands (

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