Published June 2025.

Robert Macauley is a pediatric palliative care doctor telling his story throughout his career. With his background of also being a priest, of being a medical ethicist, and in navigating parenthood, he brings a raw honesty to the emotional complexity of his work and perhaps how his own childhood trauma has impacted how he shows up for the people he helps.

Because I knew You weaves together stories of some of the patients he's cared for over the years and how they've impacted his role moving forward. The stories are heartfelt, heart wrenching and hard. Macauley documents some of the misunderstandings of his field, such as the distinction between palliative care and hospice, and how pediatric palliative specifically comes with it's own hurdles vs adult palliative care. He speaks truthfully about burnout and the impact his job has on his family and friends.

Overall, while this book was emotional and heavy, it was beautiful.

Thanks to the author and publisher for providing a review copy through NetGalley.

This book touched me in many ways. I love how Dr. Macauley teaches us you can turn pain into positive. He shares some deeply personal details which brings him to the decision to become a pediatric palliative care doctor. It is commendable to me, the job he performs. To see that his patients touch him just as much if not more than he touches them.

Their stories are heartbreaking and wrecked me. There were several times I have to use my Kleenex.

I listened to the audiobook which is narrated by the author. I love books in which the author narrates. He did a wonderful job.

Thank you NetGalley and Talkbox Productions for the advanced listening copy of this book. All opinions are my own.

Macauley has written a riveting book that underscores the preciousness of life. Poignant and profound, this book is worth the read as a wake up call to truly live before we go. Highly recommended for those of us looking for a nudge to live like we mean it.

This book reminded me a lot of the Dutch book "die ene patient" where doctors talk about that one patient that changed their lives or stayed with them. "Because I Knew You' focuses on the author and the way his patients (children with serious illnesses) made a difference in his life and helped him heal from his own trauma. Not wanting these kids to hurt the way he did when he was young, he explains how he fights for the family, which sometimes puts him at odds with his colleagues.

Every time he introduces a new patient, you wish he didn't, as that could only mean one thing: another heart-wrenching story that will leave you in tears, which this book often did to me. Showcasing the difficult decisions that parents must make in these situations, this book will leave you wondering what you would do in similar situations, and praying that you'll never have to go through what these people have gone through.

As someone who knew nothing about pediatric palliative care doctors and had never heard of an episcopal priest, this book challenged my existing knowledge/ideas. The discussions that he raises about religion and his views in the medical world opened my eyes (as someone who is not religious) to my existing prejudice against religion in the medical world. I was scared at the beginning that it would feel like someone pushing their religion, but it was very educational and a great start for discussions on many topics in this book.

Although the reading tempo was very slow for my liking (might be my adhd), I found that listening to it on 1.25 speed felt like a normal recitation of the stories the author goes through. The author himself narrates this book having an extremely pleasant voice, which makes you just want to sit down and listen.

My overall rating would be 4.75 stars, as certain parts felt a bit repetitive. However, it would be a book (if I had the physical copy) I would pick up once in a while to remind myself of the privileges I have in my own life and how lucky we are to be able to go through the days we go through, showcasing the beauties of life and death.

If this hasn't encouraged you to pick up this book... Maybe this will: the proceeds of the book go to support the pediatric palliative care program at Oregon Health and Science University, with a portion donated to Darkness to Light, which is an organisation dedicated to ending child sexual abuse.

Thanks to Netgalley for the Audio.

Sad yet inspirational.
I couldn't imagine dealing with death daily, but someone has to and I'm glad that these patients had someone like Dr Robert Maculey.

Listening to the audio narrated Dr Robert Maculey really made it special.


ps Once more with feeling is indeed the best episode!

This is a hard book because pediatric palliative care is a hard topic, but Macauley is an excellent traveling companion. His thoughtfulness and thoroughness would make him an excellent shepherd in any medical or clerical setting, but he truly seems to have found his calling and I would trust my woes to him. The hard stories he tells from his own and others lives are beautifully conveyed and I wish him much peace.

Audio ARC provided by NetGalley.