Originally published in The Boston Globe

“Thank-you cards or the death penalty” is how my children describe our family philosophy about grati-tude, and yes, I guess that’s about right.

In our house, most of December is about thank-you cards. The kids know they’ll be spending the day after Christmas laboriously composing thank-you notes, not just for Legos and scratchy sweaters but for excel-lence in garbage collection and mail delivery, too.

It’s genetically engineered gratitude. My mother, the quintessential Irish Catholic Hallmark Queen, taught us that civilization rose and fell on timely thank-you notes, and unless you had a same-day arm amputa-tion, those cards had best be in the mail by sunset.

My dad, on the other hand, made us write thank-you notes for services rendered. He came from Kansas farm country, where the quality of a man’s labor could mean the difference between a decent dinner and none. And he had a nearly religious conviction that good workmanship should not just be acknowledged and emulated it should also get its own thank-you note.

So in my childhood cultural crockpot, it became stan-dard operating procedure to thank and reward prac-tically every working person we ever met. We sent thank-you notes to everyone ditch diggers and dry cleaners and dogcatchers alike and oftentimes added a gift.

My mom was a big one for saying it with flowers, but my father’s gift of gratitude was generally booze. In those pre-OSHA, pre-Oprah days, I remember a dad-mandated mission to get a bottle of brandy to a roofing crew who had finished patching our roof mere minutes before the rain. I remember jumping on my bike to deliver some sherry to a red-nosed priest after a baptism. And I have crystal-clear memories of my mother placing beribboned six-packs of Budweiser “just so” on our overflowing trash barrels every Dec. 26th.

I look back in head-shaking disbelief: Did we really give the garbage man the means with which to drive a half-ton trash truck with a brewski wedged between his knees? At dawn? Well, yes, we did. Because he was a great garbage man. And we attached a lovely note.

My siblings have continued the family tradition of rewarding good service, albeit in a new-millennium kind of way. My sister the nurse regularly brings flats of organic strawberries to her favorite phlebotomists. My brother the tire-and-brake-shop guy sends flowers to the salesmen who ship him emergency parts past closing time, despite the endless teasing they must then endure for a solid month.

And I have become a maternal-variant and sneak outside at dawn’s early light to leave the trash guys six-packs of Gatorade, of course.

My parents’ overarching message took: Good service is a gift that is worthy of a gift. All my life, my parents surprised one charmed working man after another with bottles and bouquets and bushels of corn.

But they never thanked the doctor, ever. No matter how hard the doctor worked, no matter how many bones he set or poxes he counted, no matter how late the unblinking hour or how relieved was their pa-rental terror, my parents never gave our pediatricians more than an eyes-averted “Yah, appreciate it, Doc.”

Once in a while us kids would query: “Maybe we should give Dr. Taylor some tomatoes?” My mother’s working class Irish nose would sniff, “He could buy 10 bushels of tomatoes with one tonsillectomy; he doesn’t need our tomatoes.” So we never gave him tomatoes, or a card, and we certainly never considered leaving a six-pack of Bud at his fancy-schmancy house. It was an unspoken rule entangled with expectation and ob-ligation and class division, but the take-home message was clear: Doctors lived in another neighborhood, they existed on a different plane and they didn’t need thank-you notes.

A couple of life cycles later, I myself ended up becom-ing a doctor, a cancer doctor, and yes, I moved into a new neighborhood. Now I work at a wonderful hos-pital with a spectacular staff where we spend our days with traumatized patients, coordinating complicated cancer therapies while attending to hopes and fears and schedules and tears and fierce desires to attend a granddaughter’s wedding if they can just hold on just long enough.

And, unlike the overlooked pediatricians of my youth, I get thank-you cards. And presents, too, flowers, fruit, tomatoes, plants, and even lottery tickets. One memorable patient bought a prepaid ticket for ev-ery staff member for 52 weeks he told us he knew he might not live out the year but he’d be watching from above to see if one of us hit it big.

I went into medicine out of love for service. I became a doctor because I felt driven to make a measur-able, tangible difference in people’s lives, and I never expected a thing besides the deep-seated satisfaction such profound work brings.

I had no idea how much I’d love getting those thank-you cards.

It’s turned out for me that every thank-you card holds a life lesson. I read them aloud to my children at bedtime, hoping to convey the miracle of our wild and precious lives. I think of the cards as I work in my garden, especially the area where I’ve transplanted patients’ plants. And sometimes I reread the cards on the bad clinic days so as to be reminded of the real reasons why I do the work I do.

Sometimes when I read those notes I think, “Oh thank heavens I don’t work in a (fill in the blank . . . backroom, copy room, sweatshop, silver mine) where nobody ever sends me a card.”

And sometimes when I get a particularly poignant thank-you note, the first thing I think of is how much I wish I could show it to my folks. But alas they both are gone. And although all their lives they taught us to be tangibly thankful to those who lent them a hand, their deaths were so sudden and traumatic that we were never able to adequately express our gratitude to the people who worked with them during their deaths.

Given the riches I’ve received from my own patients’ thank-yous, I sure wish we had acknowledged the pediatric doctors from the start of my life. Since I can’t (they’re gone, too), maybe I can make up for it by sending a belated thank-you to the dozens of doctors who helped my parents at the end of theirs.

For the anonymous anesthesiologists who started my mom’s nearly impossible-to-hit IVs, thank you. For the surgical sub-specialists who tried and tried and tried again, thank you. For the nameless ICU doctor who dialed up my mother’s deathbed morphine with tears in her eyes, thank you. For the unknown foreign doctors who treated my dad’s sudden death with re-spect and awe, thank you. And for the longtime family physicians who gasped in dismay when they heard of my parents’ untimely demise, thank you, thank you, and thank you.

Consider this essay a virtual lottery ticket with num-bers preordained for the jackpot. You’ve already hit it big.