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The author presents an in-depth exploration of her work with Grace, an 11-year-old girl dying of liver failure. The experience of terminal illness in childhood is discussed with attention to the ability to cope with multiple losses (e.g., body image, body functions, important objects, a healthy future), the impact of the denial of impending death on the child and her family, the child’s use of fantasy as a means to obtain comfort and reduce feelings of loneliness, and the difficulties in the perception of self and other that result from the overwhelming stress of serious illness. Although the author was a pediatric resident at the time, the ability to work therapeutically at the patient’s bedside is illustrated, and unique aspects related to interacting with the ill body are discussed. The therapist’s ability to enter the experience of dying with the child, to understand both verbal and nonverbal forms of communication, to openly discuss loss and death and to allow the child to elaborate and address fears and fantasies regarding the child’s rapidly changing physical self in a developmentally appropriate way are illustrated. The experience of caring for a dying child is explored with a discussion of the range of affects evoked by this work and the centrality of the relationship as a way of both processing and defending against loss for both patient and therapist.