The internal struggle a child wages when faced with the possibility of losing a parent or sibling battling chronic or serious illness can provoke a tangle of emotions that makes coping on one's own a painful, if not impossible, process.

For three UB medical students, helping children make sense of that struggle has given them new perspective on the field of medicine. In working with grieving children through the support group Shelter from the Storm, the three have found that while learning about the clinical course of a disease is imperative, understanding its effects on family members is equally essential.

Steve Turkovich, Kim Leonard and Joyce Zmuda-all 23 and in their second year of study in the School of Medicine and Biomedical Sciences-volunteer as facilitators in the group, run through the Life Transitions Center, a division of The Center for Hospice and Palliative Care.

"They are three wonderful people," said Jill Jacobs, coordinator of children's support groups for the Life Transitions Center, noting that the children in the group have taken an incredible shine to the trio. "The fact that they are so busy and they have taken time to come and do this-they are really three very special people."

Turkovich, who began volunteering for Life Transitions during his sophomore year of college, said the group strives to provide a safe, stable environment for kids confronting illness and mortality-an environment in which they can talk freely about the events happening in their lives, their feelings and how to deal with them. For these children-who range in age from 5 years old to their late teens-the loss often is manifold.

"So, Mom before, who was a normal, healthy single mom, who could function fine, all of sudden who's sick, is having a much more difficult time raising her kid because she has to deal with her illness as well," said Turkovich, outlining a typical scenario in which an eventual loss through death is compounded by a loss of attention or time a parent has for the child-or even a loss of identity associated with the parent whose behavior may change throughout the course of an illness, such as brain cancer.

"That can be very scary to a kid when Dad is sometimes saying things that he wouldn't, or doing things he wouldn't," said Turkovich, noting that children can be just as adversely affected when a sister or brother is ill.

"It's the parents' natural tendency when they have a child who's sick to focus all their energy and attention on getting that child better," Turkovich said.

"The (other) kids sometimes get pushed to the side a little bit...because all the focus is on the sick person," added Zmuda, who said children enjoy the group for the one hour during which all attention and effort is focused on them.

These children-conflicted by anger, fear, frustration and guilt-often are afraid to validate their emotional tumult, or the justifiably overwhelming threat of loss. Many in the group feel isolated-from school, from friends who can't-or won't-understand what they're going through, Leonard pointed out. Being in a group with others who can empathize is comforting to the children-and can help them rebuild emotional loss through group activities. The activities, planned by Jacobs, center around art as a way to help children emotionally unwind and release. Sometimes, Turkovich said, the activities serve that purpose-other times, one less complicated.

"To get them to smile and be a kid, that's a huge thing," he said.

The rewards-evident by the affection in the students' faces when they speak of a child who finally removed her coat during the meeting, another who finally cracked a smile-clearly outweigh the frustrations, particularly in getting some to give voice to those emotions embedded down deep. To be sure, patience, here, is a virtue.

"They tend to come out with things when you don't even expect it," Zmuda said. "And it will be something huge for them-(but) you can't solicit it."

For Turkovich, a drawing that hangs on his wall at home-and what it represents-has served to affirm his career choice.

Jon, who was 13 when he was in the group, had been shifted into foster care after the parental rights of his mother-working as a prostitute-were terminated. His mother now dying of AIDS, Jon was living in a home for emotionally disturbed youth when he joined the group. Finding him to be no more challenging than other tough kids he had come across, Turkovich said the two found friendship in art. Over sketches of Santa Claus and South Park cartoon characters, the aspiring pediatrician said Jon really opened up.

"I have that there to remind me why I'm in medicine," Turkovich said, explaining the picture drawn was that of Jon's face, crying, the young man sharing personal stories while he drew. "When things get really tough, when things get really bad, I need to ground myself and say, 'It's the kids-that's why I'm doing this.'"

Unfortunately for the three who are entering their third year of med school next fall-one of the most difficult-their time commitment to the group will be considerably less, a "huge loss" for Jacobs, who nonetheless is happy they'll take away invaluable experience.

"They've got a tremendous benefit-how illness really affects kids," Jacobs said. "I think that's been a huge gift to them."

Shelter from the Storm meets the first and third Thursday of each month. For more information on volunteering, email Jacobs at jjacobs@palliativecare.org or call 836-6460.