By Sherwin Wong
During a family crisis, those in healthcare are expected to play two roles. One is the role of the health care professional, analyzing and advocating for the sick. The other is to be a supportive, caring and compassionate family member. It is a strange and delicate balance to try to keep and will be an evolving skill as we become physicians.
It was the morning before a unit exam when I received a message from my father about my grandfather’s hospitalization. I probed for details over the phone, all the while thinking of what investigations my grandfather would need, what his prognosis might be and how his co-morbidities affected his mortality risk. Speaking with my father, I asked for his symptomatology, vitals, his level of consciousness and whether they had started fluid resuscitation. I was a 3-hour drive away from the hospital, certainly not part of the care team and acutely aware that I was not adding any value by analyzing his case. Physicians often talk about the inherent desire to problem solve, act and intervene, even when inappropriate. It distances us, allows us to create an illusion of usefulness. It was more for me than it was for the family or for my grandfather. When I finally exhausted my questions, I finally remembered this, and engaged with how my family was feeling.
Later that afternoon, I experienced how the illness of one person affected my decision making. I went on to write my test and found myself struggling to choose answers that had worse outcomes for the imaginary cases. These imaginary cases were intentionally unambiguous and somehow giving a deadly diagnosis was harder. It felt as though I could only handle so much bad news in a day. It was both intriguing and horrifying to see how objectivity and evidence could be obscured by my own aversion to more bad news.
I arranged to travel home for the weekend to spend some time with the family. However, being a medical student altered my family’s expectations of me during a health crisis. I was no longer just a family member coming home. To my family, I was a source of information. And so, questions that they had when a physician was not available were directed to me. I fielded questions about the meaning of high creatinine, tachycardia, atrial fibrillation, electrolyte derangements, ascites, dialysis – providing a general understanding of what words and concepts meant. It was a strange dual role to play. I needed to be both emotionally engaged and cognitively processing his situation. Yet, I could not share all my thoughts with my family. Without his chart, bloodwork and a proper history, my understanding of his situation was limited. I needed to tread lightly and avoid any contradiction with his physicians. Otherwise I would only breed mistrust and confusion. As a family member with some healthcare knowledge, I needed to be aware of my ability to undermine the relationship between my family and my grandfather’s physicians. This, combined with the familial expectation to advocate for my grandfather due to my medical background created a tension between the urge to speak or to stay quiet. It was quite paralyzing and to this day I’m unsure about how best to proceed amidst the physician-family-medical student dynamic.
Ultimately, being a medical student during the health crisis of a family member comes with its own intricacies and complications. My experience provided me with a taste of how tempting it is to hide behind the medical jargon, how it alters decision making and what our role is in the illness of a family member.