- For the Love of Tomatoes and Movies:Lessons from a Grandfather's Passing
Near the end of 2009, I started working as a primary care physician in a private practice in Belgium. Requests from family members followed shortly thereafter.
"Would you be our doctor?" "Can we come to your practice?"
Admittedly, I was in doubt about how to handle these requests. They usually came with high expectations. Surely a doctor who was also a family member would put extra effort into providing the best possible care. My medical school professors, however, had been very clear about this type of request and advised against treating close relatives. An intense emotional involvement could cloud one's medical objective judgment, they believed, possibly leading to irresponsible decisions and issues, such as an unyielding continuation of futile treatment plans.
And yet many colleagues I knew ignored this advice and treated close relatives—husbands, wives, children, parents, grandparents and sib-lings—and most of them quite happily. Their emotional proximity seemed to be an advantage rather than a hindrance in the real–life world. They went the extra mile for their family members, but did not seem to lose their capacity for medical decision–making or clear judgment in the process.
I began to question whether the more distant form of empathy that was implicitly or explicitly portrayed by my professors as ideal, would indeed provide the best care practice. Could emotional proximity somehow be beneficial to medical decision–making, to the patient–provider relationship? Or would it indeed cloud one's judgment as a medical professional? I pondered these questions for quite some time.
Meanwhile, I did not take up the role of treating physician for any of my close relatives. That does not mean I avoided giving medical advice altogether. I felt quite comfortable talking about the medical issues family members presented to [End Page 18] me. I provided a medical professional's opinion while carefully acknowledging their primary care physician's priority. However, I came across a new dilemma when the primary care doctor for one of my husband's relatives retired. Would it be acceptable to become the treating physician for this person I barely knew? And if so, how would I decide for which relatives I could become the treating physician? Where would I draw the line? Quite unexpectedly, the terminal illness of my grandfather provided me with the answer to this dilemma, or better said, with the right question.
In 2011, my grandfather had been living in a nursing home for almost three years, ever since his general condition no longer allowed him to live independently. His primary care physician paid him regular visits at the nursing home; they had a good relationship. In the last months of his life, his health deteriorated. He suffered from chronic leukemia and generalized arthrosis. He became bedridden, often uncomfortable and fatigued. In a way, his general condition resembled the sleeveless shirts he wore. They were old, worn–out, yellowish and threadbare in certain places, but he refused to get rid of them, despite my mother's plea to replace them. During those last months, I felt he came to be just as worn–out as his old tank tops.
Through all of this, I was, first and foremost, his granddaughter. I would sometimes drive to the nursing home in the evening, after my last patient visits, to find the doors locked. The nurses were kind enough to let me in for a late visit. I brought some chocolates, truffles or grapes, whatever he liked. I never had to worry about daily necessities because my mother took care of those. So we could talk, stroll down memory lane and enjoy the candy—basically do whatever grandfathers and grandchildren are supposed to do together. Of course I was not only his granddaughter, I was also a medical practitioner. And although I was never his treating physician, my medical background almost instinctively gave rise to another role.
I became a sort of liaison figure between the care providers and my family members (including my grandfather). It was as if I did not fully belong to either side. I did not belong to the...