- Abdicating the Role of Physician, Losing the Role of Loved One
I am a pediatric intensivist and the only person in a medical profession in my family. My mom passed away from complications of endometrial cancer when I was in college (and far too young to really have any idea about what it meant to have endometrial cancer, let alone what it meant to have died from complications of it). Though not yet even a medical student, my dad sent me a copy of my mom's autopsy results and asked me to go through them with him. Despite not having had the opportunity to go to college, my dad has basically had a career as a mechanical engineer. In hindsight, to have someone so self–motivated and intelligent ask me to interpret an autopsy report with just my college–level interest in medicine should have showed me the responsibility I would have in my family once I actually had my medical degree.
This story started three years into my faculty career, long after I'd realized that any knowledge I'd had that would be practical in the care of an adult patient had become outdated long ago. On an otherwise unremarkable afternoon, I received a tearful phone call from my grandma telling me that my mom's only brother, my Uncle Dan, had "throat cancer." I was pretty grateful that the reflex to focus on the data presented kicked in. It was easy to objectify the fact that I already knew that he would die from this cancer when I could ask pointed questions about exactly how he had presented to his physician and just what was done to come to the diagnosis. At Uncle Dan's next visit with his physician, his wife, my Aunt Barb, called me from the clinic room to ask if I wanted to talk to Uncle Dan's doctor myself. I struggled with which role I'd play from that point on: the niece or the "doctor in the family". I tried to make that decision not mine to make and said, "Well . . . only if he has time to talk to me and wants to talk to me . . ." Being a kind and thoughtful man, he of course took the phone from my aunt when she passed it over to him, explaining, "My niece, the doctor, is on the phone".
We had a lovely conversation. He told me that he thought my uncle's prognosis was "good." I relayed that I was just able to appreciate that Uncle Dan's voice had changed considerably since the last time I spoke with him, and asked what he thought that meant, cranial nerve involvement or a dangerous amount of airway obstruction? I brought up the utility of a tracheostomy and g–tube. Given my uncle's favorable prognosis and the unknown risk of airway obstruction as treatment was undertaken, arrangements were made to admit him to the hospital electively, get all of the tests necessary to nail down the specific diagnosis, and have a tracheostomy and g–tube placed. I asked if I could talk to my Uncle Dan. When his doctor passed the phone to him, I asked how he was doing and what [End Page 28] he thought. Sounding as matter–of–fact as a person can while scared, he told me everything his doctor and I had just talked about.
Days later, when I asked my Aunt Barb if Uncle Dan's doctor had talked about involving a palliative care physician in his care, she hesitated and said that she did not know what a palliative care physician was. Taking that as an answer to my question, we talked about what such a physician did and how one could help whether Uncle Dan's treatment was going well or if things started going not so well. A week later, when my uncle and aunt asked about a referral to a palliative care physician, "because our niece, the doctor, told us to," his physician relayed that he would make a referral if they really wanted him to, but they shouldn't worry because he could "take care of all of that...