Portal de Periódicos da CAPES

Lessons From My Mother

2018; Lippincott Williams & Wilkins; Volume: 93; Issue: 6 Linguagem: Inglês

10.1097/acm.0000000000002207

1938-808X

Sarah Van Remmen,

Empathy and Medical Education

Paralleling my formal medical school curriculum was the unofficial education I received as I watched my mother fight breast cancer. It started in the fall of my first year of medical school as I memorized the cell cycle and the targets of chemotherapeutic agents at the same time Mom started doxorubicin therapy. The lines between home and school remained blurred in the spring of that year as I studied the kidneys during the day and used car metaphors at night to explain to my dad how metastasis was causing Mom’s obstructive kidney failure. Lectures on the blood-brain barrier during the September of my second year laid the groundwork for my discussion with Mom’s oncologist in November about why the chemotherapy couldn’t reach the new metastases on her optic nerves. My scientific understanding of the situation didn’t make it any easier to cope with her anguish of blindness. In the winter, I learned about malignant cachexia, and my phone calls home were punctuated by Mom’s need to vomit. Our final Christmas together was interrupted by the audiovisual hallucinations and paranoid delusions that Mom began to experience secondary to whole brain radiation. The psychosis that she developed convinced her that she had been cured of cancer by God. These delusions led her to frequently refuse treatments, accost strangers with her “testimony,” and ask for extra lab tests to prove she was cured. Despite her failing memory and waning strength, Mom was still able to enjoy her days at home, and we each spent as much time with her as we could. We took turns making her meals, reading her books, and narrating family vacation videos for her. Her physicians took a holistic approach to her health and were able to maximize her ability to enjoy my brother’s wedding and my sister’s graduation. As she grew sicker, my dad carried her from her bed to the couch each day, and I learned what it truly means to be someone’s caretaker. Until experiencing it myself, I had never known the depth of the burden shouldered by the families of ill patients. The weight of caring for my mom extended past the physical and into the ethical. On Good Friday of my third year, abdominal metastases eroded through Mom’s duodenum. On speaker phone with the surgeon, I helped my dad decide not to consent to an exploratory laparotomy. I flashed back to the 3 am failed ex-lap I had scrubbed in for and the patient dying attached to machines in the ICU. I couldn’t bear the idea of Mom being stripped naked in an OR all alone, blind, delusional, and confused; surgery or not, death was inevitable. And I helped my dad understand that Mom was beyond repair. Death would provide relief from her suffering. We chose to honor Mom’s wishes of no aggressive measures and to maintain her dignity. I left rounds that morning in Washington, DC, and flew home to Buffalo to spend the last day with my family before she passed. Transitioning from health care outsider to provider has given me unique insights into the stresses that we place on the families of our patients. As physicians, we see illness and death so often that we can forget how overwhelming seemingly basic decisions can feel for many patients and their families. We often take for granted that our patients have a basic level of medical understanding and fail to provide thorough explanations of their conditions and treatments. We need to remember that just another day at work for us can be a life-changing day for the families in our exam rooms. I now approach my patients through the lens of my own experiences, and I see my mother in each person I help. SarahVan Remmen, MDS. Van Remmen is a first-year resident, Department of Psychiatry, University of Maryland-Sheppard Pratt, Baltimore, Maryland; e-mail: [email protected]