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Often, we treat loss as though it only happens once. Immediately after someone you love dies, the condolences from friends and colleagues come pouring in for a short while, then the people around you settle back into their lives, and the well wishes and offers for companionship gradually, and understandably, decline.
I’ve come to learn that the experiences of loss and grief are not quite so linear. My brother, Stanley, died in January, 2016, from cancer. Me, my partner (both of us medical students at the time) and Stanley’s girlfriend spent the night camped in his small hospital room, rotating between the plastic pull-out couch, a rubber chair and the side of his bed.
No one, not the palliative-care team, our nurse or our oncologist had thought to tell us about this terrible period of waiting, where we could do nothing except hope that when my brother’s life came to a close, it would be peaceful. Nothing in my medical textbooks, so dedicated to the cure of disease, had prepared me for what would happen when, as our oncologist put it, there were “no more curative options left.”
I lost my brother that day – but in a strange way, I have lost him again and again since. I grieved anew when I connected my phone to our car and “Stan’s iPhone” came up as the last linked device. When we moved houses, I had to decide what to do with the half-written thank-you cards he’d started for his colleagues but would never finish. When I turned 25 in September – Stanley’s age when he died – I realized my older brother would never be older than me again.
These moments pull me to a difficult place; one of watching my brother grow frail, of choosing a funeral home, of hearing “I’m sorry” and “no more curative options.” They remind me that my brother is gone, that I could look for him indefinitely at all of his favorite places – his gym, his new workplace, his room in our childhood home – and he would no longer be there the way he used to be.
The most poignant reminders of Stanley, though, are from the practice of medicine itself. In the two years since his passing, I spent one finishing medical school, then the other mostly away from the clinical world. I never doubted that I would return to it, but having walked beside Stanley throughout his illness meant that I witnessed the gaps in the care he received that seemed almost unconscionable to me because of how much I cared about him, and how much I wanted his care to be as important to his providers as it was to me.
In truth, the moments during his clinic visits or hospital stay that were sub-par weren’t any more egregious than those experienced by many patients navigating our care system. We experienced long waits in emergency departments, clinicians who were hurried or unsure of the particulars of his case and, perhaps most difficult of all, the professional detachment of our oncologist, who came in that morning to declare that Stanley would soon die and didn’t check in on him or my family again.
The experience profoundly affected me because they ran so contrary to both the type of human- and patient-centred medicine that I was taught, and the kind of compassion and understanding I hope to practise.
In those moments, the clinical environment made me feel as though I was losing my brother again and again. Then, like the reliable older brother Stanley had always been, he reappeared in my final year of medical school.
First, I found him behind a closed curtain in the emergency room, where I had to give a patient bad news. This was my first time delivering a cancer diagnosis. I was equipped only with the results of a CT scan, an ultrasound and a blood test, and had no answers as to the cancer’s stage or what the treatment options were. But my patient and her daughter pulled me into their embrace all the same, and we cried together until my staff doctor came in.
I found him next in a family-practice clinic, when a woman was booked for an annual physical but chose instead to spend our time talking about her son, who had just been diagnosed with Crohn’s disease. She had googled her way to abject fear about potential future bowel surgeries, repeat hospitalizations and lifelong medications, and we reviewed the latest evidence on Crohn’s disease and its treatments together.
These patients, among many others, reminded me that in every clinical situation, I will have a choice: to be human, to connect, to try to understand. I harbour no delusions that I will be perfectly patient or generous at all times or for every patient. I’m aware of the true limitations imposed by time and the increasing demands placed on every health-care provider. But what I recognize is the importance of trying to see myself and my brother reflected in the patient and their family; to know that, equally, I have been there and have needed compassion on that receiving side of the hospital bed.
More than two years on, the pain of losing Stanley still ebbs and flows. While it shows no signs of letting up, reminders of his life and death no longer hurt as much as they once did. Instead, as I start to practise medicine, I will try to welcome them. The memory of my brother will be a guide and a compass leading me back to human, compassionate practice. I think he would’ve liked that.
Vivian Tam lives in Toronto.