Dual Roles: When Your Patient is Your Parent

Daniel Yeremin, MS3, Class of 2025

Medical school has challenges for everyone; 2023 was especially stretching for me. One such challenge occurred during my neurology clerkship. On the second day of my rotation, I received a text that my father was going to the hospital for some head imaging, the same hospital in which I was currently working. He had been unwell for several days with what my parents had assumed was ‘the flu.’ This update surprised me. I met several family members in a waiting room downstairs as my father was taken to imaging. We waited for what I think was several hours before the doctors returned, explaining that they needed to admit him to the neuro critical care unit.

For nearly two weeks, my days were divided between attending to my patients during the day and spending my evenings and weekends with my father down the hall. At one point, I was even part of the rounding team who cared for my father. My father loved joking that I was on “”double duty”” as son and student. He would often request a prescription refill from “”Dairy Queen Pharmacy,”” colloquially known as a Turtle Pecan Cluster Blizzard. That was one way in which I was able to encourage him. Being faced with the possibility of losing my father was emotionally draining, compounded by the struggle to balance my educational commitments. I had to put aside my normal, strict routine to be there for my father and my family.

This experience highlighted several things that everyone already knows, but we often take for granted. Firstly, it reminded me that every patient is someone’s loved one. As medical professionals, we can forget patients have just as much of a life as we do with goals, hopes, and dreams. Secondly, all of us as medical students and doctors have seen very sick patients in the hospital. We have also all experienced, to varying degrees, the pain of seeing loved ones endure suffering or pass away. Getting to see both simultaneously allowed me to empathize more deeply with patients and gain insight into the daily challenges faced by patients and their families.

Crying Over Mr. Ashton

Bethany Snyder, MS3, Class of 2025

“What is going on with me?”

As part of our curriculum, all University of Kansas medical students have to stumble through simulated patient encounters. Most of them are one-offs (we treat a patient once, then never again), but one patient we see multiple times, a cis-male character named “Paul Ashton.” We first meet Paul for a generic complaint and order the appropriate labs. We see him a second time to inform him that a cancer screening marker has come back elevated. During a third visit we transition his care from hospital to home, and then in the last encounter we inform him that his cancer has returned.

Throughout these encounters, note that there are several different actors who portray Paul (we have over 200 medical students after all, one man could not do it alone), and I, myself, saw a different man play Paul each time. Despite this, during the fourth Paul encounter, I held back tears as I told him I would be there for him no matter what, whether he wanted to treat his recurrent cancer or not. I struggled to keep my voice even and my face neutral as we discussed his goals of care and his desire to stay with his grandchildren as long as possible. “What in the world?” I thought. This is a fake patient, not a real person. On top of that, it’s not like I have an attachment to a particular actor because it’s been a different man every time! For some reason, it just felt so personal and real.

Weeks later I was assigned to the inpatient oncology service on my internal medicine rotation. This was my third rotation thus far, so I wasn’t quite a novice, but I also hadn’t dealt with terminal illnesses in real patients yet. “Rick” was a patient admitted to our service for extensive blood clots in his legs. He had recently had an appointment with his outpatient oncologist, who reported that his most recent experimental chemotherapy had failed, and his metastatic disease would be terminal. This news was fresh and devastating for him and his wife. Nonetheless, I faced them with calm professionalism and frankness, not letting our conversations sink into unmitigated despair. I couldn’t understand why I was able to achieve such control with a real patient, but a simulated one had gotten under my skin.

As I mulled this situation over, I began to think about my mother, who happens to be an ER nurse with over 20 years of experience. She was a charge nurse during some of this time as well. To be quite honest, I had never understood how someone like her was able to perform that job. Reason being, it’s one that requires someone with strength and quick thinking during life-or-death scenarios, and my mom is someone who cries when she sees advertisements on TV for animal cruelty organizations. She is excitable, garrulous, sensitive, and passive. Instead, I always thought I had taken after my father: the stoic, analytical engineer. Growing up I felt closer to my father than my mother, who irritated me at times with what I felt was an overreactive personality.

But this same woman was somehow able to efficiently run an ER at the largest hospital in Kansas City. Could it be that during her work she slips into a composed persona which I have never seen at home? When surrounded by family, perhaps she doesn’t find it necessary to keep a cool demeanor; we are the ones she feels safest around. But at work, her patients and colleagues need her clear thinking and composure. I realized this is a side of my mother that I have never seen before, but it is something we might have in common. In the simulated Paul scenarios, the very fact that they weren’t real meant it was safe to let my emotions flow, so I struggled to contain them. With Rick’s genuine situation upon me, however, I had no trouble keeping them in check, because I knew this wasn’t the time to let go.

I felt guilty for underestimating my mother for so many years. It’s difficult to swallow the fact that there are sides of my mom that I have never seen. She doesn’t work in healthcare anymore, so I can’t visit her during work hours if I wanted to. Even so, now I have a greater understanding of who she is. Having my own bewildering experience with the emotional aspects of practicing medicine not only helped me learn more about myself, but it also brought me closer to my mother.

Snowdrops

Sheridan Scott, M2, Class of 2026

A child smiles softly, toy reflex hammer released
a plastic stethoscope still donned
as pudgy fingers fight to apply a Little Mermaid bandaid
over thick, black fur
where Mr. Snuggles’ heart would lie.

A girl counts silently, bag-valve-mask squeezed
a plastic stethoscope no longer sufficient
her hammering heart unwilling to still
as breathing for two people
leads her to wonder
how the woman became so ill.

Older now, naivety removed
like fallen autumn leaves
she knew the burden of illness
and the cruelty of disease,
reflected in patients’ eyes and
mirrored in those who held them dear.
The fragility, unpredictability of time
that causes a loved one’s screams
to overshadow outside noise and etch
a permanent mark in memory
as compressions neglect to replenish
ink into a pen–
unwritten chapters forever blank.

Yet, older now she knew that snowdrops bloomed
despite winter’s unforgiving chill
and knowledge mixed with compassion
achieves incredible feats
and gratitude in patients’ eyes
leaves her feeling unable to speak.
For medicine is most complex
and indescribable at best
to be entrusted with patient care
is an honor above all the rest.

The Patience/The Patients

Ruth Mekuria, M1, Class of 2027

“The Patience (read downward)

Patience.
A student holding a pen in an exam, a resident with a scalpel in hand, and now an attending holding their
patient’s hand waiting for the results with…
Hope, because this doctor was once…
A bit afraid, to be honest. But now I looked in her eyes and felt comfort and felt
It will be okay. She fought as hard as she could and I was
Looking at the clock, before looking into her eyes and whispering
“I will be here for you, no matter what happens.”
“Breathe, please breathe”…I prayed for each breath as she said
Doctor…Will I be okay?
Anxiously, hopefully, patiently wait with the
Patients.

The Patients (read upward)”

Patients are People

Tyler Elmendorf, M3, Class of 2025

My first day as a third year medical student I anxiously waited in the neurology resident workroom as the team was assigning patients to students. The last two years of my life were in preparation for this moment; however, I was still overwhelmed with a feeling of inadequacy.

I soon found myself knocking on the door of a sweet 75 year old woman who was admitted for neurological deficits. Sitting tucked in her bed, she patiently answered my questions before we started looking at the cute pictures of her grandkids tapped to her walls. We shared a moment talking about her family, who was very dear to her but unable to visit her during her stay in the hospital.

Later that afternoon a team of two residents, an attending physician, and myself entered her room to update her on the results of her MRI scan. You could see the confusion on her face as the team explained her new diagnosis. She attempted to take notes on the discussion, but quickly gave up as she was unfamiliar with how to spell transverse myelitis. Seeing her disappointment, I turned to a new page in my notebook and wrote in big letters “TRANSVERSE MYELITIS.” When the team left the room I tore the page out and handed it to her. In that moment, her expression of confusion immediately subsided as she shot me a smile and a heartfelt thank you.

After rounds, I stopped by her room to check on her. She looked me in the eyes and explained how grateful she was for that simple gesture. She felt embraced by the people of the hospital, and that the individuals providing her care, truly cared.

I think about this moment often. While in many cases I can’t change the diagnosis, treatment, or outcome, this moment serves as a personal reminder of the kind of impact I can have when slowing down and thinking about the person in front of me not as a patient but as a person.

The Road to Healing

Micah Vander Griend, M3, Class of 2025

A memorable event occurred while on my overnight trauma shift during my surgery clerkship, where I cared for a woman who had suffered a wrist injury while motorcycling with her boyfriend. Beyond addressing her medical needs, I was able to attend to her emotionally—something that can easily be forgotten amidst the pandemonium on the trauma service. She was scared, in pain, and felt uncomfortable with the experience of being unclothed, having her broken wrist manipulated for x-rays, as well as having to answer the same questions about her health and the events leading up to her admission repeatedly. Although, at the end of my 24-hour call shift, I stayed with her. I felt a deep connection with her experience and pain and wanted to alleviate her suffering.
During our time in the stifling hot and impersonal trauma bay, I held her hand while she had her wrist soft casted, engaged in conversation, learned about her life, and offered her a distraction from the pain she was surely experiencing. As our dialogue progressed, she entrusted me with her fears about the upcoming operation to repair her wrist fracture. Drawing parallels from my own childhood experience of a similar injury, I shared my recovery journey and how I was able to regain complete function of my wrist.
Although the mechanisms of our injuries were different, her anxieties were alleviated by my similar situation. She felt an immediate sense of peace and hope in her eyes was reignited; she recognized that she, too, may be able to resume various activities that she cherished, such as riding motorcycles. I felt touched that, as we said goodbye, she thanked me for the time that I had spent with her, sharing that I had made this difficult experience more manageable and peaceful. This interaction was a powerful reminder that beyond the physical wounds we treat, the emotional and spiritual healing we facilitate is equally vital.

A Home for Baby

Taylor Knowles, M3, Class of 2025

Do you hear crying?
Demanded to move, she
Swallows belongings
And cradles her womb.
”This property is private, or didn’t you see?
You don’t belong near people like me.”

Without help, she scrambles alone
Packing the items that make up her home.
An ache finds her spine like the ache in her heart
For a place to exist and create a new start
But the feet in her womb push her on
Down this path.

Two miles pass and she drops to her knees, crying
In pain as she falls on the street.
Without any medicine, what can you do for a pain so engulfing it hurts just to move?
And yet, in the stillness, the baby won’t rest.

Do you hear crying?
As she’s helped from the ground, the pain overcomes her
But, also, this sound is the cadence and chorus of
Something so sweet—the sound of a battered soul
Finding relief.

I enter her room, my notebook in hand, noting the
Name on her hospital band.
She shares how painful recounting can be, and as
She details her past miseries
I remember we all are just human.

Blood tests and images unfold the truth:
Infections are sprouting in scars from her youth.
Bacteria runs from her heart to her bones and, just
As she does, continues to roam
In search of someplace a new life can survive.

More Than A Patient

Caroline St. Peter, MS3, Class of 2025

I am more than a patient.

I am more than a 90-year-old man with Parkinson’s disease and dementia. I am more than a widow. I am more than a man without his high school degree. I am more than a recovering alcoholic, and I am more than a helpless patient in the hospital.

I am a father, a grandfather, and a great grandfather. I have 3 kids, 2 of which are still living and involved in my life. I am a veteran who spent 30 months in Panama during the Korean war. I am a writer and a reader of fiction. I am a lover and a joker. I am survivor of alcohol misuse disorder who turned my life around, and I am a man with a story to share with the world.

During his admission, this patient had deterioration of his mental cognition and physical strength, which was impacting his nutritional status. His barrier to being discharged was ensuring he had enough nutrition and strength to go to a rehab facility. Attempts at medical interventions, such as a G-tube and appetite stimulants were unsuccessful, and the ultimate treatment ended up being personal engagement. We found out he had trouble concentrating and remembering to eat, and this is why he wasn’t doing so. Therefore, we shaped his care to focus on motivating him to eat with company and verbal encouragement. When I cared for him, I brought food from the floor to share with him in his hospital room, providing him with cues and companionship to enhance his care. As we sat and ate together, I asked him about his life, and he shared vast stories and immense wisdom I will always remember.

As an author, he encouraged me to write something down every day, even if it’s “boring or smart” so that I can have an account of my own story and how I see the world through my perspective. During our conversations, there were many instances where he found himself reflecting on previous experiences, such as his time in war and receiving help for his alcohol use disorder. Through this he showed me that no matter what stage of life or mental state you are in, to be grateful for what you have been through in life and reflect on that often. The past shapes who you are but does not define you. He also emphasized the importance of finding the joy in each day, no matter what the circumstances. He was vulnerable in the hospital and still focused on finding positives and continuously thanked us for our work. My time with this patient truly showed the impact that we as physicians have on our patients when we treat them as humans and the everlasting impact that patients have on us.

when does the work end?

Aroog Khaliq, M3, Class of 2025

8 o’clock in the morning watching a red moon
blossom on a woman’s neck, holding open the
edges for the carpenters to saw and scrape, to
heal the way they know how—tiny blades, tinier
forges. the small, hurried movements of their
wrists a dance i cannot mimic with any grace,
and there is no room to stumble, not here.

10 o’clock in the morning, my own gloves stained
with blood from my little blunt efforts, retracting
that little moon into fullness, then snipping it into
an eternal crescent. the case is not yet over, even
when the deft hands still and away. still, there are
my bloody gloves, a woman under blue drapes,
wet and dry cloths on her sweet, slumbering face.

10:07, and i find my own deftness in the gentlest
touch, cloth wiping away orange iodine stains
around even the nares. good morning, ma’am—
you were here, and i, too, took care of you.

The Stone Baby

Sarani G. Pachalla, M3, Class of 2025

As the surgeon carefully zapped through the final fascial connections, I felt the weight of the mass shift into my hands. My eyes went wide. It was 13 centimeters long, slate-gray, traversed by gnarled, maroon vessels, dotted with pale yellow, fluid-filled cysts, yet solid. I gingerly passed the mass to the surgical technician, who announced that it weighed 2950 grams. As the circulator wrote down the number on the board, I recalled my conversations with Mrs. G.

As a third-year student on the emergency general surgery service, I had seen her the day before for a possible bowel obstruction. Having not passed a bowel movement in days, she was extremely uncomfortable. Yet, she was in remarkably high spirits. Although the conversation was interrupted by her waves of nausea, we spoke about her daughter, grandchildren, and her recent journey with breast cancer. On physical exam, her abdomen was bloated, doughy, and tender to palpation. I remember auscultating high-pitched bowel sounds like fingernails on a champagne flute. Later, when I opened her chart, I found that her care was transferred to the gynecology/oncology service. Her chest radiograph showed bibasilar opacities. The CT of her abdomen and pelvis showed significant ascitic fluid and a large left-sided pelvic mass, and the gynecologists stated her presentation was consistent with Meigs Syndrome. She was scheduled for an exploratory laparotomy in a few hours.

Ascites, pleural effusion, ovarian fibroma: the triad of Meigs Syndrome flashed across my screen, refreshing my memory. This syndrome is an extremely rare presentation of a benign ovarian mass. I had memorized it for my board exam alongside many other triads, but I never thought I would see it, let alone in one of my patients. When the senior residents on both services agreed I could observe, I hastily made my way to pre/post to see Mrs. G.

“I knew I had a stone baby in there,” she laughed. It struck me how one could be so magnanimous in the face of something so baffling. “Make sure they weigh it. I’m curious.” I promised her I would. I noticed her shifting awkwardly, and I hoped that the surgery would ease her discomfort. We chatted more about her grandkids’ ballet recitals and soccer careers until we rolled back to the OR.

The resident confidently made the first incision. Then, as she pierced the peritoneum, the team began to drain liters of ascitic fluid. I exhaled, realizing I had been holding my breath. It was satisfying (and a little disturbing) how in an instant, the surgeons could remove the physical manifestation of the discomfort Mrs. G had been living with. It was also exhilarating to bear witness to something I had only seen in lectures and review videos. The surgery proceeded dynamically. The attending physician asked questions to us students, allowing us to connect concepts with reality. As she called out anatomical landmarks and coached the residents in surgical technique, I was in awe of her expertise. I craved to achieve the mastery it takes to understand every side of a condition, from the patient experience to the pathophysiology to the treatment.

I could not wait to see Mrs. G again. Albeit groggy from anesthesia, she was much less uncomfortable. When I told her that her stone baby weight 6 pounds and 8 ounces, she replied, “talk about a weight lifted.” Despite the fact that my role was so miniscule in the grand scheme of her care, I felt a genuine sense of fulfillment from my proximity to it.