Sunday, December 13, 2009

On Relationships, Boundaries, and Definitions

Despite having practiced Medicine as a full-pledged physician in this country for more than five years already, I've never really had a member of my family as my patient. Sure, I check on my mom's diabetes once in a while and there was a time when I had to perform minor surgery on a superficial abscess she had a few years back, but my family has been relatively healthy, with no hospital admissions or acute illnesses that required expert, subspecialized care. So during this past few days, when the mother of one of my dearest friends got admitted at a nearby hospital for acute heart failure and severe abdominal pains, I had a brush with the terror of having to act as a doctor to someone I regard not simply as my patient, but as family, although in this case, well, it isn't really family, in the strictest sense of the word.

This brings to mind several unexplored issues on the nature, definitions, and limitations of certain relationships. Society has an organized, typical way of looking at things. While there are well-described roles for people involved in certain types of relationships, I realized that these roles become limiting and the boundaries are not as well-defined as they should be. For instance, my good friend and I have been friends for years, but the nature of our friendship has always been undefined. Undefined because it is extraordinary, as atypical as my friend itself. It is atypical because it does not follow the usual temporal and geographic probabilities, it is extraordinary because despite these strange and almost absurd circumstances, the basic elements of mutual knowledge, esteem, affection and respect that constitute friendship are undeniably present.

Of course it's a pointless discussion trying to dissect the nature of these things, as I have vainly and almost fatally contemplated on it for the longest time. I have recently resigned to accepting things the way they are, with no definitions and no expectations, but several times during the past days, during my stay in the hospital, I couldn't help but be asked, not just by myself, but by other people as well.

Scenario #1: Resident sees me and suddenly endorses the case. (Hey doctor, don't worry, I'm not an attending!)

Scenario #2: Friend's mom/patient wakes up in the middle of the night and sees me. Surprised, she asks, "Oh, duktora, why are you still here?" (Sorry maám, I don't know too. Maybe you can tell me?)

Scenario #3: Attending physician calls me, "Jean, I didn't know she's your tita! So, how are you related?" (Long story maám, but it has nothing to do with bloodlines and genes.)

So before stories get mixed up, my good friend and I agreed on the simplest explanation: I'm a cousin. Alright. Fair enough. Most people accept the explanation without batting an eyelash. And somehow, I've gotten used to answering "Oh, she's my aunt" without batting an eyelash too.

So there I was, the fake cousin in the white coat, trying to be a good friend and a good doctor at the same time. And then the issue of my role as a doctor in "the family" comes in. During my past five years in the business, I know how irritating it is to have some other doctor sniff around the tracks of your diagnostic and management strategies and mess them up like he's the master of the universe. It took a great deal of patience and restraint but I somehow managed to have enough empathy and self-respect to keep from making bad comments about the management plans or even poring around the charts scrutinizing other doctors' plans and prescriptions (whether they allow that in private hospitals is a question I didn't even bother to ask).

So for all this grappling with the mysteries of my roles and limits as a doctor, or my functions and boundaries as a friend, I'm somehow stumped in the end. The roles and expectations society sometimes imposes are as puzzling as the diagnostic cul-de-sac we are pretty much in right now. So despite the occasional ravings and protests of my mind, I let instinct win. Intuition and instinct - they make medicine an art. Love - they make this art, not just a chance to heal, but an opportunity for goodness.

Last night I went to the hospital again. I purposely stopped wearing my white coat. I just went there as me - fake cousin, distant relative, close friend. Just Jean without the white coat, holding a sick old lady's hand.



1 comment:

will said...

diagnostic cul-de-sac. i love cul-de-sacs.