Healers, scientists, leaders — these are all terms that we equate with being a physician. As we spend our years if not decades in training, we strive to become all of these components. But when you miss something — the small details, the nuances of a history and these are the clues that could lead to healing it can be disheartening. When it comes to your own family member, such misses can feel tragic, and the feelings of guilt can become all-encompassing.
My brother and I grew up nearly a decade apart. I followed a fairly straight path through medical school and subsequent training. My brother followed in my footsteps. I went into cardiology, and my brother entered family medicine residency. Although we were very different in personality, our shared profession allowed us to grow closer despite the large gap in our ages. We would randomly run into each other, often in the middle of the night, while we were on call and discuss some cases or share some random laughs.
This past year, my brother passed away unexpectedly. It was a Tuesday morning, and I got a call that he had not shown up for hospital rounds … particularly unusual as he was usually the earliest resident to show up. He was ultimately found to have passed away from both a heart attack and a stroke — at the age of 28.
Looking back, there were many telltale signs of poor health in my brother. Both of us have early-onset hypertension with his being much more severe with the requirement of multiple medications since his high school years. Through the stress of medical school and training, he had gained a significant amount of weight and had thus become obese. As many can relate to, residency training does not lend itself to a healthy diet, and this component along with lack of exercise and training-related stress contributed to poor physical and mental health. It also appeared that likely due to limited time, my brother had not seen a physician in several years and was likely not taking the medications he should have been for his severe hypertension. He also snored very loudly — so loudly that we had an anecdote in our family that I used to actually sleep in the bathroom on trips just to try and sequester myself from his snoring. In retrospect, I feel certain that he had undiagnosed severe sleep apnea.
I am a cardiologist — specifically an interventional cardiologist. My job is to identify people with signs of heart disease and treat heart artery blockages. In retrospect, my brother had all of the warning signs and risk factors for heart disease and stroke … the very same things that I talk to patients about day in and day out. What kind of a cardiologist am I when I don’t even recognize these risk factors in my own brother? That isn’t to say our family didn’t try at different points. We bugged him about diet and exercise. I even had him come with me to a personal training session that he hated. It wasn’t necessarily for lack of recognition on his or our end. I think we were all fooled by his age. No one expects to die from heart disease at the age of 28 — the pervasive lie that youth is the preventative pill against all things.
In the days and months after my brother’s passing, I’ve been racked with guilt over missing these signs — things that were so obvious in retrospect that it seems almost like malpractice. In the legal field, the term involuntary refers to an unlawful act in the setting of neglect leading to harm. There is no malice or intent, but there is still culpability for negligence. When you lose a family member to whatever condition, regardless of whether the condition is in your primary field, the situation feels similar.
The fact that I am an interventional cardiologist who worked at the same hospital as my brother also lends to many other thoughts of irony — why couldn’t he have had the heart attack while at work at the hospital? I literally possess the procedural skills that could have saved him. Why wasn’t I or one of my colleagues given a chance to save him? In the days following his passing, as we waded through our grief and attended to details of his service, I fought with all of these emotions as I also underwent testing to assess my own health as premature heart disease can be genetically linked. As the months passed, I gave up fighting, per se, mostly from emotional exhaustion. However, the guilt will always linger, but I’ve realized that may be secondary to the nature of what we do. As physicians, it is hard to remain dissociated from our patients, and in many ways, this is what makes us better caretakers. When the “patient” is a family member, it seems nearly impossible to separate caring and emotion from guilt and personal responsibility.
As much as our family has chided ourselves for not pressing my brother more to take care of his health, we have come to some sort of understanding that his passing was beyond our control. However, we recognize components that contributed to his poor health such as limited time for personal health appointments and training related stress. In order to facilitate physician wellness, we have started a fund in his honor at our shared institution to promote initiatives to improve the health of those who care for others. Although nothing can bring my brother back, through this initiative, we aim to provide support for physicians, both physical and mental, to support better health (at any age) and avoid, perhaps in small part, what led to his early passing.
Ki Park is an interventional cardiologist.
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