Family Medicine Vital Signs

By Jake Whetzel, MD

I think there were a lot of things that pointed me towards medicine initially. This included provider role models, family members with illness, and a love for understanding how the body functions and reacts to its environment. The most significant influence was a specific role model, my main primary care provider as well as a close family friend – who eventually married into my family and became my aunt. Aunt Janey’s life was my ideal, providing care for a small rural community and then getting out to hike, hunt and fish on her time off. Once she married into our family, she became the main advisor and advocate for our health concerns. Through this connection I learned what family medicine was really like before I committed to it for life, both the ups and downs.  Thankfully, Janey loved her career enough to continue to guide me once I made my choice that medicine was the life for me.

Fast-forward a few years, I am in college and completing my pre-med requirements, still determined to become a physician. I receive a call that my grandmother had a post-op complication and suffered a stroke. Thankfully, Janey was there to have discussions with the doctors and translate for the rest of us what was going on. At the time I knew we would have been lost without her, but I didn’t realize all that she was taking on acting as both a medical advisor and a major emotional support system.

Fast-forward again to this past year, my first year in residency.  My grandma had recovered some function from her stroke, but was still weak and required a walker for assistance. Although this was a drastic change from prior to the stroke (running marathons and bungee jumping well into her 50s), she had made great progress overall and was back to cooking, crafting and gardening. I was just starting my first vacation after the initial few months of residency. Life was good as I had recently became a first time uncle and was getting ready to enjoy a week in the mountains of Montana. Then I got the call from Janey that grandma was sick and in the hospital, and it was obvious that she was concerned. My plans changed immediately and I headed to the hospital. Shortly after I arrived, grandma had an ERCP and biopsy performed. In the post-op area the physician informed my grandparents and me of the diagnosis – pancreatic adenocarcinoma. These words didn’t mean anything to my grandparents, but as soon as I heard them I felt my heart sink.

The next few hours were a blur as I spent most of the time on the phone explaining to the rest of the family what was going on and what needed to be done going forward. Thankfully Janey was there again and knew a good oncologist in town who could see grandma quickly and discuss her prognosis. After this appointment we decided to hold a family meeting to go over all of the details. Up until this point, Janey and I had shared the majority of the management of information, but prior to the meeting she asked that I lead the discussion and answer the questions. This was a surprise, because here was someone with over 30 years of experience as a nurse and PA asking me, with only three months of experience, to lead the way. Later I would discover that she was mostly asking to share the burden as the family’s healthcare advisor.

I was lucky enough to have been exposed to a number of family meetings and end-of-life discussions during a palliative care elective in medical school. I felt that talking about death didn’t phase me as much anymore because of that experience as I was able to look at the data objectively and know that death is a natural process. However, nothing prepared me for having to tell my family that grandma’s life expectancy was likely less than six months. Now, the people I had looked up to for advice my entire life were suddenly looking at me to guide them. Eventually we decided to go forward with palliative and hospice care. Over the next few months the hospice nurses were there to answer the day-to-day questions for my grandparents, easing the load on Janey, and providing some rest and relief for my grandpa. Within five months of her diagnosis, grandma passed away peacefully in her home.

Over the past year I have been reminded what it is like to be the patient or family member of a patient. The level of stress surrounding a major illness can be immense and difficult to handle without the proper support. I try to remember this prior to having major discussions with patients and families, and remind myself to be available both as a medical professional and as an emotional support. The best advice I received from the palliative care team is to remember to be  fully present during these discussions. Take a moment to gather your thoughts prior to starting, schedule appropriate time, and most importantly turn off the pager and cell phone. It is important to the family that they are being heard. As physicians, it is important to remember how people rely on us to help guide them through these difficult times and I look forward to continuing to learn how to fulfill that role for both family and community.

Jake Whetzel, MD is an intern resident at the University of Utah’s Family Medicine Residency Program.