One kidney for an entire family: my first-year patient

Alexia De Simone is a medical student in the Class of 2021 at McGill University

 

In our first year of medicine at McGill University, each student is paired with a member of the community who has had an experience navigating the healthcare system. Upon meeting Mr. H, a 62-year-old man from Montreal, I expected to quickly understand the chronic pathology leading to his kidney transplant while discussing his co-morbidities and medications based on my first-year courses. However, after visiting Mr. H, I learned that medicine goes beyond a patient’s diagnosis, and that illness impacts many people in one’s life — including mine.

As part of our course, we were responsible for meeting our patient four times throughout the year. Initially, it was very challenging to elicit Mr. H’s perspective on how his illness had altered his life. During our meetings, Mr. H (with Mrs. H present) always told me his approach to life was “simple and easy.” Mr. H had no qualms about dying. He neither shed a tear nor hesitated when discussing the magnitude of his medical disease. Only after our third visit, and in the absence of Mrs. H, did Mr. H share his fears and worries. I distinctly remember Mr. H telling me that life was very short and, given its length, you must be present in every moment and do what works best for you. I felt shocked when Mr. H confessed to us that he wished he had taken better care of himself. Almost as if in secret, he admitted to me that he wished he could have managed his diabetes better and believed this was why his kidneys had failed. I learned two things that day: sometimes, it takes time and care to be able to get our patients to share their fears with us — other times, our patients may be hesitant in sharing those fears because they are trying to protect the ones they love.

One of the most valuable pieces of knowledge I gained from meeting Mr. H was that it is important to consider how illness impacts the relationship between a patient and their spouse. Mr. H’s wife was the one who organized our meetings and was always present. In a sense, Mr. and Mrs. H as a couple were both my first-year patients, and Mrs. H’s perspective on Mr. H’s illness was invaluable. Despite her husband’s illness, Mrs. H told me that two things had kept their relationship strong: date nights and learning how to adjust their lives. Mr. H asserted that spending time with your spouse allows you to stay connected and keep the romance alive in your relationship. He thought that couples could not neglect their relationship, regardless of the presence of children or illness. In terms of adjusting one’s life, Mr. H explained to me that learning how to cope with old age and increasing frailty was a part of life that he and his wife had always accepted. Preparing for the inevitable had allowed them to view Mr. H’s disease within the broader context of life and find moments of happiness. They also agreed that the key to a successful relationship was to have “me” time. This allowed each of them to destress and avoid growing bored or annoyed with one other. While Mr. H’s illness had been hard on Mrs. H, she continued to support him, saying with absolute certainty, “[We’ve] got each other’s backs, no matter what.” Although illness creates tension and feelings of despair in relationships, my first-year-patient experience has given me confidence that it is possible to make relationships work — and even thrive — under circumstances of illness.

Mr. H’s illness has also had an enormous impact on the rest of his family, especially his daughter and son. While sharing fond memories of raising his children with me, Mr. H recounted an argument he’d had with his son after discovering his son was a perfect donor match. Mr. H refused to let his son give him a kidney since he knew his son needed both kidneys for his work. His son also had two young children, and Mr. H was unwilling to risk his son not being in good health for his own children. Understandably, this created tension between the pair. Mr. H’s son was angry at his father for refusing his kidney, especially since he desperately needed one and did not know when he would receive another opportunity. After discussing their perspectives with one another, though, they were able to sort out their differences. I learned from this story that family plays a pivotal role in the outcome of a patient’s disease — especially in the case of transplants.

Mentors and older students in medicine often tell me that there are a few key experiences in training that mark you in your journey to become a doctor. My meetings with Mr. H and his wife have undoubtedly been integral to my medical career. I learned that the most impactful physicians do not simply treat their patients directly from the words in a textbook; they modify their treatment based on their patients’ social histories, cultural backgrounds, and unique needs while understanding the depth of human suffering that affects all loved ones in a patient’s life. I have come to realize that illness is more than just the opposite of health... it is a psycho-social experience that changes the way the patient sees themselves and the way those around them see the patient.

 


Note: This is a true story, though the patient’s name has been changed. Consent has been given for this story to be told.