Halfway through medical school, I discovered my dad’s age: 66.
Of course, I knew how old he was before then — I’d celebrated his birthday every year, but the number didn’t really stick. It didn’t seem to matter.
I had a vague notion of what his age meant, a coalescing of rounding decades and the occasional use of a senior discount. Somehow, though, my dad didn’t seem to be aging. He didn’t look as if he was getting older, and he wasn’t slowing down at work. But according to my medical training, this number carried some intense baggage that made it mean something almost sinister.
The age of 65, medicine teaches, is the River Styx in the geography of epidemiology. You need a doctor to get you safely to the other side. While I felt increasingly invincible the more I learned in medical school, my dad’s health grew increasingly tenuous.
It’s a common narrative in medical school that the curriculum turns students into hypochondriacs. As someone closer to age 30 than 20, I feel I have cleared the threshold of onset for the most terrifying pediatric diseases. The diseases of old age feel a long way off. So I didn’t feel vulnerable to hypochondria.
To be sure, factors such as fitness, stress and even income contribute to chronic disease and affect how healthy a person is, regardless of age.
But there was my dad, at 66: now high risk, now eligible for screenings of diseases I didn’t know existed before medical school. He was at an age that is young enough to be “too soon,” but old enough to be biologically fair game.
During one memorable hospital rotation I was at the bedside of a new patient. He was a few obstinate hairs away from completing the balding process and his stomach was bulging out from under a stained T-shirt. He had the capacity to realize that using his second language, English, would avoid the mutual annoyances of a translator phone.
He asked the female resident: “Do I get a male doctor?” She responded with a practiced bit on how she’s the doctor he gets, brushing aside his sexism. As this unpalatable moment hung in the air, she started telling the team about this “66-year-old man.” Instantly, my focus evaporated. I was aware of one thing only: This patient could be my dad. My dad could be this patient. Like some cartoonish anvil, the weight of my dad’s mortality hit me.
Sexism, racism, homophobia — this family of “ism”s and “ist”s — was what I had expected to be the greatest challenge of providing equitable care to patients. As a gay Jewish medical student, I had braced myself to respond to politically unpalatable comments or denigrating questions with professional aplomb. I had even comforted a patient by holding his swastika-tattooed hand when he was too unsteady to stand for a blood pressure reading.
I feared moments like this patient’s comment, where I, as the least superior member of the team, would face the conflict of wanting to step up to avoid being a bystander to sexism but also respect the team’s chain of command.
But now, at this 66-year-old patient’s bedside, my composure was gone. The alignment of only two demographic details, age and sex, in a universe of possible details vaulted this patient into universal importance. What sideswiped my caretaking ability was not the patient’s “ism”s. It was a selfish flood of empathy.
This patient, this 66-year-old man with chest pain for a day, is not my dad. My dad does not have poorly healed scars on his stomach. My dad is not bleeding into his abdomen. My dad is not hemodynamically unstable, with low blood pressure and increasing signs of organ damage. My dad is breathing easily at work hundreds of miles away, not being transferred to the intensive cardiac care unit after some other medical trainee performed violent chest compressions.
But the concordance, however tenuous, between this patient and my dad was something I was not prepared to process. Nothing in my tool kit for politically challenging patients prepared me for this. I had never even considered the possibility that my caregiving skills would be compromised because a patient reminded me of someone I loved.
My mental preparation and professional development for my clinical year had been focused on finding a balance between being myself and being professional. Should my ear-piercing stay in? Is my Spanish too offensively bad to use? Will patients see the L.G.B.T.Q.-rainbow sticker on my badge and make assumptions about my caregiving? These are the questions I prepared myself to answer, on the spot and in the moment, only to snap back into my best professional, equitable-care-giving self. I was prepared to deal with otherness, not closeness.
I have a cogent and academic vocabulary that helps me navigate sexism, racism, homophobia and their manifestations in tattoos. I have a professional skill set for checking my biases. I am passionate that medicine never be used as a weapon in the form of care inequities. But this experience of not-dad transference revealed to me that politics won’t be the only barrier to my care giving. What happens when someone in my care reminds me of my boyfriend, my brother, my best friend?
I have a medical vocabulary, algorithms and protocols, equipment I’m trained to use when a patient needs them. But for my family and friends, none of this helps. It doesn’t change the reality of illness, the reality of people you’ve known for much longer than a single hospital admission becoming victims to the biology in a textbook and protocols at your workplace.
Patient not-dad moved on to the intensive care unit, with someone’s hands pumping into his chest because his heart stopped again. Whatever composure I had regained since the morning’s first encounter evaporated all over again. I was not feeling professional. I was feeling resentful. Resentful at myself for having never thought about this wide-open hole in my professional skill set. Resentful at the I.C.U. for having an open layout with nowhere to hide as I teared up watching my not-dad actively die. Resentful at my actual dad for being 66, and mortal, and having a chest on which compressions could be — might one day — be done.
Resentful that I was not ready for that day to come.
Sam Dubin is an M.D. candidate at New York University researching H.I.V. prevention and L.G.B.T.Q. health disparities.