How her grandma’s end inspired this young doctor’s new beginning

Each year, soon-to-be graduating medical students count down to the third Friday in March, also known as "Match Day," when they find out where they will continue their medical training. Lauren Kelly, a fifth-year MD/MPH candidate in the Perelman School of Medicine at the University of Pennsylvania, describes how caring for her family members informed her own path.

As the first doctor-in-training in my family, I never have a shortage of health questions and concerns to address. I field questions about treatment for bipolar disorder, which rears its head among my family, and about the types of food everyone should be eating. My phone rings when my grandpa's legs are swollen or when my step-mom has nosebleeds from her nasal cannula oxygen. I'm on calls with physicians to discuss care plans for my loved ones when they're hospitalized, and I'm everyone's favorite person to take to their medical appointments. While at times, providing this type of medical advice can feel a bit like "always being on call," it's also my passion. I am pursing residency training in Primary Care Internal Medicine—the specialty that trains you in, well, everything.

I began my tenure as the caregiver in my family at a young age, as I watched and tried to navigate my father's challenges with drug addiction. To this day, we count our successes as a team: stretches of sobriety, cure from Hepatitis C, new job opportunities. My mother, a Cuban immigrant and single parent for many years, was my first mentor; working long hours to give me a first-rate education.

The pursuit of knowledge and understanding, learned and creative, was always the way I picked myself up when the world around me had little semblance of order. As a young person, I imagined there was no limit to what I could know. Back then, I never would have guessed that my future medical training would involve a great deal of unlearning.

In medical school, we're taught to treat patients using the many therapies learned in the lecture hall. Not to do so might even feel, for some, like a moral failure.

When someone has a broken hip, you replace the joint—right?

Such was the question in our fourth-year Bioethics class a couple weeks back, where many of my colleagues (myself included) reflexively voted to replace this fictional patient's hip. After all, as we've learned, time is of the essence in hip fractures, since high mortality rates are at stake.

"But what about the mortality associated with hip surgery for a sick patient?" noted one classmate. The room grew quiet and pensive. In my mind there was another "what-if."

I wondered, "What if this patient has advanced dementia?"

It's often not until we have personal experiences that rock us, that throw knowledge to the wind, that we recognize the art and nuance to the practice of medicine.

I was in my clerkship year when my grandma's Alzheimer's disease took a steep decline. Despite my modest experience, I was the family liaison for all of her medical decision-making, a role with heavy responsibility not unfamiliar to me. I was the one who said yes to the unrevealing lumbar puncture and temporizing antibiotics. Later, I said yes to home hospice and cared for her in her final days. I faced the great challenge of balancing my family's concerns with what I knew about who my grandma was.

Maria Rosa Perez was her name. She was a brave, independent matriarch who uprooted her family in search of possibility. My grandpa had her heart, but she was the one who made all of the rules in our family. Stern and tight-lipped, she asked us to never let her end up like her own mother did, bedbound and dying in a nursing home.

No experience in my life has come close to that of administering oral morphine to my very own dying grandma. She died at home of an otherwise treatable complication of her diabetes, surrounded by the people she loved. There were no feeding tubes, no intravenous hydration, and certainly no heroic measures. There was a dim blue light by her bedside and soft Buena Vista Social Club playing well into the night. We all gathered around her on recliners and makeshift beds waiting for her final breaths—it's a painting I can picture when I close my eyes.

I'm moved to think I can play a meaningful role like this in the lives of my future patients who face serious illness. I look forward with great purpose to identifying patient-driven goals of care amid a sea of therapeutic possibilities. I'm energized by the call to simply be with patients and their families as they're confronted with large and seemingly insoluble problems. Even if my only medicine is a small sense of order or wholeness that I can help to create, the work will be worthwhile.

Follow Lauren and the rest of PSOM's class of 2017 using #PSOMMatch to stay updated as Match Day approaches on March 17.

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