When I called Ma one afternoon during my first year of medical school, she told me to talk to my grandmother.
I planned to call her this weekend, I said. The time difference between Boston and Kolkata, India, was bridged most easily with the flexibility of late mornings.
OK, but call soon. She’s been in a lot of pain, and they’re telling her she needs her knees replaced.
My grandmother, whom I call Dida, lived with my family in Kansas for seven years. She was one of three grandparents with whom we shared our home, until she and my grandfather returned two years ago to the solace only one’s homeland can bring in old age. She was a grandmother in the wonderfully prototypical ways, forever taking my side in arguments, placing bowls of cut melon in front of me, and fretting about my sleep habits. They were the purest acts of love, now all replaced by biweekly phone calls.
While my grandparents were living with us, my parents served as their tireless advocates to take care of their medical needs. Our mailbox filled unfailingly each week with insurance explanations of benefits, hospital bills, and MyChart instructions. I would frequently awaken to the sound of Ma on the phone assuring the front desk receptionist that she was indeed authorized to speak for my grandparents, who didn’t speak English. Though somewhat frenetically, things always got taken care of – appointments attended, prescriptions filled, pain managed.
But now, my grandparents lived alone and an ocean away. They had no extended family nearby and no other children. Their needs were theirs to navigate, my grandma at 79 and my grandpa at 89 years old. I tried hard to imagine what it was like for them, though I’d never actually been to India. The image I had of my grandparent’s locale was but a composite sketch, a hazy mental map drawn from WhatsApp video calls and railway station names.
So, when Ma told me that Dida had already gone to one doctor, and then two more, I was unsure how to imagine the journeys. I learned that it was a 22 kilometer aka 13 mile aka two hour journey to get to an orthopaedic surgeon who quoted a $6,000 upfront cost. The closest heuristic I had was the monumental effort it once took to get my grandpa out of bed, down the stairs, into our SUV, back out of the car, and into a doctor’s office when he had disabling arthritis in his knee. But who was helping Dida, who could now barely set her foot down without shooting pain? I was scared to ask.
I was a medical student, so I at least asked my mom what her doctors were doing. Did they take an X-ray? Which NSAIDs did they recommend? Were joint injections an option? The responses were often perplexing, different from the standard of care taught to me.
In fact, just that week we had covered osteoarthritis in class, visualizing the narrowing joint space on X-rays, exploring invasive and noninvasive treatment options. Our anatomy instructor held up a donor’s knee joint and exposed the fibular surface. He tapped a metal tool against two spots, one tap producing a harsh clink, another nearly soundless. That’s the difference between having cartilage and not having it, he said. Any other day, I would’ve thought the demonstration was beautifully illustrative. This knowledge was supposed to be empowering, but it instead felt burdensome. Who was I to sit in a classroom in a medical nexus when I was powerless to apply the knowledge to those I love?
It was a dilemma I’d faced before. In college, when my grandparents lived here, there was an unspoken familial purpose to my education. I was only halfway through my neuroscience degree when my parents texted me Amma’s head CT after her stroke, asking if I could make sense of the report. Back then, I reassured myself that I’d finally have more answers and solutions when I got to medical school. Yet I hadn’t anticipated the frustration of having to wait even longer to administer care to patients and my loved ones. It’s a reality of pursuing this profession – a career that demands patience and rewards delayed gratification, the coveted MD after eight years of higher education. But life keeps happening while we keep training. As I sat in class that first year, the desire to provide care grew but had no outlet, like a sneeze stuck in the back of the throat.
As a student now nearly done with her clinical year, I’m closer to being on the other side of this feeling. I finally have the privilege of not just acquiring knowledge but applying it. It’s been worth the wait. I slowly grow more certain when counseling my family members through their medical concerns; the satisfaction is unparalleled when I can equip them to better advocate for their health needs. As the first doctor in my family, I’m honored to help in this way. Admittedly, it is still much harder with my grandparents; the distance remains difficult to bridge and the barriers to their care remain high. I haven’t found many solutions to this, so instead, I call them.
That’s what I did that night, more than a year ago now. Dida always picks up on the third ring with the same sing-songy “Didan!” It's a nickname she’s always used for me, one I’ve always liked because it makes me feel like an extension of her. We chatted about my recent trip to New York City and my upcoming school year. I caught snippets of the Bengali news blaring in the background and remembered when it would do so in the bedroom next to mine. Nothing in that moment could resolve the dissonance forged by the distance, and nothing could easily resolve her pain. But I still possessed physician’s tools that went beyond testing and prescribing – connecting, talking, listening. Dida and I could at least talk, so that is what we did.
Romila is a third-year medical student at Harvard Medical School. She is also a writer who advocates for those with disabilities.
Image by Amr Bo Shanab / Getty Images
