When a Parent Gets Sick: What Doctors Learn About Healthcare When They Become the Family, Not the Physician
What happens when a pediatric ER physician who has spent three decades caring for children suddenly has to navigate the adult hospital system for his own dying mother? That's the question at the heart of my latest conversation with Dr. David Spiro, host of the Human podcast, and it's one of the most personal episodes I've recorded on The Interesting MD podcast.
This isn't an episode about bashing the American healthcare system or convincing anyone they need to move to Canada. It's about something much harder to talk about: what it actually feels like, as a physician, to watch someone you love move through a hospital system you know intimately as a professional but are experiencing for the first time as a son.
The Difference Between Pediatric and Adult Medicine Isn't Just Clinical
David made an observation early in our conversation that stuck with me. After three decades working in pediatric hospitals, walking into the adult facility where his mother was being treated felt rough. Blunt. Not inviting, not warm — and he used the word "loving" deliberately.
As David put it, there's a love that happens when children are sick in a hospital, because they're not supposed to be sick. That emotional framework doesn't automatically carry over into adult medicine, and David felt that absence acutely — first when he walked into the neuro ICU and found his mother's bed completely empty with no communication about where she'd been moved, and again when her oxygen monitor alarm went unanswered for fifteen minutes because the covering nurse didn't know her.
These aren't catastrophic medical errors. They're small communication failures. But as David said, they're the kind of small things that make a big difference — because twenty minutes of not knowing whether your mother is alive or dead is its own kind of trauma, regardless of the outcome.
Knowing What Your Loved One Would Want — Before You Need To
The most important part of this conversation, for me, centers on a phone call David received from a resident physician asking for permission to place a G-tube in his mother so she could be transferred to a nursing facility. David refused. Not because he was in denial about her condition, but because he and his brother knew — with certainty — that their mother would never have wanted a gastrostomy tube or a long-term stay in a nursing home.
That certainty didn't come from nowhere. David and his mother had talked about it directly. They'd watched her own parents pass away in nursing homes and had promised each other they'd never end up there themselves. When the moment came to make an impossible decision, David and his brother weren't guessing. They were executing a wish that had already been clearly expressed.
This is something I come back to again and again in my own practice, and I said it directly to David during our talk: the question is never "what do I want for my mom?" It's "how would my mom want to live?" Would she want more time alive if it meant losing her independence? Would she rather be home with the dog and the bird feeder, or in a facility where she might get more medical oversight but lose everything familiar?
These conversations are uncomfortable. Nobody wants to sit across from a parent, a spouse, or a child and ask what they'd want if the worst happened. But having that conversation in advance is what allows families to make decisions instead of being paralyzed by them. David and his brother were in lockstep because the groundwork had already been laid, years before the crisis hit.
The Fleeting Gift of Lucidity
One of the most moving parts of this episode is David's account of a single morning near the end of his mother's life when she was suddenly, completely lucid. After weeks of confusion and one-word sentences, she sat up, called him "Dave," asked about his life, and told him to give her love to his son. David had a feeling — he doesn't know why — that it would be the last real conversation they'd have. He was right. She died about a week later, while he was on the phone with her ICU physician in an airport terminal.
I shared my own version of this with David. I experienced something similar with my father before he passed. These lucid surges are real, even if nobody can fully explain them. My advice, for anyone who finds themselves in that moment: take advantage of it. Say what needs to be said. It's usually fleeting — a day, sometimes just hours — before the decline continues. But it's one of the only gifts that end-of-life illness sometimes offers, and it shouldn't be wasted on small talk.
What I Learned From My Own Father's Death
This episode became more personal than I expected. I talked with David about moving my family from the United States to Canada in 2020, in the middle of COVID, while my father was chronically ill. I wasn't able to see him as much as I wanted to in his final years — partly because of the pandemic, partly because of the demands of starting over professionally in a new country. I was the one who eventually had to have the end-of-life conversation with him directly, after a hospitalist gave me an unflinchingly honest picture of how bad things had become.
I don't find it useful to linger on past mistakes. I try to learn from them and move forward. But I'll say this honestly: I regret not finding a way to be there more. That's the cost that doesn't show up anywhere in a decision matrix about career moves or healthcare systems. It's just the quiet weight you carry afterward.
The Takeaway: Make Healthcare Personal, Before You're Forced To
David closed our conversation by reading the final lines of the JAMA essay he wrote about his mother, Elaine — a piece he titled "Making Healthcare Personal Again." His point, and mine, is simple: healthcare systems, however well-resourced, can feel like conveyor belts when communication breaks down. What makes the difference is intention — from physicians, from families, and from the conversations we have long before a crisis forces our hand.
If you're a physician, a caregiver, or simply someone who loves another person who will eventually get sick, have the conversation now. Ask the people you love how they'd want to live, not just how long. It won't make the loss easier. But it will make the decisions clearer when it matters most.
Thanks so much for watching another episode of The Interesting MD podcast. If there's anything I can do for you, reach out anytime at rob@interestingmd.com.