I am a health professional, but my loved one has cancer.

A friend of mine is an internist. He is recovering from cancer. His wife died from cancer several years ago after a long illness, despite his constant vigil; he was nurse and lover, feeder and cheerleader. When he returned to work after his treatments, I expressed warm concern. He told me how much more difficult it is to be the relative than to be the patient. He was referring to his wife, to the feelings of impotence, frustration, and unrelieved rage that gnaw alongside love and despair. Physicians are accused of overtreating, of acting as if this is some grand hunt for the core of a single problem, not part of a life. They get lost in the search. It is understandable, though perhaps not commendable. As family members who are also professionals, we can do our own searching, we are participants, but we are not on the field (neither on offense or defense). Our goals as loving family are different from our professional goals, and the lines may become blurred. Often, our loved one becomes part of the problem. If only they would respond, if only their pain were relieved, if only the tumor would shrink—go away. These are understandable miseries, but we have a duty to be loving, supportive, and mostly quiet. What is our role with the health care system? How much should we push our loved one to ask? How much can/ should we “take charge”? The empathy, the learned exterior that surrounds our professional demeanor, is shattered when our loved one becomes this ill—when the prospect of death is real, and it is part of us. Why is there the ethical injunction against taking care of a loved one (even though you are sure you are best)? You have lost access to the boundaries, to the brakes, to the emotional distance that allows you to love in a limited role but as the physician who has another life. We can all recount stories of the physician/relative who invaded the treatment of his wife/daughter/husband/parent. It is usually a mess. Chances are they alienated colleagues, distracted caregivers, and disagreed with their adult patient/ relative. After all, professional health care relationships are not equal; the patient is sick and usually anxious, often uncomfortable. For the patient, this is a unique experience, and a dreaded one. For the professional, this is everyday business as usual. The loved one who is affected is not the decision maker, and he is thus ineffective as a professional. How far should you go as you vacillate between what you know and your wish to take over, to fix, to change it? The primary tool of the professions is information, and you have that, but you may not use it. That is not your job. But you often envision the worst; can’t you rush in? There is another piece of the scenario: as you envision the worst, you want to control the flow of information, the aggressiveness of the treatment, or the emphasis on comfort. You want every symptom managed—now—and you cannot help secondguessing. You may rail at the false hope, or you may succumb to it. Comfort is short when the physician is reassuring; perhaps you are silent, but you know better. I believe the feelings of frustration and impotence are overwhelming. They sit alongside the pain at watching. What should you do when your loved one makes choices different from those you would choose? We talk about respect in the abstract, but this is a real conflict. Ethical principles guide us to honor a person’s values and choices. But I know better than you, because I have the knowledge. Is it about knowledge? Why is the physician not giving you information in such a way that you make the choices I want you to make? Is he or she to blame? Having a loved one with cancer means that I have to forbear, and that conflicts with my feelings, my gut, my loyalty. It requires me to be patient and to trust. Unless I have known the treating professionals, that seems Cotler