“Do your parents realize that he could die?”

I had been summoned to the workspace of the ED physician who was trying to save my brother’s life. I remember noticing that he was short with thick brown hair and a crisp white coat which were both too tidy and incongruent with the message he was delivering. He struck me as someone who was earnestly playing the role of a physician instead of actually being one. I glanced over my shoulder and saw my parents waiting outside of Kevin’s ED room looking so old and helpless.

By now, I was feeling guilty that I had been irritated by my mom’s 2:00 a.m. phone call. My mom can be quick to ring the alarm bell, and I was expecting to be unimpressed when I arrived. So I was shocked to see the blood pressure of 50/30 emblazoned on Kevin’s bedside monitor and to hear that the team was planning to intubate him emergently. This was the real deal.

I was used to being asked medical questions by my mom, especially about my youngest brother Kevin. He was born when I was in college, much to my embarrassment at the time. But he immediately won the hearts of his parents and older siblings. He was a toddler as I made my way through medical school, as I learned about health care maintenance recommendations for children with Down syndrome and insisted that Kevin have an echocardiogram and yearly blood work to check for leukemia and thyroid problems. Kevin was five when I met with my advisor to nail down my decision to match in pediatrics. “You’re the oldest of six? I could have told you three years ago that you’d be a pediatrician.”

Kevin had been pretty healthy aside from some constipation and intermittent eye and skin infections. Maybe one baby admission for RSV. Until one day when he was 17 years old and started having bloody stools. He was also anemic and got admitted to the pediatric hospital where I work by one of my partners. He was followed by a GI consultant, and his hemoglobin was stable for several days. I was even on call one of those nights, but another partner was on back up so I wouldn’t have to be my own brother’s physician.

Plans were made for a scope at a later date since it was a weekend and New Year’s Eve, and he was discharged home. He didn’t make it to that scope, though, because he started bleeding out through his GI tract a few nights later. The ambulance took him to an adult hospital this time because it was closer to my parents’ house.

I had now arrived to assume my role as the sister/daughter/medical jargon translator. The man who looked like a someone playing a doctor but was actually a doctor showed me my brother’s chest X-ray and rattled off the numerous units of blood and liters of fluid that were being pushed into Kevin to keep him alive.

“Um, yeah, I guess they do …”

We waited in the overly bright hallway outside of Kevin’s room, glimpsing the many staff members buzzing around him and the repeat blood pressure numbers that flashed up on the monitor every few minutes. The numbers were so, so low. 40s/20s, maybe even a diastolic in the teens at one point. But as my mom methodically called each of our other four siblings to report Kevin’s dire state, the numbers started to go up a bit. Then a bit more. The constant flow of packed red blood cells and saline boluses eventually slowed, and Kevin was pronounced stable enough to be transferred to the ICU.

I accompanied my parents and Kevin to his new room as the sun was coming up. I felt satisfied that Kevin was reasonably stable and wanted nothing more than to go home to my own babies while my parents stayed at the hospital with theirs. I felt guilty again as my mom thanked me for coming, knowing that I hadn’t actually done anything, knowing that I had been annoyed when first summoned, knowing that I just wanted to leave. Guilty for the many times I had sighed internally or rolled my eyes when she called me for medical advice. I drove home and held my beautifully healthy four-year-old daughter and the-month-old son.

Somehow, incredulously, as the week went on, Kevin was extubated and scoped by another GI consultant and back to his usual Kevin-y self in less than seven days.

Seven years later, my 24-year-old brother Kevin still lives with my parents. He enjoys the performing arts and visiting state capitals and fast food. He and my dad are still “the two pals.” Sometimes I am his “best sister,” but he is also quick to bestow that title on Brenda or Paula or Anna depending on the day. Sometimes my mom still asks me medical questions about Kevin, who is no longer a pediatric patient but will always be my goofy little brother.

Lisa Sieczkowski is a pediatrician. 

Image credit: Shutterstock.com