Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What The Big Sick says about our profession

Lindsay Ripley, MD
Physician
August 3, 2019
Share
Tweet
Share

“The Big Sick” is an intimidating name for a movie. I never know what to think when “sick” is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn’t give you much insight, neither does the beginning of the film. It has nothing to do with illness. It’s about a Pakistani standup comedian/Uber driver who starts dating a white girl, but can’t find a way to integrate that into his family’s cultural values. When she, Emily, finds out that he hasn’t told his family about her and has instead been meeting with potential wives for an arranged marriage, she is furious and breaks up with him. That could have been the end of the story.

But it wasn’t. Kumail (the ex-lover) gets a call from Emily’s friend that she’s in the hospital and goes to check on her. The big sick is the time when she’s intubated with an undiagnosed and unpredictable illness, and Kumail and her parents hold their breath at her side. This period isn’t about her — she’s out of the picture in a “medically-induced coma”— it’s about the people who love her, their interactions with the medical community, their attempts to process what’s going on. And it gives us some perspective on what the medical institution can be like in times of uncertainty. Kumail and Emily are real people, who after the events of the film, get married and eventually make this movie.

Emily’s illness starts out as “a really bad flu or something.” In the end, it turns out she has adult-onset Still’s Disease, an autoimmune disorder affecting multiple organ systems that can be very severe and difficult to recognize. I’ve seen it be fatal. She is critically ill from a mysterious process. This means she has teams of doctors taking care of her. At one point Emily’s parents, played by Ray Romano and Holly Hunter, are sitting in a conference room as a string of physicians in starched white coats come in to update them. It’s a montage of medical terminology. The parents ask plenty of questions, and Romano scribbles everything down. But it’s clear they don’t really grasp what’s going on, and you can see the fatigue of trying to keep up wilting their faces.

If a doctor throws out any term, for example, MRSA, they latch onto it and remain fixated. Back home, Hunter Googles “pleural effusion” and “empyema,” trying to wrap her head around what she’s heard. She’s attempting to cross the rift left between her understanding and the medical reality. And because the medical providers have not helped her to do so, she turns to the internet for guidance. The script highlights the dangers of this: “Wow, they should call this website everythingiscancer.com. Whatever symptom you put in, could be cancer. Hiccups could be cancer.”

Throughout delivering their diatribes of jargon, the doctors seem very certain of themselves. They never doubt their diagnosis or their plans, despite things clearly not going well. In a way, this seems reassuring, but it also seems misguided given Emily’s state. Do they have any doubts about the care they are providing? I would in their position. But any emotions of the physicians are hidden. They are machines. And it comes off as callous and uninvested. That’s how the audience, and presumably the family, perceives them.

But it can’t be that they don’t possess feelings or second guesses. I think part of the reason we have trouble communicating with patients and families is because of the emotions that we do have. Especially in situations where we as doctors aren’t sure what’s going on or what to do next, we give tidbits of information. We use big words. We focus on what we are doing and deflect from what we are not able to do. We hide behind the crispness of our white coats and our professional manner.

We have years of education and honed skills of pattern recognition through further years of training, but each case we see is unique. Every time we encounter a disease, we’ve never seen this exact presentation. Every time we do something, we have never done that exact thing before. Many patients fail to recognize that, and it’s certainly not a concept we advertise. Hunter is the only one who detects the disarray that must lie behind the facade. “I feel good about the surgery,” she says. “Yeah, me too. These doctors know what they’re doing,” responds Kumail. “No, they don’t. They’re just winging it like the rest of us.”

After days to weeks without improvement, Hunter decides she wants to transfer her daughter to a better ranking hospital. Kumail is worried. Is this really the best thing for her? Is it safe to move her? But instead of talking to a doctor about his concerns, he turns to the bedside nurse, someone he has come to know. “Hey, do they [the doctors] know what they’re doing? Because they don’t tell us anything.” And it’s the nurse’s opinion that he relies upon. “Trust me, she is fighting this, and so are we.” She serves as a liaison and a proponent for the elusive, robotic figures sending down orders. She is in the trenches, humanizing us and using plain English. She helps to fill the void of communication and trust, but she cannot fill the void of information or transmit the gravity of the situation.

Though the movie starts out with the lives of two relatively normal twenty-somethings, those lives are lifted out of their normal operations and displaced to the hospital. Most of us start off healthy and relatively carefree, but we all eventually have interactions with disease and death. Those usually increase over time. “The Big Sick” gives us a view of what the beginnings of those interactions are like from the other side. It shows how we as physicians interact and communicate, or at least how it’s perceived. And while Emily survived in the end, I don’t think we came off very well.

Lindsey Ripley is an internal medicine physician.

Image credit: Shutterstock.com

Prev

Roundsmanship: the skill you didn't know you needed

August 3, 2019 Kevin 1
…
Next

Physicians need better PR

August 3, 2019 Kevin 3
…

Tagged as: Hospital-Based Medicine, Rheumatology

Post navigation

< Previous Post
Roundsmanship: the skill you didn't know you needed
Next Post >
Physicians need better PR

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Lindsay Ripley, MD

  • A physician’s lonely New Year’s eve

    Lindsay Ripley, MD
  • Physicians should move away from pagers. But it’s not that easy.

    Lindsay Ripley, MD

Related Posts

  • Advocating for a sick parent by confronting physician bias

    Erin Paterson
  • The medical profession needs more shadowing opportunities

    Edwin Leap, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Our health system is a sick system

    Heather Finlay-Morreale, MD
  • Is medicine really a model family-friendly profession?

    Kristina Fiore
  • Restoring the trust in the medical profession

    Philip A. Masters, MD

More in Physician

  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Mastering medical presentations: Elevating your impact

    Harvey Castro, MD, MBA
  • Marketing as a clinician isn’t about selling. It’s about trust.

    Kara Pepper, MD
  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • In a fractured world, Brian Wilson’s message still heals

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Recent Posts

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Recent Posts

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What The Big Sick says about our profession
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...