There’s a stretch of days at the beginning of July, between Canada Day and Independence Day, when I find myself holding my breath. It’s a liminal space that I know intimately as a professional, a mother, and a dual citizen. Born Canadian and naturalized American. Over the past several years, as I have come into the full realization of who I am as a parent of a child with complex health care needs, during this week when both countries celebrate independence, I feel the full weight of interdependence instead.

This year, I find myself sitting with gratitude, grief, and the complicated decisions that come with belonging to two different nations, and two very different systems of health care. Today, the weight feels even heavier, as the future of Medicaid hangs in the narrow margin of a divided Congress, bouncing between the Senate and House, in the United States where I live and work.

Last year, I was offered a job in Canada.

It would’ve brought me closer to my family. Closer to the forests, the rocky outcrops, the soft power of a glacial terrain that doesn’t shout but listens. There is something in that landscape that holds a version of myself I miss, that I haven’t been able to locate in this barren southwestern desert.

I wanted to go back home.

But I didn’t take the job.

Because as I dug deeper, I saw signs—some subtle, some loud—that my son’s complex health care needs might not be met within Canada’s universal system.

There would be longer wait times. Few pediatric specialists. More hurdles to coordinated, multidisciplinary care. The very values I cherish—equity, universality, shared care—would come at the cost of the individualized support he needs.

And in the balance between my own well-being and my son’s, I chose him.

Of course I did.

So I stayed. I stayed in a country with a fragmented but fast-moving system, a system that could meet his needs, even if it exacts a cost of its own.

It’s hard to describe the quiet grief that comes with that kind of choice. To know your heart might be healthier in one place, but your family might be a little less whole. To carry a passport that says “citizen” while wondering if the systems underneath it will ever fully welcome the needs you hold.

I am a health care coach and medical school professor. I work with physicians and care teams navigating the moral injuries of modern medicine. I teach students about the human dimensions of clinical work—how empathy, burnout, bias, and communication shape the quality of care. I spend a lot of time thinking about the word itself. CARE—who gets it, who’s left behind, and how systems both nourish and deplete those within them. I’ve come to understand that care is more than a clinical act. It’s a cultural value. It shows up differently in different places. And, I have no easy answers when it comes to choosing between health systems.

When it came to my family’s care, I had to make a choice that no amount of theory or training could simplify.

To be clear, this isn’t a story about which system is better. It’s about what it means to live between them. To belong to two nations whose cultural and clinical values differ profoundly. Sometimes inspiringly, sometimes painfully.

I’ve witnessed both countries offer excellence and inequity. I’ve seen both claim compassion while failing to deliver it. In Canada, I grew up experiencing a deep cultural value for equity, humility, and collective well-being while also witnessing the exclusion many at the margins of those care needs. In the U.S., I’ve participated in fierce innovation and advocacy, often driven by those who’ve been failed by the system. Neither country is perfect. But each teaches me something essential about what it means to try to do right by the people we love.

I’ve also learned that health care systems don’t just reflect policies. They reflect priorities. They reflect what a culture believes about interdependence, about worthiness, and about who gets to be well.

We talk often in medicine about what care costs the system. But we talk less about what it costs the caregivers to live in constant trade-offs. We talk about access and efficiency, but not about the ache of watching your values and your realities collide.

In choosing to stay in the U.S., I chose my son’s care. In choosing not to return to Canada, I left behind a version of my life that may have nourished my own nervous system more fully.

That is a kind of grief I carry every day. Not regret. But grief.

Citizenship, like caregiving, is not just about loyalty. It’s about ongoing, uncomfortable choices. It’s about loving something enough to name its limits. It’s about telling the truth: That no system is perfect, and no solution is simple when a loved one’s well-being is at stake.

So as I sit in this in-between space between July 1 and July 4, I’m not waving a flag. I’m holding the tension. Between heart and logistics. Between landscape and infrastructure. Between collective ideals and individual needs.

I don’t have answers. I have questions:

• What does it mean to be a citizen not just of a country, but of a profession grounded in care?
• What would it mean to choose a system you believe in, even when it can’t serve the ones you love?
• How do we hold the truth that every choice carries a cost?

To everyone holding complex truths across systems and borders this week: May your reflection be as brave as your care.

And may we keep asking the hard questions, even—especially—when there’s no easy flag to raise.

Kathleen Muldoon is a certified coach dedicated to empowering authenticity and humanity in health care. She is a professor in the College of Graduate Studies at Midwestern University – Glendale, where she pioneered innovative courses such as humanity in medicine, medical improv, and narrative medicine. An award-winning educator, Dr. Muldoon was named the 2023 National Educator of the Year by the Student Osteopathic Medical Association. Her personal experiences with disability sparked a deep interest in communication science and public health. She has delivered over 200 seminars and workshops globally and serves on academic and state committees advocating for patient- and professional-centered care. Dr. Muldoon is co-founder of Stop CMV AZ/Alto CMV AZ, fostering partnerships among health care providers, caregivers, and vulnerable communities. Her expertise has been featured on NPR, USA Today, and multiple podcasts. She shares insights and resources through Linktree, Instagram, Facebook, and LinkedIn, and her academic work includes a featured publication in The Anatomical Record.