Guest Commentary

Oct 19, 2021
By Samer Al Hadidi, MD, MS, FACPDr. Samer Al Hadidi
It was the first year of fellowship. I remember it was a rough start. A household with dual trainee physicians in a new city. Two daughters dealing with fears related to a new school. A wife worried about a new job. Multiple hospital systems with five different badges centered on a devastating disease: cancer. 
Patients with cancer are special. They have these extraordinary hearts. They spread hope wherever they go. Listening to them, I learned how to deal with my own difficulties. Simple life issues didn’t matter anymore. I felt blessed and thankful. 
A few months into fellowship, my Crohn’s disease decided to act up. In residency, I was diagnosed with Crohn’s. It was severe. I got it under control with a biologic, and I managed to not be admitted to the hospital. It taught me how to appreciate patients’ symptoms better. Being a patient is a special experience. You cannot learn this anywhere else. The medications worked. I felt blessed and thankful. 
Around Thanksgiving, during my first year of fellowship, I was admitted to the hospital for the first time. I had plans with family and friends. It was rare that my wife and I managed to get a holiday off together. A perfect plan that didn’t work. I spent a few days in the hospital. I lost 30 pounds in less than a month. I had to buy new clothes to fit my new body. I cancelled my plans to go to my first fellowship conference. However, I was able to go back to work after a few days. It was a hematology service. I saw many patients with hematologic malignancies. I was called after hours several times. I diagnosed some life-threatening conditions when called. Patients were strong and dealing with diseases that were way more devastating than mine. They taught me hope. I felt blessed and thankful.
My first vacation was in March. God, I was looking forward to some time off. My daughters and my wife were excited, too. We went to Jordan. My parents lived there. I missed them. It was the spring, a beautiful time for a 2-week vacation. We thought this would help in forgoing the earlier difficulties we encountered at the start of the year. We had a great 5 days until the morning of March 28, 2019. 
A day before that, I spent some time with a few friends. They shared their life challenges, limited job opportunities, and training difficulties. They were not happy. Many were trying to find jobs abroad. We had dinner together. I left to go home late in the night. My mother and father were sleeping. I adjusted their blanket. I felt blessed and thankful. 
I woke up the following morning on Thursday. My father usually leaves for work early. I found him lying down on the couch. I said good morning. He didn’t respond. That was unusual. I walked close to him. He was covering part of his face. I initially thought that he was having a nap, but that seemed unusual for him. I uncovered his face. He was able to move one eye. His mouth was deviated. He had facial palsy. I didn’t understand what he was saying. I ran to my mother. I asked her about the last time she interacted with him. She said that she saw him less than 20 minutes ago and they talked about their plans for the day. She thought he was leaving to work. He was normal. We called the ambulance. I checked his ability to move. He was only moving one side and was aphasic. I checked his vitals. I thought about giving him some aspirin, but he was not able to swallow. 
When the paramedics arrived, they got him into a wheelchair. I reassured them that he was okay 20 minutes ago. I told them to take him to a nearby hospital. He was having a stroke, and it seemed ischemic. He had a remote history of coronary artery disease. At that time he didn’t complain. In my mind I was not sure if he was really okay, or if he was hiding something.  We took his insurance papers and all the cash we had handy. Private hospitals in Jordan refuse to care for patients without a down payment. Medical insurance does not guarantee care. Having an acute condition does not necessarily mean treatment. We followed the ambulance. I have no idea how I was able to drive. In my mind I started thinking that he may be disabled. He may not be able to walk. He may not be able to speak. I cried. I didn’t know any better. 
I thought of the 20 minutes. It was a short period of time. Even if it was an ischemic stroke, we were within the window to try to do something. We rushed to the hospital. They refused to accept his insurance. We paid them cash. They ran the imaging. There was no bleeding. A neurologist came. He suggested that we do a thrombolytic and a study to look at the arteries of his brain. My dad got a thrombolytic. He then went to the procedure room. He had a clot in one of his major arteries. They took care of it. The intra-procedural images looked good. He was transferred to the intensive care unit for recovery. I felt a touch of hope. I told my mother and sister that the procedure went well and we should wait for him to wake up. I felt lucky that I woke up early to see him and rushed him to the hospital in time. I briefly felt that my dad’s decision to support me in going to medical school was worth it. I waited for him to wake up. He didn’t.
We got him to the radiology unit. I was in the technician room. The scan showed an intracranial hemorrhage. It was in this moment that I wished I had never gotten into medicine, or even understood any of this. My hope drowned. He was unresponsive. He had a seizure. He was back in the intensive care unit. His heart stopped. He was a full code. Nobody was expecting anything bad to happen. They approached me on what should they do. I knew this wouldn’t have a good outcome. I knew that he always wanted to be functional if he was alive. I cried. I didn’t know any better.
It was less than 12 hours. The whole thing. It was not fair. I was not prepared. My mother was not prepared. My sister was not prepared. He was okay. He loved our children and was happy that he saw our daughters. He didn’t show any sign that he would get sick. My brother was abroad. He was not able to see him before he died. It was not fair. I cried. I didn’t know any better.
Not knowing is a blessing. Hope is an advantage. I carried the burden of knowing. I suffered the lack of hope. I knew the stroke, the disability, the brain bleeding, and the cardiac arrest. Physicians carry the encumbrance of knowledge. It is painful to know that there is no chance of hope.
I finished my first year of fellowship. I am done with training. I started a job. None of this was possible without my family’s support. I still remember my father every day. I cry when I do, and I always will. I cannot do any better.
Dr. Al Hadidi is an assistant professor in the Section of Myeloma at the Department of Hematology and Oncology at University of Arkansas for Medical Sciences, and a member of the ASCO Trainee and Early Career Advisory Group. His research interests include areas related to plasma cell dyscrasias, with a focus on drug development, health equity, and medical education. Follow Dr. Al Hadidi on Twitter @HadidiSamerDisclosure.


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