Learning from loss: Her brother's death changed how this doctor treats patients

When Vivian Tam's older brother Stanley was diagnosed with cancer, she wanted to be his person — the one who would help him navigate the disease and the healthcare system.

Although she accompanied him to medical appointments and stayed by his side in the hospital, the young medical student found she was actually quite helpless.

"As a medical student you know enough to worry, but not enough to know anything to do with the actual disease," Tam recalled to White Coat, Black Art host Dr. Brian Goldman.

Instead, Tam came to realize that that Stanley, who died in 2016 of Burkitt's Lymphoma, would be the one guiding her as she worked towards her medical degree.  

The classroom versus the hospital room

Stanley Tam was driven and smart; he loved to play hockey and was on his way to earning his Chartered Professional Accountant designation. He died in January, 2016, from Burkitt's Lymphoma. (Submitted by Vivian Tam)

At the time of Stanley's diagnosis, Tam was attending medical school at McMaster University, and was learning to practice patient-centered medicine and to be an empathetic caregiver.

What she was seeing first-hand in her brother's case often contradicted that. 

"Healthcare can be a de-humanizing experience especially when we put patients in gowns and summarize them as one-liners…'the 40-year-old with chest pain,' or 'the 80-year-old with bowel disease'. I think Stanley often felt he was a one-liner for his clinicians who were seeing him," Tam said, adding that the doctors were often rushed.  

He felt like he was the twenty-four-year-old with cancer when really he was so much more than that.- Vivian Tam

"He felt like he was the twenty-four-year-old with cancer when really he was so much more than that."

Tam, now a first-year medical resident, wanted to tell the doctors about Stanley, the rabid hockey fan who loved to play at his local rink. Or Stanley the chartered accountant, who was so intent on earning his Chartered Professional Accountant designation that he studied while he was in hospital and earned a diploma that was delivered to his bedside.

Lessons in what not to do 

Tam's own feelings about how she wanted to practice medicine were shaped by the last days of Stanley's life. One moment in particular stands out for her.

A specialist came to the room and told them matter-of-factly that Stanley's blood work and vital signs pointed to the fact that death was imminent.

"And that was the last that we had heard from him," she recalled.

The oncologist's professional detachment left Tam, who wrote about the experience in a piece for the Globe and Mail, feeling deserted and alone.

Vivian Tam was only a couple years younger than her brother Stanley, and the two had a close relationship growing up. (Submitted by Vivian Tam)

"It would have been really special for us to know that our oncologist was thinking of us throughout the day or wanted to visit just to make sure that we were coping with everything. There was barely any conversation about what his death might mean for us or how to approach these final few hours or days with him," Tam said.

That memory shaped the way she delivered bad news to a patient the first time she was presented with the challenge, just a month after Stanley died.

Putting empathy into practice

While working in the emergency room, Tam was tasked with telling an elderly patient that she had a mass in her ovaries, which was most likely terminal ovarian cancer.  

"It was really difficult. And prior to going in I had tried to gather as much information as I could to learn about ovarian cancer."

Armed with information, Tam found the elderly mother and her daughter waiting in a small area protected from the bustle of the emergency room by just a thin curtain.

The moment she saw them, she realized that they weren't looking for a download of scientific facts, but a simple human connection.

Vivian Tam is a first-year medical resident at Mount Sinai hospital in Toronto. (Submitted by Vivian Tam)

"They needed someone to understand that they were just thrown a curve ball — that they were undergoing something that was so overwhelming and receiving this diagnosis that was going to change their lives."

After the news was delivered, Tam, the patient and her daughter broke down, cried and hugged.

The most important thing she could do, she realized, was "just be with them in that moment."

Tam focused on her brother to get through that difficult exchange.

"I knew how he would have wanted me to act in that situation, and I was also thinking consciously about what he would have wanted if he had been the one on that side of the hospital bed."  

Tam says her goal as a doctor, with guidance from her late brother, is to always treat patients as if they are a 'whole person' and not a 'one-liner.'