Elective Procedure
Synopsis
Illustration by Ashley Floréal
Medical student Pablo Romano tells the story of losing his mother to complications of surgery, and how he continues her legacy as a medical student.
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Storyteller
Pablo Romano is a fourth-year medical student at Stanford University School of Medicine interested in psychiatry and palliative care. He was the 2019 honorable mention of the Irvin David Yalom, MD Literary Award for an essay exploring themes of death and education. At Stanford, Pablo created a recurring storytelling series called Talk Rx, where students at the medical school are given speaker coaching and a platform to tell their stories, live and in front of an audience of peers.
Credits
Hosted by Emily Silverman.
Produced by Emily Silverman and Jon Oliver.
Edited and mixed by Jon Oliver.
Original theme music by Yosef Munro. Additional music by Blue Dot Sessions.
Illustrations by Ashley Floréal.
Story coached by Roshan Branston and performed at The Nocturnists’ “Mistakes” live show at Brava Theater Center, San Francisco in March 2019.
Emily’s interview with Pablo was recorded at Women’s Audio Mission, San Francisco, November 2021.
The Nocturnists is made possible by the California Medical Association and people like you who have donated through our website and Patreon page.
This episode of The Nocturnists is sponsored by Chartnote.
Transcript
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The Nocturnists: Stories from the World of Medicine
Season 4 Episode 5: "Elective Procedure"
Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
This is The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today I speak with Pablo Romano. Pablo is a fourth year medical student at Stanford University interested in psychiatry and palliative care. He grew up between the suburbs of Los Angeles and Guadalajara, Mexico, and studied cognitive science at Occidental College. At Stanford, Pablo created a recurring storytelling series called Talk RX, where medical students are given speaker coaching and a platform to tell their stories in front of an audience of peers. But before we speak with Pablo, we hear the story of how he lost his mother to medical complications after an elective procedure and how that affects his worldview as a medical student. It's a story he told at The Nocturnists live show on the theme of “Mistakes” in March of 2019. Here's Pablo.
Pablo Romano
My college experience started out on a rough note. I went to college in LA about 40 minutes from where I went to high school, and after spending my first night sleeping in a room with total strangers, I got a call to come home because my dad was headed to the hospital. They called an ambulance and I was supposed to meet them there. When I got there, a nurse pulled me aside and told me he died. I remember the fluorescent lights glistening off linoleum floors, and all I could think was that I didn't get there in time. He had a heart attack. He was 50 years old. I was 18.
Fast forward two years, and I'm wrapping up my sophomore year of college. I'm at home with my mom and my brother when my mom brings up the idea of having surgery. She wanted to lose weight, she said. My brother and I were kind of ambivalent about the surgery, but my mom had tried every diet and every workout program out there, and we didn't know what bariatric surgery was about. So she explained to us what it looked like and where she'd get it done and asked, "Do you think this is a good idea?" "Of course," I agreed. My brother did too.
You see, my mom was an OBGYN in Mexico before she moved to the United States. She told me once that her record was 13 babies in one night. And so she knew the risk of surgery and we trusted her, we always had. My mom moved to this country so that I might have a better life. She sacrificed her career and her family for safety and a better opportunity. And so she did some research and she went to the best hospital in LA, and she went with a surgeon who had a great reputation. And she had the surgery.
That was mistake number one.
Her recovery was slow and hard. She was having a hard time keeping liquids down, including her beloved Coke Zero. You see, ordinarily my mom was sharp and bright. She swore like a sailor and she spoke a million miles an hour, but she was in pain and she wasn't doing well, so we went back to the doctors. And we are in an exam room when a tall man in scrubs in a white coat walks in—a beacon of hope and confidence. And I tell him, "Hey, my mom recently had a sleeve gastrectomy and she's in pain." He nods and he listens and he says, "Let's get her some IV fluids to make sure she's not dehydrated. This kind of pain is normal for somebody who recently had a bariatric procedure." And I was relieved when the nurse came in and hung a bag to my mom's IV. I felt like I had done my job. The doctor said this was normal. And we trusted him.
That was mistake number two.
Some days passed, and I'm headed home from my summer research job, ever the pre-med. My brother and I had been taking turns taking care of my mom, and when I get to the house she's lying on the couch. She's got this baby blue two-set pajamas on, and I sit on the couch next to her. And even though she's not feeling well, the medication is helping, and I'm looking forward to being home, to spending some time with her. Every time I went home, she'd spoil me with home-cooked food, and we'd have these great conversations. See, my mom had this policy where she wouldn't lie to me if I asked her a direct question. And so we had conversations about work and school and relationships in a way that felt raw and candid.
After some time, she got up to take a shower, and I started flipping through the channels. A few moments later, I heard a loud bang from the shower. And so I run over and I knock on the door. No reply. I knock harder and still no reply.
So I opened the door, and I see that she fell, and the shower curtain's been pulled from its rods. So I run in and I grabbed the towel next to me and I cover her, and I ask "Are you all right?" "Yeah, I'm okay." "Que paso?" "No sé. Me caí." And then she started mumbling things that didn't make sense to me and I was terrified.
I called my uncle and I called my brother and we decided that the best thing to do was to call 911. Better safe than sorry, we thought.
"Everything is gonna be okay, Mom, I'm right here. You fell in the shower, but it's gonna be all right. I'm right here. Okay." "Gracias," she said.
An ambulance arrived and painted my neighborhood in blue and red. They put my mom on a stretcher, and they were headed towards the same ER where my dad died. I didn't want to go, but my uncle and I chased that ambulance as it made its way across town.
When we got to the hospital, the doors burst open and my mom comes out on a stretcher. Only one of the EMTs is on the bed with her doing CPR. "Fuck," I thought. The double doors of the emergency room slide open and I can see the same linoleum floors and fluorescent lights. My uncle and I sit in the waiting room and we wait. We wait for my brother to arrive. We wait for the doctor to give us news. We wait for hope.
Eventually, the doctor comes and says to me that they were able to get her heart beating again and that they have her on medications to control her heart rate and her blood pressure. He said they did some imaging and that she appeared to have a ruptured small intestine. He said that when they did the imaging, they also saw what he called dark spots in her brain, and that she might not make it out. And that if she did make it out, she might not be the same person she was before.
They moved us to a room labeled "Quiet." And it seemed clear to me that this is where they sent the families of patients who died. There were plastic plants and funeral brochures and plastic stands. Eventually, they moved her to the ICU and we all breathed a sigh of relief. It felt like progress. I still thought she was going to get better.
After the nurses and the doctors all had a chance to get familiar with her case they let us into the room. And I saw my mom and she had two IVs coming off her arms and she was intubated. And they had her bed such that her head was below her feet, and she looked uncomfortable. I felt a knot grow in my throat. I was scared that she was going to die. I was scared she wouldn't see me graduate and she wouldn't see me go to medical school. She wouldn't see me become a doctor. I was scared she wouldn't see me get married and have kids and help me teach them Spanish the way she taught me.
And this wasn't just about losing my mom. This was round two. This was the same hospital where my dad died. I was aware all of a sudden that I might very well become an orphan that day. And then all of a sudden a light went off above my mom's door and everything happened at once. A dozen people rushed in, someone started shouting orders, and someone started doing compressions again. CPR.
After a few minutes, a doctor comes to me and says, "We can do compressions for as long as you like, but there are no other interventions we can do. This is it." Perhaps it was the normal temperature of the hospital, but I felt so cold in that moment. I felt my body grow weak and numb. And it felt like I was in shock. My mind couldn't grasp what my body was already beginning to process.
As they were doing compressions, my uncle frantically called for a priest to come and absolve my mom of her sins. I come from a Catholic family and even though my mom hadn't been to church since my dad's funeral, it felt right that someone was looking out for her eternal soul. I was standing by the nurses' station and I could feel the eyes of every person in the room on me and on my brother. I was leaning on the counter, and my brother was standing next to me weeping silent tears, shaking his head, pounding his fists on the same counter that was keeping me from falling apart.
She died that day. I was 20 and my brother was 21.
And now I'm in medical school. And I see things a little differently. Recently, I had my first shift at the emergency department at Stanford. As second-year medical students, we're offered the opportunity to place IVs and ECGs. A friend of mine astutely summarized these shifts as an exercise in staying out of the way.
As my first shift was coming to an end, a call came in that a patient was being brought in, and he was undergoing CPR. I was in the room and the nurse asked if I wanted to help. This was my first time doing CPR on a real person and not a plastic mannequin. His chest felt different. There was no metallic click to let you know that your compressions were deep enough. I was amazed at the amount of force it required.
For 20 minutes, we tried to revive this patient, and we coudn't. And then his daughter walked in and I wasn't ready for that.
All those mistakes, the surgery, the first trip to the doctors. Those mistakes have haunted me for years. But now I'm on the other side, and I'm not sure that they were mistakes. The decision to have surgery may not have been a mistake after all. Don't get me wrong, I wish for anything that she were here. But I think having the surgery was a way for my mom to take control of her life. The way she always did. She divorced my dad when his drinking became a problem. She sued Toyota and won when they sold her a bad car. She bought a house in this country that often crushes immigrants, and she raised two kids to be strong and sensitive and driven. My mom was courageous and fearless, and she saw this as a way to move forward. And it went horribly, painfully wrong.
This is not a common outcome for that procedure. The first trip to the hospital though—the doctors, where they gave her IV fluids and pain medications—that one's a little harder to reconcile. See, I'm still learning how to be a doctor, but I can't help but feel that maybe that doctor didn't take us seriously. I don't remember his name, and I don't remember his face, but I feel like he dismissed us. And maybe he dismissed her pain because she was a woman, or maybe he dismissed her pain because her English wasn't perfect. Maybe he dismissed her pain because she was overweight and had an elective procedure. Or maybe he dismissed her pain because he was tired and overworked and busy. But he sent us home.
In my eyes, medicine can be a force for healing. It can be a way to start a new chapter, embrace a new path, and to end suffering. But it's also flawed. And it's riddled with mistakes. I've spent years of my life agonizing, whether these moments were mistakes or not. And I'm not convinced that it matters. I think what really matters is what we learned from these experiences. And I'm still learning from mine. Thank you.
Emily Silverman
I am sitting here with Pablo Romano. Pablo, thanks for coming in today.
Pablo Romano
Thanks for having me.
Emily Silverman
So, we were just talking about how you told this story in March of 2019, which was quite a while ago. Very much in the pre-COVID era. So how have you been since then?
Pablo Romano
Yeah, it's been a really long time. It feels like I've lived a whole lifetime since then. Just after telling that story, I took a year to work on a creative writing project between the second and third year of med school. And so now I have this really long word document that I tinker with occasionally and hopefully one day will become a book. And I've completed essentially most of medical school since then. I did my third and most of my fourth year rotations, and I'm now in the process of applying to residency and will hopefully be a psychiatrist in the coming months.
It's funny, I listened to that story on my drive over here. I hadn't heard it since I shared it with you and I really haven't visited the Word document that I have of it since then. And a lot remains true, but also my perspective on it has changed. I think when I shared that story, I was really angry with the resident when we went to the emergency room a few days before she passed. As a second year med student, I was like, "Should we have done imaging? Like should we have done something?" I don't know. It felt like there was something that should have been done there. What's interesting is about a year ago, I got her medical records from the hospital. As I started kind of working through rotations and learning how to write notes and thinking about what that might look like, I was like, "I wonder what my own parents medical records look like." And so I went through this whole lengthy process and I finally got them. And her vitals were totally normal. Everything looked very normal, like I felt a lot kinder towards that physician.
Emily Silverman
We learned in the story that your mom is a physician herself. That you had a really beautiful relationship. So talk to us a little bit about her.
Pablo Romano
Yeah. Man, I miss her so much. My mom was really a remarkable person. She was training to be an OBGYN in Mexico. She was, I think, a few months shy of completing her residency when she decided to move to the United States. One of the really unfortunate things about the fact that they've passed—both of my parents—is that a lot of the story I've kind of had to piece from things that I remember from my childhood and then conversations I've had with family and things like that. After my first year of med school, I actually went to Mexico with the explicit purpose of interviewing my family, and I bought this like nice recorder, and I like made a whole show of it. Because I really wanted to understand the story of how she gave up her career as a physician. The longer that I'm in medicine, the more I'm like, "Oh, well, it's a big ask." Like, it's hard to do, right? It's hard to imagine myself giving it up. My parents fell in love when they were in high school, and they had this really kind of storybook romance. I think my dad was like the classic "Bad Boy" kind of guy, like he had a really nice car, and like ditched class and smoked cigarettes and the whole thing. And my mom was like, the classic straight-A student who like never even missed an assignment, let alone miss class. And they fell in love and got married right away. And my mom went to medical school. And the story, as far as I understand it, is that my mom wanted to have kids, but they had a hard time conceiving, and then they got pregnant with my brother, who's about a year older than I am. And I think that they were really already on the rocks. You know, I think that was a really big blessing for her. But it kind of complicated the idea of getting divorced.
She had this really very honest relationship with us. I remember I was in high school when she told me that she had basically just given birth to my brother, and she had already conceived of this idea that like, perhaps that relationship wasn't gonna work. She described my dad as a really excellent father, but as an awful husband, which I think is probably a fitting description. And so one day, her word was she "seduced" him. And afterwards, she said to him, "You've just conceived your second child," which was me. And she told me a story when I was in high school, which was like, I just remember being like, "Why are you telling me this? Like, I don't want to know this." But all of that is to say that my parents had kind of a complicated relationship. But yeah, she moved to the US with my dad, and then divorced. I think the most unfortunate part of all that is that you here you have this single mom who speaks some English, but certainly is not the most proficient in the world, and has two kids. And we're like a handful at that. And she was never able to practice medicine again. So I think it's particularly meaningful for me now as I'm coming to the end of medical school and getting ready to graduate and getting ready to practice medicine.
Emily Silverman
Earlier, you mentioned that one of the more difficult pieces of the story to reckon with is this decision to have bariatric surgery. How do you think about that?
Pablo Romano
I have a really hard time with it. I think it was a really brave thing that she did. I think she really wanted to take control of her life again. Here you have a single mom who really sacrificed a ton for her kids, and finally, we were kind of on our own. And when she brought up the idea of surgery, we were kind of, the three of us—me and her and my brother—were having conversations about what her life would look like now that we had both left home. And my brother and I kind of considered whether she would want to go back to school, and we're thinking we could encourage her to do that. We also thought "She's 50 and like, young, and could very easily find a partner and have a whole new chapter of her life that could be very meaningful and really exciting." I think weight is something that she had struggled with for much of her life. Certainly, I think after having kids and, you know, thinking of my grandmother and like I can kind of hear her voice. I don't know that she was the kindest all the time in terms of how one might look. And so I can definitely understand why she felt the way that she did. It just breaks my heart that these days, at least the way that I conceive of beauty and the way that I conceive of bodies is very different than it was then. And I think it's different than the way that she conceived of them at that time. And it's heartbreaking because it was an elective procedure. It's one of those things that didn't have to happen.
In the moment, it was very easy to tie the two together—surgery and then the death. I think she had surgery on the 13th of June. My birthday is the 15th of June. And she passed on the 25th of June. So it was all a very short amount of time where a lot of these things were happening. But, you know, I think my grandmother has a blood clotting thing. And so what I'm wondering was the things that happened to my mom, were they related to a blood clotting issue? Were they related to the surgery? Surgery is a hypercoagulable state. I mean, like, I don't know, my mind starts to spin. At the end of the day, I think it's all just kind of a defense mechanism. Like really what happens is she's gone. And whether or not it needed to have happened or it could have been prevented, she is gone. And that's hard.
Initially, grief for me was a very self-centered thing. I was 20. I was a kid. But it was very self centered. It was like, "I miss her. And she's not here for me, and I'm suffering, and I'm sad." And a lot of "I" sentences. And as I've gotten older, I think there's a bit more nuance to that. The way that it affects relationships. The way that it affects my education, my worldview, but also, and I think more importantly, you start to grieve the things that they may not get to experience. I think the first time that I felt that really acutely was when I graduated college. Similarly, at white coat, and match day is just around the corner. And I think it's one of those other milestones, at least for those of us training to be a physician, where the joy is really theirs. I mean, it's a big accomplishment on our part, but nobody gets here on their own. Like we all got here, because we had tons of support from tons of people. Maybe I shouldn't say we all got here, but at least I got here with a lot of support from both of my parents. And it feels like a moment that belongs to them. I try to keep them around by telling stories and like letting people into my world. It's a big part of my identity, and in previous chapters of my life, I was very private and very secret about these big losses and this big part of my identity. And now I'm the opposite. I talk about it all the time.
Emily Silverman
You mentioned how one of the ways that you keep them around and keep the memory alive is through storytelling. And so I'm wondering, telling this story on stage at The Nocturnists, what was that like for you? I know that a lot of your friends and colleagues were in the audience because I saw them, and I saw the love surrounding you. So I'm wondering, did they already know the story? Was that their first exposure to the story? Was there something different about telling the story in a way that was so public? What kind of response did you get?
Pablo Romano
Well, the whole experience was terrifying. I mean, I felt really well supported. And I have a lot of people in my corner, and a lot of help from Roshan who helped edit the essay and helped me put the story together. But yeah, standing on stage was, woah, that was very hard. I'm trying to think if I've ever felt quite so nervous in my life, and nothing else really comes to mind. I think a lot of people in the audience, at least the people that came from my corner, knew the story in broad strokes. I don't know that everybody had as much familiarity with the fact that she had surgery or some of the more intimate details of the story maybe we're not as familiar to some friends there. But yeah, I felt really lucky to have a lot of people there. My brother came from LA and that was really lovely. I'm glad he was able to hear it. It's funny, immediately after he's like, "Yours was good, but it wasn't my favorite." And I was like, "Cool. Cool, thanks, man."
Emily Silverman
Thanks, brother!
Pablo Romano
Yeah, thanks. But no, I felt really lucky. The response from folks I didn't know was also quite positive. Yeah, I found that every time I tell this story in some way or another, inevitably somebody will come up to me and share their story of loss and their story of grief. And I think that that's really the beauty and the magic of storytelling. It's something that brings us together and creates community where maybe there wasn't one before.
Emily Silverman
Do you feel like this life story shaped your decision to choose psychiatry as a specialty?
Pablo Romano
Hmm. You know, when I did my OBGYN rotation, I like felt really drawn to become an OBGYN. And if anything, I think I had to like fight to like become a psychiatrist. I had to like really reflect and say, "What are my reasons for choosing the career path that I'm interested in choosing?" I just thought it'd be so poetic to become an OBGYN, right? Like, how cool would that be? And I love delivering babies. That was probably my favorite part of med school. Don't tell the psychiatry folks that. But I don't see myself as a surgeon. And I think that's a big part of what an OBGYN does. I think in many ways it did shape my desire to become a psychiatrist. I think having confronted these really big losses at a relatively young age forced me to have conversations that I didn't want to have, or I didn't know how to have both with myself, with family members, with therapists, with friends. I mean, it really is an exercise in how do we communicate with one another. And I think that at the heart of psychiatry is communication, and that's something that I'm really drawn to. Also, I just think the brain is really cool, and I was like fascinated by the ways in which we use narrative to shape our lives, and I think that a lot of therapy is taking a narrative and helping somebody reframe it or understand it in a different way that might just lead to a better life, whatever that might mean for the patient. So in many ways, yes, it did shaped my career, and it did shape my desire to become a psychiatrist, but not without some detours. Yeah.
Emily Silverman
I want to talk about the moment where you and your mom go back to the hospital and you encounter the doctor, which now it sounds like it was a resident.
Pablo Romano
I think it was a resident.
Emily Silverman
It was a resident. And you were expressing concern, and the doctor said, "This kind of pain is normal." And you said, "We trusted him." It's interesting to hear that you got the medical records and saw that there was a lot to be reassured about. But I don't know, I still think about, you know, I was listening to your story this morning. And the words really stood out. "Like I can't help but feel like that doctor didn't take us seriously. I feel like he dismissed us maybe because my mom was a woman or because her English wasn't perfect, or because she was overweight, or maybe because he was tired and overworked and busy." And part of why I bring this up is there have been a lot of conversations about bias in medicine that have been simmering throughout the years, but also resurrected pretty strongly in recent years around things like gender and socioeconomic status and race. And we just had a guest on the podcast, Elinor Cleghorn, who wrote a book called Unwell Women, and it's all about the medical professions' bias against women and not taking their pain seriously, and so on and so forth. That said, you did get the records and things looked okay, so I don't know, I'm wondering, like, how do you step into that tension? How do you hold all that nuance?
Pablo Romano
I think that had he done imaging and if there were something that could have been intervened on, then she might still be here, right? So I mean, none of us are perfect, right? And the medical record is like relatively sparse as emergency medicine notes tend to be. I think there was a sense of, and this is probably true because my mom was an OBGYN, but we really trusted medicine and I saw it as being infallible. I saw it as being this omnipresent, omniscient force that could fix anything. And that's maybe just a product of being really lucky as a child and not really having to confront a lot of medical illness in my own life, or in my family life. We all have biases, and I'm sure that this physician, for better or for worse has biases just the way that I do and the way that you might as well.
It is really hard. There's a lot of tension there. I think, I guess the reason I brought it up was to say only that, one, I feel more empathy for him, because I understand what it is to be really busy. And, frankly, med students, we don't carry that much responsibility, right? So like, I can only imagine what it's like to be a resident or an actual physician where you're really, truly responsible for a patient. I mean, I've been extraordinarily tired at times, but also I go home and know that none of the decisions that I made will ultimately be life or death for a patient in the way that they might be for other providers.
Yeah, it's complicated. I don't know that I remember the details of that encounter as well as I would have liked. That's why I got the medical records, right? 'Cause I was like, I wonder like, what did we say? What was our chief complaint? Was it nausea? Was it pain? Was it just like, this doesn't seem right? I don't remember. I think it's probably some combination of all three, just being like, "Oh, I am out of my depth. I don't know what this is. She is not happy. Let's go to the doctors."
I wish he had done imaging. And it would have been, I think, an easy thing to do. And certainly, I've seen folks get different care for a much lower threshold, so I don't think that it was entirely out of the question. I also don't know entirely that it was a wrong decision. I thought about reaching out to him in the past, because now I know who he is, right. Like I have his name. But I haven't yet. I don't know what I would say to him, right? Or like what the conclusion would be. I do remember, after she passed, I called the surgeon who had operated on her and he's a really nice guy. I remember meeting with him before the surgery and he answered all my questions and really I felt comfortable with him. He was really devastated, I remember on the phone. I really don't think he saw that coming. And I think he knew that she was a single mom and now he's getting a call from a son, so I think he kind of put together the implications of everything that was happening.
Emily Silverman
Right now we're working on a series called Shame in Medicine, and we've heard a lot of stories about shame and error. And this phenomenon, the second victim phenomenon, and how often physicians are super traumatized by bad outcomes. And the fact that you are feeling into your empathy for the medical team, I think is really amazing and admirable, and I think demonstrates how you're able to kind of hold it all at once. And I guess what I'm wondering is, you're a fourth year medical student, so you've been moving through the hospital now for a couple years, and you've done medicine rotations and surgery rotations and OBGYN rotations, in addition to psychiatry. So what is it like being on the other side? Because these moments come up all the time where we're standing around in a circle in the hallway, and it's like, should we do imaging or shouldn't we? And it's like, meh, meh—
Pablo Romano
Yeah, totally.
Emily Silverman
—you know, being a part of those conversations and realizing how impactful those decisions can be. I mean, often they're not, often it doesn't matter. And it's give or take, but, but sometimes it does. And so, what is that experience like for you being on the care team?
Pablo Romano
I think it's been really hard. I like what you said, sometimes it matters. And sometimes it doesn't, right? Because there are so many decisions that could go either way. And it's funny, sometimes I feel like attendings will just let the resident decide, whatever you want. And you're like, okay, like, it feels like there should be a right answer. And there isn't oftentimes the right answer. I think it's actually part of what scares me about emergency medicine in particular, right, is that you make these decisions. And then sometimes you don't really know what happens with the decisions that you made, or the patients.
I think that's why I thought about reaching out to this young resident and talking to him and saying, like, "Hey, I don't know if you remember, you probably don't, you probably saw a bunch of patients at night, but also like this one decision that you made, maybe wasn't the right one, maybe I don't know." But like, maybe it'd be interesting to talk about it. Also, it'd be really painful to talk about it. So I've been like neglecting it on purpose. It's been really hard to be on the other side. It's easy for me as a medical student to advocate for patients, right? And be like, "Ah, we should do the imaging, like why not? Right?" Especially because, one, I don't know that much about medical insurance. And, two, it's not my name on the record, I just get to say what I want. And then somebody else has to own the decision, which is why I think the transition from medical student to intern that I'm about to face is a little scary. But yeah, definitely, I find myself more inclined to be safe than sorry.
It's been really interesting to be on the other side, because you realize how complicated it is, and how difficult some of these decisions are. And I definitely have been very fortunate that most of my care for patients thus far has been free of really obvious mistakes, or free of harrowing things that are difficult to reconcile, like, I've definitely seen a lot of people die in the hospital, but not, fortunately, from like medical mistakes or things of that nature.
Emily Silverman
Talk to me a little bit about you and your brother and moving forward in life. Your parents are gone. Where do you source support, love, community? What uplifts you? Part of why I'm asking is my mom died in June and my dad is almost 80. I don't know how much longer he'll be with us. Hopefully, it will be a long time, but you never know. And so, I might be somebody without parents sometime soon. So yeah, I'm curious how you navigate that. Obviously, you were much younger than I would be. But what is that like? And how do you support yourself?
Pablo Romano
I don't know the situation around your mom. But I know that loss is hard. No matter how you slice it, so I'm thinking of you as you share that with me. I find a lot of support from my brother. We grew up. We're exactly one year and six days apart. He likes to remind me of this. It was a contentious childhood. We did not see eye to eye on literally anything. We would fight all the time, and god, my poor mom. We had like a booger wall. I mean, it was awful. Like it was just tough. It was tough, tough for her. And we just could not get along throughout middle school, throughout high school. I think we're just a little bit too close in age. Like I'm thinking of like guitar strings when you're trying to tune it and like the closer you get the worse it sounds until it's finally okay. I think when my dad died, we saw a little bit of comfort in each other, not as much as you might imagine. But certainly softened a little bit. And then when my mom died, I mean everything had to change. It was really not an option of whether we wanted to or not at that moment. In many ways, it feels like we're a team, and he's my best friend and we talk all the time.
But before I wax too poetic about my brother... I found myself really fortunate to be surrounded with friends and family. My uncle, who's my mom's brother, is my godfather, and we always kind of joke, "Bet you didn't realize what you were signing up for," you know, but like now he's he's the person that I'm closest with and the one that I consider to be really kind of home base. I'm going to his house for Thanksgiving in a couple of days. And, really remarkably, I think within a few months after my mom passed, he moved into a different house that had an extra room for me and my brother, so we had a permanent address. And my stepmom and my stepsisters have been really a big part of my life, too. We've stayed really close. My oldest sister's getting married soon, and I'm going to be one of the groomsmen, so I'm really excited about that.
And I don't know what your experience has been like with recent loss, but I think that the more you are open to people, the more they come to you. And I found a lot of support, sometimes even from strangers or from people that I don't know that well, in ways that are really surprising. And sometimes it's the person at the grocery store who, you know, you strike up a random conversation with and you have a really meaningful interaction with and those kinds of moments can buoy you when you're feeling particularly low. And certainly in medicine, I think I find a lot of support from other people who are going through the same training and the same experiences. And even though you may not have a long history together, I think there's something that really binds you as you kind of go through these things. I found that after loss, there's a whole new kind of community that comes to be, and it never really fully replaces the people that you've lost. And I don't think anyone's ever trying to replace the people that are gone. But I found that a lot of my relationships have blossomed in the absence of my parents.
Emily Silverman
I think that's a beautiful way to end. Is there anything else that you'd like to share with us today, Pablo?
Pablo Romano
I really do feel very humbled and very grateful to be here. And very grateful for the space that you've made for us to tell stories and to be able to have conversations like this one. So thank you, Emily, for all that you've done. I really appreciate it.
Emily Silverman
Thank you. Okay, we have to stop this interview before I start crying.
Pablo Romano
Oh boy.
Emily Silverman
Agh.