The Doctor in the Family

• Physician's role
• Probability
• Knowledge, attitudes, practice
• Astrocytoma
• Family relations

My nephew died at home this morning.

Sam's mother sat on a soft taupe sofa, holding him in her arms. The May sun streamed through the windows while Sam's father leafed through the mail in a worn armchair nearby. The schoolyard down the street was alive with children's games, including those of Sam's older brother. A brain tumor, now coma, had been blended into the ordinary happenings of daily life for a long time. And then Sam took his final breath.

Sam spent most of his 5 years living a healthy, vibrant life at home with his parents and brother. He dressed as an ice cream cone last Halloween, and as Doc from Snow White and the Seven Dwarfs the year before. He loved his dollhouse, the color yellow, his best friend Lilly, and salty pretzels. But Sam also spent many days in hospitals. He had an astrocytoma, diagnosed when he was 4 months old. Throughout his life, the juxtaposition of apparent health with periods of critical illness obscured the hazy boundary of futility and appropriate medical care. Sam would undergo brain surgery one day and be home swinging in the back yard the next. At 2 years of age, he reported nausea one evening after dinner. Several hours later he became lethargic. His parents rushed him to the hospital, where he had seizures and was posturing on arrival; his parents were told that the end was near. The following day, he awoke asking for his mother. He was discharged from the intensive care unit 3 days later and went home to bake a cake covered …