The Seesaw

Aakash Shah
4 min readApr 4, 2023

Two days before my Indian engagement, I found out my paternal grandfather was hospitalized in India. As the rest of the day unfolded, various family members at the bedside sent a myriad of texts and pictures of the various diagnostics and therapeutics being gathered. Slowly the puzzle pieces began to reveal themselves. It started with shortness of breath which then transformed into ‘acute myocardial infarction’ (aka a heart attack) along with radiographic evidence of a lobar pneumonia. Twelve hours later as I was getting ready to go to the airport my family and I were informed that he had COVID pneumonia along with but not limited to hyponatremia (low sodium), acute kidney injury (on baseline chronic kidney disease), anemia (low red blood cell count), elevated inflammatory markers, etc. Moreover, because he had an active COVID infection, he had to be transferred to a tertiary care hospital. We were 8000 miles away trying to prognosticate the situation.

Lots of medical jargon, lots of traveling, and a lot of uncertainty. When my dad picked me up from the airport he asks me as series of questions in the format — “Aaku, what is ___?” What is a pneumonia? What is an acute myocardial infarction? What is kidney injury? The real question he was asking was really — are things going to be okay?

It’s one thing to explain basic medical conditions to patients, who are usually strangers where physicians typically are in the position of power. The situation becomes infinitely more convoluted when that ‘patient’ is your own parent. The parent who used to teach me algebra, is now the one I’m explaining lung physiology to.

The father-son dynamic has evolved as I have matured (especially now that I’m a competent physician) and there are at times where my father now treats me as his equal (one of the many laudable qualities that I love about my dad). But this was the first time where the roles were completely reversed. As he asked me the questions I listed above, I could feel the seesaw of the relationship swaying which crescendoed when he asked, “What would you do?” All this the night before my engagement.

How many Indian (or immigrant) fathers have the trust and vulnerability to ask this question to their child? Here we are sitting at the kitchen table in the same seats we have sat in for the past two decades where he used to admonish me for not studying hard enough for the college entrance standardized exams to now me trying to explain how covid pneumonia can lead to a type II non-ST elevated myocardial infarction that reversibly damaged my grandfather’s already suboptimal kidneys from an optimistic lens. The seesaw had tilted in the complete opposite direction.

At the same table I faced my own academic mortality, my dad and I were now discussing actual mortality. I was deferring telling my dad exactly what he should do, instead choosing to educate so that he could make his own informed decision.

On the morning of my engagement, I sensed that my parents sought more from me. As I finish this stage of my medical training (and now am fully licensed in Texas!!), I have realized the power of being decisive. Portraying confidence has the power to construct a relationship of trust and foster a positive relationship. I told my dad that if I were him, I would go. Now I know my dad doesn’t need my permission, but with the relationship seesaw tilting into uncharted air, I appreciated that this act of decisiveness was an act rooted in love and trust.

So at 4:30AM, the morning of my engagement, my dad booked a one way flight to face his own father’s mortality.

The entire rest of the day for my family was spent in the presence of our loved ones and I could feel the familial love as I entered this next phase of life with Nithya.

I wrote the first draft of this manuscript on an airplane flying to my ‘new’ home while my father was on a flight to his childhood home. I couldn’t help but think of the parallelism of this weekend. As my relationship with Nithya formally changed, my relationship with my father (and mother) has informally changed simultaneously.

Through the vehicle of my medical knowledge, I have been blessed with privilege of having meaningful conversations. However, with this privilege comes a great responsibility of seeing my parents, family, and friends in their most vulnerable states. It’s one thing to see a patient cry, it’s completely different when it’s your mom and dad. My parents still try to shield me from the hardships of life. Now it’s my turn to try and do the same for them. The seesaw can finally be in balance.

Acknowledgements:

Thank you to everyone (family, friends, teachers, colleagues, supporters, etc) for making me the person I am today. If you managed to read all the way to the end, know that I’m still a work in progress and forever grateful for your support. The journey is just beginning…

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