One of my favorite axioms of emergency medicine, and medicine in general, is that patients come for our care, not our judgment.
In times when my empathy meter is running particular low, for example during my recent string of overnights, I will actually repeat these words to myself prior to pulling back the curtain. It helps me reframe the encounter and leave whatever personal baggage I may be carrying at the door. (It would likely be a helpful exercise for dealing with my children as well … but that’s a separate blog post.)
Unfortunately, my ritual doesn’t always work. This past week I found myself unknowingly judging a very young pregnant mother of four children. I said to her (in front of one of our senior nurses), that she must really have her hands full with so many young children at home. The patient then informed me that it “wasn’t so bad”, because her oldest child was living with her parents. At which point, I apparently grimaced.
The nurse, an excellent ED nurse and therefore a certifiable Jedi master of interpreting facial expressions, was kind enough to pick up on my response and, in the hallway shortly afterwards, correct my ignorance. She explained to me the Maori custom of “Whāngai” (pronounced “Fahn-guy”), whereupon a child, usually the first born, is raised by someone other than their birth parents, usually a relation and most often the child’s grandparents. The arrangement is designed to strengthen whānau (family) ties and pass down tribal traditions and knowledge. It also serves more practical purposes: alleviating some of the burdens of child rearing from young working parents, and providing both purpose and companionship for the elder members of a family. A child who becomes a whāngai is often described as having ‘been whāngaied’ or ‘whāngaied out’. The child continues to have a strong relationship with mom and dad and his/her siblings, but lives elsewhere. As a result, the whāngai develops a deep lifelong attachment to their grandparents.
It is a tradition that unfortunately is becoming less and less common as Maori society becomes more and more mobile.
I’ve been thinking a lot recently about this custom. As much as I’ve come to appreciate the wonderful benefits of having loving and engaged grandparents both in New York and near our home in Washington D.C., I have a hard time fathoming the idea of shipping my oldest son out as a toddler to live somewhere else! But there exists a real beauty to this tradition that has real world applications here and elsewhere.
The care for our seniors has and will continue to be an enormous issue for our medical systems, both here and in the United States. Too often back home, I see elderly patients who are effectively abandoned by their families, sometimes with frank neglect but just as often by circumstances outside of their control (e.g. patients who survive all of their immediate family members, or whose children all live out of state). These are often the same patients who end up requiring enormous medical resources, receiving both expensive testing and treatments and/or requiring prolonged hospital stays for social reasons. Well intentioned doctors and nurses often find themselves unsure about what to do with these patients in terms of setting limits on costly and often ineffective inpatient care, especially in the case of patients who lack the capacity to understand treatment options (in the case of dementia patients, for example). There is often simply no one to take care of these people at the end of their lives.
The same challenges do exist here in New Zealand; no society is perfect in its care for its senior citizens. Historically the Maori however, like many traditional societies, have been very deliberate in their approach. They pay it forward. I’ve noticed that it is quite common here for grandchildren to accompany their grandparents to the ED (something that I had initially found odd). They are engaged participants in their family member’s care. I suspect the tradition of Whāngai has much to do with this observation.
I do hope my children and future grandchildren find a similar interest in my health when the time comes for me to need assistance.
Happy Thanksgiving from our whānau to yours!