Right Brain: Questions

Back when I was living in Singapore, my family hosted an annual Lunar New Year party every Spring. On that day, friends and relatives would pack into our modest, three-bedroom apartment, fold pieces of circular dough over dollops of meat, trade red envelopes stuffed with money, and slurp pieces of shrimp and napa cabbage out of a steaming pot. After I left for North America, I made a new tradition of video calling my relatives on the evening of New Year's Day. Year by year, they watched as I grew, matured, and took on new identities: from acne-riddled teenager to young adult, from undifferentiated high schooler to college graduate and, in a couple months, from medical student to the first doctor in my extended family. That was when my conundrum arose.

It started with a seemingly innocuous question, asked by my aunt during our Lunar New Year catch-up call.

“Lele,” she said, referring to me by my childhood pet name, which means “happiness,” “I want to ask you about this herb your grandpa is eating. It's some sort of sea product.”

Apparently, as a graduating medical student and future neurologist, I was expected to know all things in medicine, with some zoology and botany thrown in as well.

“What is it called?” I asked.

Even as I asked this, I could hear my 2 personas arguing. The Chinese nephew in me posited that my aunt probably had cultural expectations that my training would benefit the family somehow—in the rural part of China where she grew up, a doctor in the family is equivalent to a doctor for the family—but my American-trained professional persona protested. After all, most ethics papers and professional societies discourage giving medical advice to family members because there is no way for the provider to maintain complete objectivity.

“海参,” she said, meaning “ocean ginseng.” The words themselves evoked images of a pensive, wispy root much like ginseng, its terrestrial sibling. Much to my surprise, after typing the Chinese characters into the Google search bar and hitting Enter, my screen filled with images of a black slug-like creature with a gelatinous coat. A few images showed the slimy body lounging on the seabed. Others showed it cupped by hands as though being caressed. One depicted it in a dish with goji berries and a mint leaf. 海参, otherwise known as the sea cucumber, noted one caption.

I stared at it for a full minute as my aunt stared at me through my screen, awaiting my response. In Chinese folklore, eating something that looks like an organ is considered beneficial for that organ. Walnuts are good for the brain, for example, purportedly boosting cognitive function.

So I wondered: Why was my grandfather eating this flaccid thing?

Maybe that is irrelevant, I thought. After all, I appreciated the desire to ingest the odd herb or sea creature every now and then, having grown up in a Chinese household very much in touch with its cultural roots. I have eaten bird's nest (swiftlet saliva), hasma (frog fallopian tubes), and snake gallbladder. On the other hand, after spending the past 5 years learning the potential harms of unstudied medicines and watching medical providers scoff at the patients who take them, I felt reluctant to give my aunt any advice that was not scientifically sound.

A quick search on PubMed revealed several articles claiming that sea cucumber extracts had antioncogenic properties. Never mind that these studies were performed on cell lines and animal models, which do not necessarily translate into clinical results. If I told my aunt that, all she would hear was “it prevents cancer,” and soon my entire extended family would be munching on sea cucumbers as tea snacks.

“What did you find out?” asked my aunt, impatiently.

“Seems like this thing has a good amount of protein and some vitamin A, calcium, and iron,” I said, referring to a dubious page on Nutritional Facts of the Sea Cucumber, something I have told patients not to do. “Chinese herbs really aren't my specialty. I probably know about them less than you do.”

There, I did it, I thought. I have walked the tightrope between my filial duties and my professional ones, and all I lost was some respect from my aunt.

Sensing her disappointment at my lackluster answer, I changed the topic.

“How's uncle doing?”

“He's doing alright, all things considered. Hey, you are going into neurology, right? What is that, like, treating crazy people?”

“You're thinking of psychiatry. Neurology deals with strokes and seizures and stuff.”

“That's great! Listen, your uncle was diagnosed with epilepsy 6 years ago, and he stopped his seizure meds a while back. He has not had a seizure since. Do you think he still needs the meds?”

In that moment, I realized that my aunt, who helped raise me and feed me, was treating me like an authority figure, a source of knowledge and assurance. Unlike with the sea cucumber question, I could no longer use “this is not my specialty” as an excuse. I wanted to say that even if I were a fully trained neurologist, I did not know my uncle's full history and that most of my knowledge came from clinical studies and trials based largely outside of China with limited Chinese patient recruitment, so the results may not even apply. Would she understand that? Or would she just see an unfilial nephew, ungrateful to the ones who helped raise him?

“He should follow-up with his neurologist,” I said, using an answer I would pick on a licensing examination.

In this real-life case, however, my relatively innocuous advice had serious implications. The nearest reputable neurologist was in the city, 250 miles from the relatively rural area where they lived. A simple “follow-up” would mean a weekend trip, at least, which meant lost wages for both my aunt and her husband. At the risk of betraying too much professional hubris, I, a doctor-in-training, may be the best source of information they had.

There I was, caught between my aunt cast virtually on a screen and my cozy New Haven apartment, between my duties as a soon-to-be physician and my duties as a member of a Chinese family. I imagined this must be how sea cucumbers feel, torn between their identities as marine animals, underwater vegetables, and Chinese herbal supplements. After all, in that moment, who was I: a student or a health care provider? A professional or a nephew? I sat at the center of an identity tug-of-war. What was I to do?

That same Lunar New Year evening, tired of COVID-19 and missing my family, I experimented with making dumplings on my own. Carefully, I folded pieces of circular dough over dollops of chopped vegetables held together by shiitake mushroom. I replayed the conversation with my aunt in my mind. Did I say the right things? Have I offended them? Did I commit any ethical breaches?

Just then, my phone buzzed. My aunt had sent me a message: “Grandpa getting check-up soon. Will see if sea cucumbers help him or not. Also, your uncle and I are making a trip to see a neurologist, just to be safe. Just needed to hear it from you. Love you.”

I placed my phone aside and returned to my dumplings, feeling a sense of wholeness as I squeezed each piece of dough into a neat little packet of ingredients, transforming the disparate parts into a cohesive whole, as though I, too, was being packed into something complete.

Appendix Authors

• © 2021 American Academy of Neurology