There exists a period at the start of July, between Canada Day and Independence Day, where I find myself pausing. It’s a transitional phase that I know well as a professional, a mother, and a dual citizen. Born in Canada and naturalized in the U.S. Over the years, as I have come to fully understand my identity as a parent of a child with intricate health care requirements, I am reminded during this week of dual celebrations of independence of the profound reality of interdependence instead.

This year, I sit with feelings of gratitude, sorrow, and the challenging choices that arise from belonging to two distinct nations and their vastly different health care systems. Today, the burden feels particularly acute, as the future of Medicaid teeters in the tight confines of a divided Congress, shifting between the Senate and House in the United States where I reside and work.

Last year, I received a job offer in Canada.

It would’ve allowed me to be nearer to my family. Closer to the trees, the rocky formations, the gentle force of a glacial landscape that listens rather than shouts. There’s something in that environment that encapsulates a part of myself I yearn for, one that I’ve struggled to find in this desolate southwestern desert.

I wished to return home.

But I declined the offer.

As I investigated further, I perceived indicators—some faint, some pronounced—that my son’s intricate health care needs might not be adequately supported within Canada’s universal system.

There would be increased wait times. Limited pediatric specialists. Additional obstacles to synchronized, multidisciplinary care. The very principles I hold dear—equity, universality, shared care—would come at the sacrifice of the personalized support he requires.

In weighing my own well-being against my son’s, I prioritized him.

Naturally, I did.

So I remained. I stayed in a nation with a fragmented yet dynamic system, one that could address his needs, even if it imposes its own costs.

Describing the quiet sorrow accompanying that decision is challenging. To realize your heart may feel healthier in one location, yet your family might feel slightly less complete. To possess a passport marked “citizen” while questioning whether the systems beneath it will genuinely embrace the needs you bear.

I am a health care coach and medical school educator. I work with doctors and care teams navigating the ethical dilemmas of contemporary medicine. I instruct students on the human aspects of clinical practice—how empathy, burnout, bias, and communication influence care quality. I often think extensively about the very term itself. CARE—who receives it, who is overlooked, and how systems both support and drain those within. I’ve come to recognize that care extends beyond a mere clinical action. It embodies a cultural value. It manifests differently in various locations. And, I have no straightforward solutions when it comes to deciding between health systems.

Regarding my family’s care, I had to make a choice that no amount of theory or education could simplify.

To be clear, this narrative isn’t about which system outweighs the other. It’s about what it signifies to exist between them. To belong to two countries whose cultural and clinical philosophies differ immensely. At times inspiringly, at times painfully.

I’ve observed both nations offer excellence and inequity. I’ve seen each claim compassion while falling short. In Canada, I grew up with a profound cultural appreciation for equity, humility, and communal well-being, while simultaneously witnessing the exclusion faced by many at the margins of those care needs. In the U.S., I’ve engaged in vigorous innovation and advocacy, often driven by those who’ve been let down by the system. Neither nation is flawless. Yet each imparts vital lessons about striving to do right by those we cherish.

I’ve also learned that health care systems don’t merely mirror policies. They embody priorities. They reflect a culture’s beliefs regarding interdependence, worthiness, and who deserves to be well.

In medicine, discussions often revolve around what care costs the system. However, less attention is paid to the toll on caregivers living with constant compromises. We address access and efficiency but rarely explore the pain of witnessing the clash between your values and your real-life experiences.

By opting to stay in the U.S., I chose my son’s health care. By deciding not to return to Canada, I let go of a version of my life that might have better nurtured my own mental health.

That is a type of grief I carry daily. Not regret. But grief.

Citizenship, akin to caregiving, transcends mere loyalty. It involves continuous, uncomfortable choices. It requires loving something enough to acknowledge its limitations. It’s about stating the truth: that no system is without flaws, and no solution is straightforward when a loved one’s well-being is involved.

So as