I am a doctor daughter. I am exhausted. My emotions are bubbling close to the surface, and I fear that at any moment, someone will do or say something to me that will cause me to lose control, which I’m not allowed to do because I’m also a female physician in a leadership role, and our emotions must be held in check.
I watched one of my mentors be memorialized last week after he lost his battle with cancer. This week, I will watch my father, a man who has meant more to me in my life than any other except my husband, go through a revision prostate surgery, a bone marrow biopsy, and an inpatient stay for a urinary tract infection that was on the verge of turning into urosepsis. This isn’t the first time I have felt like this. A few years ago, my mom was admitted to the hospital in septic shock after a simple lithotripsy procedure in an outpatient setting. Two weeks and one major surgery later, she was finally home: weak, disoriented, and tired. But she was alive, and she has recovered completely; a miracle when you think of the mortality rates with sepsis.
The morning he was admitted, my father called me at 6:22 a.m. to tell me that he felt horrible and was getting in the car to come to where I live to be seen. I live 2 hours away from him. Moreover, he felt so poorly that he was letting my mom drive; this had to be an emergency. When they arrived, we were ushered into the emergency department after his internist called to tell them we were coming.
We were met at the door by the triage doctor who chatted easily with us as he was put into a wheelchair and brought back to a room in the ED. A patient care assistant (PCA) quickly came in and hooked him up to monitors while the nurse, the resident, and the attending all came in together to get his history. Patiently they listened as my father described his history.
His southern accent grows heavy, and his speech is slower when he is trying to make a point, and he wanted them to hear his story. ED doctors are designed and trained to hear pertinent facts and make quick decisions, but they listened and waited and asked questions when it was time, never interrupting. The hospitalist of the day then came in and introduced himself, also having been called by my dad’s internist to alert him of our arrival. He assured us that he would take good care of us and get us admitted quickly if it was indicated.
Some of the labs started coming back, and the doctors were worried about heart failure in addition to a urinary tract infection. They asked about shortness of breath and orthopnea — both of which my father denied — both of which I knew he had. After the doctors left, I reminded my dad that it didn’t do any good to deny symptoms that were clearly there, even if they weren’t new. The nurse told the doctors that my dad did, in fact, have both shortness of breath and orthopnea. They wanted to admit. The hospitalist didn’t think he needed admission and felt that if the UTI could be treated as an outpatient, dad would be more comfortable at home. He agreed; I didn’t. A 6:22 a.m. phone call, a 2-hour drive with my mom driving, and weeks of feeling badly means he isn’t comfortable at home.
Four months before, dad had a prostate surgery because of acute urinary retention. He was also found, at that time, to have SIADH. A workup did not reveal the cause of the SIADH. However, the urinary retention would require surgery. Since then, he has felt “under the weather,” sleeping little, struggling to urinate properly, and losing 25 pounds unintentionally. He had also been diagnosed with macrocytic anemia months before, and a bone marrow biopsy had been recommended to rule out myelodysplastic syndrome. Knowing that if the treatment was to be chemotherapy which he wouldn’t do, my dad elected to decline the bone marrow biopsy.
Today, he needed to be admitted for IV antibiotics and to ensure he would not have another episode of acute urinary retention. Dad often waffled between agreeing with the admission and not. The urologist understood my frustration with my dad. Dad wanted to be home, but was anxious about that too. Finally, as the doctor daughter, I made an executive decision to push for him to be admitted overnight. Dad wasn’t excited, but he didn’t argue much either.
So, up we went. He had requested to not have vitals done overnight so he could get some rest, which the nurses agreed to accommodate. His room was very nice, overlooking a beautiful prairie. However, at night, the lights were bright, and the noises were noisy. Hospitals are not restful places, and they don’t ever sleep. The hospital is the worst place for a sick person because patients cannot rest.
Early in the morning, before 6 a.m., the residents came to round. They told my dad he would need to go home with a Foley because of the concern for acute urinary retention. He also would go home with antibiotics and would return two days later for a platelet transfusion so the surgery could safely be performed. In addition, the bone marrow biopsy would be done the next day so we could see if he has cancer. He agreed to it all, but 4 hours later, the Foley was still not in, and we were still in the room, waiting for discharge so he could be home for 48 hours before returning.
Recognizing that everyone has a lot to do in a hospital, sometimes the patients get forgotten. As the doctor daughter, I was tasked by my parents with pushing the nurses and techs to move faster with their processes. I am expected to get the lab results, talk to all of the doctors, and translate everything from the doctors and nurses to my mom (my dad usually understands what they mean), my sister and my brother, and back again to the doctors and nurses.
Organizing his hospital stay, setting up the appointments, reviewing the medications and the labs are part of my responsibility as the doctor daughter. It wasn’t requested by my parents to be that way, it just is. It’s what I do. It’s my responsibility, and I’m mostly OK with it. It has also been my responsibility to gently nudge my dad in the direction I think is best for him.
That makes me uncomfortable. He has never needed nudging. He has always been completely in charge of his own health care. He has never needed me like this, and I don’t want to screw it up. It’s scary to be the doctor daughter. For God sakes, I’m a pediatrician! I don’t know anything about MDS or prostate issues! I don’t know what interacts with Coumadin or why his BNP is high even though his EF is normal! I’m just a kid, but not really! I don’t like making decisions that I know will make him uncomfortable. I don’t like being the one who has to remind him not to be so persnickety with the nurses when they wake him up for vital signs. I don’t want to be the one who reprimands him for not eating enough or feeling irritated that he won’t just “get over” the fact that there’s too much light in his room.
Can’t he see that everyone is doing their best for him? Sometimes, I just want to be “the daughter,” like my sister, or the “kid” like my brother: both of whom are capable attorneys, but they’re not medical. They don’t have this weight on their shoulders — although they have their own. And, what if I make the wrong decision, and something goes wrong? What if I push him to do the surgery or have the overnight stay for antibiotics or the bone marrow, and he gets hurt? I work in a hospital; people get hurt in hospitals every day! What if I’m the reason I don’t get to call him every day? What if?
So, I’m exhausted. It’s only 24 hours into this two week long (at least) odyssey here, and I’m exhausted. The good news is I was a resident before the work hours limitations were implemented, so I can handle it; but I might cry a little, alone in my office when nobody is looking.
Shelley W. Collins is a pediatrician.
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