The line between family member and personal doctor

I, like many physicians, am the only doctor in my extended family. To say that they are proud is probably an understatement. I’ve been a practicing physician for seven years now and yet my grandmother each time I see her greets me with, “There’s my doctor grandson.” I have worked quite hard to get to where I am, and I enjoy what I do. I, too, am proud to be the doctor in the family. However, I don’t want to be the doctor for the family.

I think that most physicians find themselves fielding questions about Aunt Jane’s rash or cousin John’s blood pressure. On the whole, I’m happy to answer basic questions and perhaps translate some doctor speak into plain English for my family. Where I have struggled is when the line between family member and personal doctor becomes blurred.

I told my immediate family right off that I wasn’t interested in being their doctor. That if they had general questions, I would happily answer them but other than a little gentle nudging of my dad to quit smoking or to both my parents to get out and go for a walk now and again, I was not going to insert myself between them and their actual doctors.

I told myself, great, I set the boundaries, and I can be a son that just happens to be a doctor. Little did I know how soon that was going to go out the window.

For me, this happened in December 2012. I was walking out of the office after a day of clinic, a freshly minted attending having graduated residency only six months prior. As I walked to my car, I got a phone call from my mother. I could tell immediately that this wasn’t a call for a friendly chat.  She wasn’t calling to talk to her doctor SON, she was calling to talk to her DOCTOR son. At the age of 62, she was having vaginal bleeding. She knew it wasn’t normal but was traveling from North Dakota to Arizona for the winter and needed me to help her decide what to do.

Putting aside the fact that I was talking with my mother about vaginal bleeding, I put on my medical hat and walked her through all of my questions and thoughts on how she should proceed. Over the course of the next few months, I tried to help my mother and father, her major other support person, navigate numerous appointments, scans, studies, and questions. I flew to Arizona twice to be present for doctor’s visits and surgeries. I even called and talked with her gynecologic oncologist while he was on holiday in South Africa when none of the studies coming back were making any sense, and no one would give a straight answer. To this day, I don’t know why he answered the call other than sainthood.

In the end, surprisingly, she was diagnosed with stage 4 colon cancer. Over the ensuing three years, she underwent numerous rounds of chemotherapy, doctor’s visits, and additional surgeries. For which, I was often on the phone if not present in person.

My most difficult moment came in early 2015 when I got a call from my mother that she had shown up for her chemotherapy appointment and the doctor said that rather than getting chemotherapy, she needed to be admitted to the hospital and he didn’t know if chemotherapy, her second line, was helping at all. I was on a plane that night headed back to Arizona. I arrived to find my mother thin, frail, but in surprisingly good spirits. As I sat with her and my father for the next two days in the hospital, several different hospital teams beat around the bush and refused to say it outright that they didn’t think any further chemo was in her best interest. They wouldn’t bring it up, and so I did. Did they think it was time for hospice? The medical teams seemed to be relieved that I brought it up. They still wouldn’t outright say yes but said things like, “That would be a reasonable option,” and “It is certainly something that we need to consider.”

They wandered out of the room without any real discussion of what hospice meant or how it worked. That left me to not only discuss it with my mother, a process made easier by having already started the conversation years earlier, but also to actually call different hospice organizations back in North Dakota to get things set up.

Three days after arriving, I was pushing my mother through the airport in a wheelchair to help her fly back to North Dakota and start hospice. While the last three months of my mother’s life on hospice in North Dakota were filled with good times to connect as a family and just love one another, my role as doctor hadn’t ended. I was constantly being asked about dosing her medications for pain, nausea, sleep, etc. The hospice nurse, who lived 60 miles away from our rural home town, could only come by once a week, so I made any adjustments needed.

My final decision as my mother’s doctor came at around 9 pm on June 20, 2016. My father called to say, “The nurse thinks we should give her some IV fluids tomorrow, what do you think?” Up until this point in her hospice care, she hadn’t received any IV fluids but we had had an ongoing conversation about the fact that she still had a port in place from her chemo so it would be easy to do. Her biggest issue had become keeping hydrated as her nausea increased likely due to increasing obstruction from her progressing colon cancer. I responded by asking, “Do you think it would improve the quality of her life?” When my dad said, “What quality? She hasn’t had any quality in weeks,” I told him no. I didn’t think she should get IV fluids.

My mother died in the early morning hours of June 21, 2016, before any decisions about fluids could be implemented. Again, I was on a plane. This time not as her doctor but just as her son. A son needing and seeking to provide some comfort in the arms of all of the family that loves her.

I wish I were writing this to tell you I have since come up with a solution on how to avoid being in a similar situation yourself. Unfortunately, I haven’t and ultimately I don’t know that I would avoid the situation if I were able to do it all again. I love my work and I love my family. Combining the two isn’t ideal, but sometimes it still feels like the right thing to do. Hard, but the right thing.

Brian Vukelic is a family physician. This article originally appeared in Family Medicine Vital Signs.

Image credit: Shutterstock.com

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