It’s been a while!
Hard to believe it’s almost the end of June. There’s been a lot going on in my world, most of it pretty good.
My dad is on the mend from his kidney stone issues and has remained pretty stable with respect to his memory and the Alzheimer’s disease (AD). Two rounds of infection, two general anesthetics, mild delerium and his memory testing was the same! Unbelievable really. The thing with AD is that the patient kind of remains oblivious to the reality around him. He recognizes that his memory has declined but he doesn’t understand anymore the impact it has on everyone else, his wife especially. If there is any blessing with AD it is that the patient loses their higher executive, frontal lobe functioning early. It is quite the opposite for the family. My mom is a strong woman though and she is managing pretty well; she goes to her weekly support group, my brother works from their place once a week and she visits the kids when it gets too much. I wish there was more I could do for her and for my dad.
As for me, I’ve done two races this month with decent results, given how awful the winter was with my running. I have another 10K race this weekend and I am not expecting to do any better than 1:15 but that’s okay. It’s an opportunity to have some fun, run on the highway and get a cool T-shirt and medal!
I’m starting a new part-time job next month in addition to my family practice. It is an opportunity I sought out and I am excited about. It is an opportunity to grow as a physician, learn about a different model of care and will be a great change of scenery for me. I’ll be a lot busier, working 5 days a week (instead of 4) but I think I’m up for the challenge. The future of primary care in my province is looking hazy right now and I am a little worried. We have been without a contract with our Government for over two years and they are planning on implementing change to how primary care is delivered without consulting the front line workers, ie me! I felt it was time to start looking at other opportunities where my work is actually appreciated.
I’ve missed the blog. I hope you missed me too.
It’s Saturday night, I think. Honestly this week has been a blur. I feel terrible complaining because I know for a fact there are others struggling with a lot more this time of year (a few of them are my own patients), but I have to say this has been one of the crappiest weeks I can remember.
It started off with me getting some kid of flu/GI virus that decimated me for close to 36 hours, then I get the phone call that my dad is going to the ER and after spending 15 hours at the hospital he gets admitted. I missed seeing a theater performance of Cinderella with my daughter and my aunt that day. (I’m still really bummed about that). When I got home that night, around 1am I found my husband in bed with shaking chills. He spent the vast majority of Wednesday in bed. Despite exhaustion, I took my older kids to an indoor play center to blow off some steam. Later that night my brother, wife, stepdaughter, and my best friend came over for an already-planned Christmas Eve-eve dinner. Husband and I were exhausted but it was wonderful to have family over and they helped out by wrapping all of our kids’ Christmas presents.
Christmas eve saw husband going out for last minute gifts, still unwell. I took one of the kids to see Pappou in the hospital. The kids watched Santa on Norad as he made his way from Morocco to Ireland, we set out milk and cookies for him and the kids went to bed with zero fuss. Husband and I settled in to watch our annual holiday classic, “Die Hard”, and promptly went to bed around 10pm.
Christmas morning the kids were up early, as expected. Christmas gifts were opened in a frenzy. I had planned on taking all the kids to see Pappou in hospital, so after breakfast everyone got ready, except husband who was still not feeling great. Over the course of the morning, my older son, the 4.5-year-old, started complaining of a tummy ache. He barely touched the apple juice he got from my mom, nor the donut. He looked pale and complained even more about his tummy so we left the hospital after a short visit. The entire car ride home the little guy was moaning. As soon as we arrived home, he was curled up on the couch with his new Star Wars blanket. Ten minutes later, he’s running to the bathroom calling for me and threw up.
Merry f*&king Christmas.
We were expected at my brother-in-laws house for Christmas dinner later that evening. I called my mother-in-law and told her everything. I wasn’t sure we should bring my son so I warned her that he and my husband may be staying home.
As it usually is with stomach flu, once you throw up you start feeling better. My son seemed to make a pretty fast recovery and I spent the afternoon watching him build Star Wars Lego. The 7-year-0ld was happily entertained with her new Nintendo 2DS from Santa.
Later that afternoon, with the two boys (husband and son) feeling better we piled into the car and headed west to my brother-in-law’s house. We were going to arrive about 2 hours late, but I had called my mother-in-law to explain. When we were about 10 minutes away I suddenly remembered that we, well I, had forgotten the dessert. Among the chaos of the week, I had gone out to buy two pies and ice cream as we were expected to bring dessert. We found an open Shoppers Drug Mart and were saved. Cheesecakes and eclairs to the rescue. (Seriously though, could this week end already?)
Christmas dinner was lovely. Husband and I ate but neither of us were particularly hungry. For me it was likely due to the stress of the week, my appetite has been shot. For husband, well, he was still recovering from the illness. An hour after dinner, my older son started turning pale again and complained of his tummy hurting. With profound apologies, we piled back into the car and drove home. Thankfully he wasn’t sick in the car but he did fall asleep and didn’t wake until almost 9am the following morning.
Boxing Day. Another trip to the hospital to see my dad. A relatively uneventful day and I was beginning to think the worst was over when the 2-year-old started screaming. Husband went to see him and called out – “He threw up.”
That poor little boy emptied his stomach over the course of the next 5 hours. I slept on a cushion on the floor of his room and he finally stopped dry heaving at 2am. He was awake at 6:30am as if nothing happened. Meanwhile husband is curled up in bed, moaning.
What the actual f&#K?
I’m ready for this week, hell, this year, to be over.
Only one person has been spared so far … my daughter.
Pray for me.
It’s two days before Christmas. We haven’t quite finished getting the kids’ presents and nothing has been wrapped.
I had a fitful 4 hours of sleep last night while husband lay next to me with the chills. As if things couldn’t get worse he is sick with whatever flu-like illness I had a few days ago.
The kids have been cooped up so this afternoon I took them to an indoor play center so they could run around and you know, be kids.
On the way there, I told the older kids that their Pappou (grandfather) is sleeping at the hospital and that I was there very very late last night when they were sound asleep. Of course the older one asked why and I tried to explain.
My 4.5-year-old son: “Mommy you should have told me you were home. We could have talked and I would have gone back to sleep.”
The 7-year-old daughter: “Wow, mommy that sounds like a long day.”
Sometimes I underestimate my kids. They understand a lot more than I give them credit for.
Waiting in the ER as a family member is boring and nerve-wracking. Waiting as a family member and a physician, watching your parent wince in pain is excruciating.
When I arrived he was seated in a wheelchair in the “Green Zone”, where the sprains and strains are waiting. He looked pale and sweaty and his heartrate was about 110. (Normal is 60-80). I found the nurse, explained who I was (daughter, not doctor) told her in medical terms what I had found when I saw him. She did an ECG (normal except for the fast rate) and moved him into the main ER. And two hours later we are still waiting to see a doctor. He is triaged as “back pain” and so we wait.
I finally couldn’t take it anymore watching him wince in pain and asked a nurse if we could get him something for pain and moved to a bed. About twenty minutes later the doctor shows up and my dad is lying down in a bed. He’s still sweaty and in pain. He also says he’s a bit winded and has a bit of chest discomfort.
The squeaky wheel gets the grease.
Percocet on board and labs drawn.
And the worst of it? I was supposed to be with my daughter and Aunt watching a live production of Cinderella.
I’m really trying very hard not to feel like a complete idiot right now.
I attended another appointment with my parents today. It was a follow up with the physician that made a diagnosis last year of minimal cognitive impairment (MCI). Since we were seen there last year there’s been some worsening of his memory and behavior and we were assessed by a different neurologist to rule out a structural brain disease called Normal Pressure Hydrocephalus. It was at that appointment a few weeks ago that the diagnosis of Alzheimer’s dementia was made.
At today’s appointment I sensed a bit of push back from the geriatrician as to why we were seen at a different clinic. After explaining, I then asked her a few questions about disease progression and whether starting medication last year might have helped. I didn’t think I was being critical but when the physician turned to me and asked, “Well, you’ve read the literature, right?” I felt like she went on the defensive. I said I had, (and I had read about minimal cognitive impairment last year!) she asked me what I remembered.
Um, excuse me? This wasn’t a teaching moment. I’m not her resident. I’m asking as a daughter, not a physician. I couldn’t believe she was treating me that way, and in front of my parents. I don’t care if she was pissed off that we went to another hospital and got a diagnosis, she had no right to treat me like that.
I was honest and said I couldn’t recall. She then answered my question. 10-15% of patients with MCI progress. Sadly my father is one of them. And starting medication earlier would not have been indicated. In fact it could have made things worse. As she related the information to me it started to come back. Still, I felt stupid for not remembering it and even more stupid for asking the questions. All I can see is my dad and his diagnosis. I should have the intellectual capacity to look clinically at the literature and apply it to my dad but you know, I can’t.
I’m just his daughter today.
I debriefed with my colleagues today and they agreed that it really wasn’t appropriate the way the specialist treated me. I have to get over my anger because this is the person who will be caring for my dad. I have to find a way to put it behind me. But right now, I can’t.
Day 30 – National Blog Posting Month.
My heart and mind are heavy. It’s been a busy weekend and an emotionally exhausting one as well. I’m finding it really hard to focus and am constantly thinking about my parents. I know that my worry will not go away and that I have to find a way to manage it. The doctor in me tells me to research and learn all I can but the daughter in me can’t bear to carry that knowledge. Now there’s a double-edged sword if I ever saw one.
I was up at the crack of dawn this morning (what else is new?) but this time to take my dad to a specialist appointment. We are the first ones here, even before the receptionist!
Since I have taken over this role of being present at most of my parents’ various specialist appointments, I have come to enjoy watching another physician do a physical examination. It’s a great refresher for me, especially the neurological exam. This was my nemesis in medical school. It is probably the most complex sequence of tests and observations I have ever had to learn and I still feel like I never mastered it.
Today I witnessed a skilled clinical fellow perform a thorough neurological examination on my dad.
I knew everything she was doing and why. There were tests I had forgotten about, ones that are very specific and others more general. At the end of the 3 hour appointment, we had some answers and now a few hours later, I have nothing but questions.
I need time to process. I know the road ahead of us. I’ve seen patients and their families go through it. It’s not what I wanted for my parents, least of all my father.
But this is life. It is hard. It is ugly. It is rewarding. It is love.
Day 9 – National Blog Posting Month.
Last night I took my elderly father to his MRI appointment at a downtown hospital. As the machines in my city run 24 hours a day, 7 days a week it wasn’t surprising to me that his appointment was for 10pm. Both my parents can drive but neither my brother, nor myself or my husband wanted them driving that late at night, so I decided to take him myself.
Walking through the hospital hallways at night reminded me what I loved most about my medical school and residency training. The quiet and tranquil feeling of walking down a hospital corridor at night. No matter what kind of day I had, or night for that matter, being allowed to roam the quiet hallways at night was always comforting for me. It didn’t matter if I had just lost a patient or was heading to the ER for yet another consult, walking those quiet hallways was like therapy. I honestly felt right at home. The lights are dimmed. Patient care areas are quiet except for the occasional sounds of IV machines beeping. Cleaners are buffing the floors. I might see another resident walking in the opposite direction, sometimes a family member from the ER who had gotten lost and asked for directions back to the unit. It was a privilege to be one of the club.
For a few minutes last night, I yearned to be back in that club again.