Do I vote yes and be complicit in accepting a 4 year agreement that knowingly under funds health care and continues to reduce my income; or do I say no and be subject to further unknown unilateral fee cuts for the foreseeable future.
Not so easy a choice is it?
Better to be screwed facing your attacker? Or better to be blindsided from behind?
Because that’s essentially what the physicians in my province are facing.
Damned if we do. Damned if we don’t.
I am not political. Never have been and really, never want to be. But I just can’t stay quiet on this any longer.
I am being asked to trust a government that has grossly mismanaged health care for years now and wastes taxpayers money on scandal after scandal.
I am being asked to help manage utilization of health care resources. What does that mean? Do I tell a patient that they can’t have that ultrasound because we have exceeded the budget for that month? Do I close my office one day a week because I am exceeding the budget for that month? Do I tell my staff to take an unpaid vacation day once a week because I can no longer afford to pay them for 40 hours of work anymore?
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.
December is not a good month to be a family doctor, or any doctor for that matter. I have lost count the number of bad diagnoses I have had to give before Christmas. What an incredibly shitty way to end a year.
“I’m so sorry to have to tell you this, but that lump in your groin is lymphoma.”
“The biopsy has confirmed it’s malignant melanoma.
“Unfortunately, your baby stopped growing around 9 weeks of pregnancy.”
“The lump in your breast is suspicious for cancer.”
January is sometimes even worse. Who wants to start a new year with bad news?
Every year I feel like I’m back here lamenting the fact that it’s supposed to be a magical time of year, these “holidays”, and I’m forced to give more people more bad news. Can’t I just have one year where everyone is healthy? Is that really too much to ask for?
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.
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.
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.
All day my eye was bothering me. Between patients I’d go to the bathroom with a saline spray and remove my contact lens to clean it. My eye would feel better after a while but then the irritation would return. It felt like a grain of sand or dust was in my eye. I thought I might be getting a stye. By the end of the day I felt like scratching my eye out.
I had some fluorescein stain at home so I put a few drops in my eye and used the blue light of my ophthalmoscope to look at my eye. Yellow and blue make green. A corneal scratch or abrasion will light up green.
I was a little surprised to actually see that I indeed had a few scratches on my cornea. Suddenly the pain got worse (psychosomatic?). I called for my two older kids to come to the bathroom so I could show them.
Needless to say they thought it was pretty cool. I had to wear my glasses for the rest of the evening. They have lenses from 2006. They haven’t been updated and my eyes have gotten worse. I really need to get the lenses updated.
Corneal abrasions hurt. Wow. Do they ever hurt. I woke up with a brutal migraine today and I still want to scratch my eye out. It’s going to be a great day.