The Sword

Day 30 – National Blog Posting Month. 

  
Well, here it is. The last day of November and the last day of daily posting for a little while. 

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. 

The Corridor at Night.

Day 9 – National Blog Posting Month.

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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.

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Facing the Void

My brother and I had a long talk the other day about our parents.  He has positioned himself to be their power of attorney for finances and I am their power of attorney for personal care.  In the past year, it has become evident that we may need to start exercising our roles.   I can’t tell you how sad that makes me.

Growing up, my father was larger than life. He was a tall, formidable man with a deep voice but he was for all intents and purposes, a gentle giant.

Over the past year or so he’s become impatient, occasionally verbally aggressive toward my mom and is forgetting things.  He was diagnosed with mild cognitive impairment last fall but his condition seems to have deteriorated in the last 3 months.  He has a much shorter fuse now and asks my mom to repeat things several times a day.  He denies feeling depressed but we all think he is. Thankfully his family doctor suggested a trial of a low dose antidepressant and he actually agreed.  

He will be having an brain scan soon. I fear it will be normal.  Why? Because the thought of watching him continue down the road of dementia is heartbreaking. It would frankly be much easier if he was diagnosed with a brain tumor. I don’t think I could bear the day he forgets his grandchildren and then me. I don’t think I can watch him become aggressive and angry and frightened at his memory loss.  I see it already happening with my maternal grandmother. 

And there’s the kicker: dementia on both sides of my family? What does that mean for my brother and me? Are we destined for the same end?

We talked about all of it. Dad won’t want to go into a nursing home when the time comes. Will I have to have him declared  incompetent and take over as POA?  If dad moves into a nursing home, mom won’t be able to stay in the condo; will she live with me or my brother or alone in an apartment?  How long are we going to have to watch him deteriorate? He would never want to live like that. I certainly wouldn’t. 

I fear the road ahead. 

Sandwiched.

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The time has come. My parents are getting old.  My dad is going to be 80 next year, my mom is 74 this fall.  Both have been relatively healthy except for a few issues (hypertension and type II diabetes), but that is starting to change.

For as long as I can remember, my dad has suffered with back pain.  I remember him going to chiropractor appointments weekly for what seemed like years for chronic low back pain.  He was told many years ago that there is nothing that can be done about his back pain.  Well, now he’s finally had some imaging, and we saw a surgeon today.  But, unfortunately for my dad, surgery is not an option right now. Even though he has narrowing of his spinal canal (spinal stenosis), it isn’t producing enough leg symptoms to warrant surgery.  Sure, he could have it anyway, to open the canal up, but it may make his back pain worse in the long run.   You see, surgery doesn’t help back pain, it only helps leg symptoms (pain, numbness, tingling, etc).   And in my father’s case, his back pain is far more debilitating than his leg symptoms.  I know he was relieved to hear he wasn’t a candidate for surgery, and I think he finally heard that he needs to get up off his ass and start walking more.  He used to walk all.the.time.  He was very active when I was growing up – he’d go for walks in the evening and play golf in the spring/summer.  But all that gradually changed over the past ten years or so.  As his back pain became more pronounced, so did his excuses for why he couldn’t walk.  Well, that hopefully is about to change.  He was prescribed physiotherapy and exercises to start doing at home.  Even before his appointment, he told me he realized that he’s done nothing to help himself.  I really hope this was the wake up call he so desperately needs.

Today was an eye-opener for myself as well.  It was the first medical appointment I have ever attended with my dad. I stood in the room as his daughter first, but the physician in me knew from the questioning that surgery wasn’t going to happen.  Reading the MRI report is one thing, but hearing the story from the patient, my dad, was quite another.

Back in medical school, or maybe it was residency, I can’t really recall, we learned about the sandwich generation – becoming the caregiver for your own elderly parent while being a parent to one’s own children.

A study published in 2013 found that,

  • 20 per cent: Proportion of employed women and 17 per cent of men in the large survey which are part of the sandwich generation of Canadians.
  • 40 per cent: Portion of workers in the overall survey who report high levels of overload – both at work and at home.
  • 25 to 30 per cent: Portion of caregivers who cope with the pressures of work and family by bringing work home, giving up on sleep and trimming social activities on a daily basis – a response which raises the chance of employee burnout (and grumpy workers).
  • 20 per cent: Portion of male and female employees who are caregivers who turn down promotions because their plate is too full.
  • 63 per cent: Portion of caregivers who report emotional consequences of juggling work and looking after family, which includes stress, anxiety and frustration.

Add all of the above to a caregiver (me) who is also a physician? Oy.

Are you sandwiched?  Have you any advice? I’d love to hear it.

The worst patients.

There’s a saying, I don’t know the origin, that doctors make the worst patients.

It’s true.

I have several doctors in my practice.  All are very nice, I hardly ever see them, but when I do, I remember why that saying is true.  See, doctors diagnose themselves, then go see their own physicians for confirmation.  For examples, a female physician patient of mine came in to see me a few weeks ago.  The first words out of her mouth were, “So, I think I’m having dysfunctional uterine bleeding.”  Right.  Ok then.  One might just give her the requisition for an ultrasound or a referral to a gynecologist and be done with it.  But what if she’s wrong? (Okay, she’s probably not, but still, it’s my job to take a proper history).  So, I do my due diligence, take a proper history, do a physical examination and come to the same conclusion.  She probably has DUB and needs an ultrasound.  She could have just ordered the ultrasound herself, but she didn’t. She did the correct thing and see her own physician.

Many physician patients don’t though.  The self-diagnose and self-treat.  This can get them into trouble.  I’m sure you’ve heard the tale of the male physician who dropped dead of a heart attack at the age of 50.  I certainly have.  He had probably been having chest pain, angina, for many months but either chose to ignore it, or took a baby aspirin and nitroglycerin spray, hoping it would go away.  Denial is something we see in our patients, but physicians can carry that burden as well.

I have been a patient myself a few times since becoming a physician.  Most recently, of course, during the birth of my two children.  I remember being in the recovery room after having my daughter by Caesarean section for failure to progress. After surgery, my heart rate stayed between 120-130.  I could hear the monitor beeping at me.  Nurses came in every 5 minutes to check my blood pressure, asking how I was feeling.  I felt fine. Tired, but fine.  Suddenly I started to worry, oh God, was I having an amniotic fluid embolism?  Was I hemorrhaging?  Of course I wasn’t, but I’m sure those thoughts didn’t help my tachycardia.  I later found out the reason for my tachycardia was the cephalopelvic disproportion I’d had.  The dysfunctional labour had caused me to lose a little bit of blood.  My post-operative hemoglobin had dropped to 90.  I recovered.  All is well now.  But for those few hours I was seriously worried that something was very, very wrong.  Any other person wouldn’t have know what was going on but a physician?  Our first thought is the worst thing we can think of.

And don’t even get me started on physician parents!

For example,  a physician’s toddler stands in the bathtub, then slips and does a faceplant on the side of the tub.  Instant bump and bruise develop under the left eye. First thought of physician parent?  Fractured orbit.

After a viral infection, child develops peeling of the skin of the fingers and toes.  First though of the physician parent?  Kawasaki’s disease.

I could go on and on and on. And yes, those two examples were of me.

I should have started this post with doctor-parents make the worst patients.