Friday, January 22, 2010

Doctor for the Family?

In retirement I get a lot of inquiries from family and friends about aspects of their disease or care. I try not to be intrusive and to mostly provide reassurance, but sometimes I just can't stand by.

My sister in rural Pennsylvania had severe shortness of breath and also a known leaky heart valve (stable since childhood). A local cardiologist told her she needed three heart valves replaced! This was so over the top that I "interfered" by advising her to head to the relatively nearby Cleveland Clinic (her records didn't arrive so it took two trips there). The description of the consultant she saw there was a disinterested "cold fish." He told her no surgery was indicated and that all she needed to do was lose weight. He saw no need for further tests or referrals.

So I entered the picture again and contacted a Pulmonologist at the University of Pittsburgh Medical Center who was very gracious. Doctor's don't necessarily look forward to being the third consultant - basically a referee. He did pulmonary functions, CT scans and cardiac ultrasounds to evaluate her pulmonary hypertension. My sister subsequently went all the way through a thoracoscopic lung biopsy which unfortunately showed a serious irreversible lung disease.

I check in by phone with my sister every few days. She is now on Hospice care, but the Hospice base is 40 miles away and several different RN's have been to see her. In treating her shortness of breath she got pretty goofy and unstable on the sedative/narcotic regimen so they put her in the inpatient Hospice Unit for a week. She's pretty much bed ridden, on oxygen and at peace with her Swedenborgian-based belief that she will pass into a vibrant spiritual world in a much more perfect disease free spiritual body. Although, she's reluctant to leave her beloved husband and extended family behind, she's actually looking forward to the day when all of the family can be together once more.

After coming home from the Hospice Unit, she casually mentioned that she really felt hyper, shaky and jittery. After reviewing her meds, we discovered that she was on both long acting plus short acting asthma inhaler meds. So I said, "check with your medical team, but for now stop the short acting albuterol and use it only as needed." The jitters resolved. I told her to send my apologies to her team and that I'm sure they would have given the same advice.

In general, doctor's are advised not to provide direct care for their families. That certainly didn't apply to our family when we were kids. My father was an "old time" family doctor. We got our ears checked, penicillin shots, etc. by going into dad's office after school.

I stitched up my son's laceration at a Boy Scout Camp when I was the doctor there. It would have been silly to send him back to Seattle. Of course my son, now a lawyer, still points to the scar on his knee and says, "boy, you can sure tell that wasn't done by a plastic surgeon."

The label of nurse or doctor carries over to the stage of retirement. I hope I have been of some help to my sister, but it's a balancing act. In general, being supportive with bits of education and reassurance is probably the best medicine we have to offer for our own families.

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