Tuesday, 25 February 2014

Family

As a trauma surgeon, my biggest fear is walking into the trauma bay as my wife or one of my children is rolled in on a gurney.  I've often wondered how I would react in that situation - would I be able to keep my cool?  Could I possibly treat one of the people about whom I care the most?  I've often heard that treating a family member is a "conflict of interest", but is it really?  My interest in that moment would be to make sure my family is taken care of, that they get the best possible treatment.  Whenever this hellish scenario pops into my head, the answer to those questions is invariably and obviously "no".  I would immediately call one of my colleagues and have him come in and take over.  It would be absolutely impossible for me to be a sane, rational, objective doctor while looking down on my injured, bleeding wife or child.

Ok, that was probably a bit more maudlin and dramatic than I was intending, and I think the answers to my questions were probably fairly obvious to anyone with more than the brain capacity of a salamander.  But what if the medical problem were outside my area of expertise?  What if someone in my family had a medical (rather than surgical) emergency?  Would I go into Doctor Mode or would I go into Daddy Mode?

I had the chance to answer that question a few years ago.

On a cold Sunday morning my wife and I were startled awake by my daughter coughing.  This wasn't anything new - she'd had a cold for a few days, just a cough and some congestion.  But this cough sounded different somehow.  We rushed into her room to find her sitting up in bed and hacking so hard I thought a lobe of her lung would come shooting out of her mouth.  It wasn't just a normal cough either, but a loud, raspy, barky cough typical of croup.  The cough sounded terrible, but it wasn't the cough itself that bothered me.  Rather, it was the high-pitched, wheezy noise she made as she was inhaling.

OH.  SHIT.

That wasn't a wheeze, it was stridor.  It sounds similar to wheezing, but instead of being on expiration, stridor is on inhalation.  It is a sign of the airway above the vocal cords collapsing, and it is very ominous.

This was clearly no ordinary cold.

Mrs. Bastard, who happens to have asthma, ran and grabbed her nebuliser and some of her asthma medicine, and we held the mist in front of our daughter who sat quietly and breathed it in like a little champion.  This settled her down, she was able to breath normally, and she went back to sleep for a few hours.  I, however, did not, not after hearing that sound.  Over the course of the day, she had several more mild episodes which all went away, but late in the afternoon it got worse.  It was then that I found out the hard way that severe stridor is the most terrifying sound I've ever heard.  She sounded like she was struggling to breathe.

We drove her straight to the nearest hospital (where I happen to work), and after hearing her coughing and breathing the nurse brought her straight back to an exam room.  She checked her vital signs, and her oxygen levels were fine, but she was obviously working a bit to breathe.  The paediatrician told me she needed the nurse to place an IV for some medication, and that Daddy had to hold her down during the IV placement.  I held my daughter tightly, and she screamed as they poked her hand with the needle.  As tears ran down her face, her huge eyes stared directly into mine with a look that I will never forget and unmistakably said, "Daddy, how can you let them do this to me?  You're supposed to protect me!  Why, Daddy?  WHY?"

Fortunately the IV went in quickly and without difficulty, and they gave her a small dose of steroids along with some more nebulised medicine via a facemask to calm down her breathing.  After just a few minutes, her breathing had settled down significantly, nearly to normal.  A rapid lab test confirmed that her croup was due to the Influenza A virus.  She fell asleep on the hospital bed with the facemask still hissing quietly, delivering the fine mist of medicine that would open her airways for good.

Sometime after midnight (which was the latest she had ever stayed awake), we brought her, sleeping soundly, back home and put her to bed.  It was only after she was safely in her own bed that I realised my breathing had also just returned to normal.  I'm absolutely positive that it's impossible to hold one's breath for 6 hours, but it sure felt that way at the time.  Her cough lasted for a few more days, and fortunately she had no more episodes of stridor and quickly reverted to the normal, happy little girl she had always been.

So how would I grade my performance?  Under the circumstances I would say I kept my composure reasonably well.  I never panicked, but I was more nervous that day than on any other day in my professional career, and it reaffirmed my belief that doctors should never treat family.  It also reaffirmed that I will never treat my own children.

Unless I'm treating them to ice cream.

15 comments:

  1. Well, I'm glad it ended well! I don't think I could ever treat a member of my own family if I decided to go into the medical field.

    I've also heard it said that family members make the worst patients.

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    Replies
    1. I completely agree!

      And Doc, do you live in Australia? Just a random guess. Or not... ;)

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    2. I always thought he was British , based on his speech and my own intuition.

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  2. I don't know about doctors but in my experience, nurses tend to NOT see medical problems in their family. My mother is a nurse with several nursing friends. When my sister had extreme abdominal pain, my mother said it was constipation. Only after she started vomiting did my mom take her to the doctor and discover it was appendicitis. My godmother's son had a broken arm for three weeks before she decided it was time to get it looked at. When I dropped a table on my foot and it swelled up with a rainbow of colours, my mother said that it was no point going to a doctor because all they would do was take xrays to confirm I had broken bones and she could just give me painkillers herself. My school teachers used to write to my mother and ask her to keep me home for a few days when my pneumonia coughing was too distracting for the rest of the class. Whenever I meet kids of nurses we swap stories like these.

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    1. That sounds kinda like my mom! I had to go to the ER once because I fell badly on my wrist and I thought I had broken it. When we were in the waiting room it stopped hurting as much and she actually got really mad at me for "making her drive to the ER for a twisted wrist". It was sprained. And then there was the time she made me go to school with pneumonia for several weeks because it was "just a cold". She's not even a nurse. She teaches elementary school. She never let me or my brother stay home when we were sick.

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  3. I agree, raggedtooth. Most of the medical types in my family (and some friends too) are actually rather poor at diagnosing, recognizing medical issues in people they are close to. Non-medical family members thrown into caregiver situations are often misinterpreted as aloof, or detached. It is out of necessity to remain sane, day to day. We switch hats..Mom one minute, nurse or PA the next..and back to Mom.

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  4. Hey doc since you said that doctors should never treat family. (Your belief) so does that mean that a surgeon like you can operate on a family member in a case of a life saving surgery?

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    Replies
    1. We can, but only under the direst of circumstances.

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  5. Interesting post Doc'. I completely understand your worry that you might panic or be somehow unable to act professionally with a family member but I also wonder whether you would be able to stand by and watch someone else take control.

    We all hope you will never have to find out, but I can imagine being torn between feeling that you can't or shouldn't be responsible for treatment of your family, and the feeling that it's your job; who else should be doing that to your family if not you? The flu' thing is perhaps a little different because it's not your core practice (as far as I understand it) but what if your wife or daughter needed an appendix out in a hurry? Would you rather watch someone else do that?

    If my kid needed an operation then I would have to let someone else do it because I don't have the skill myself. If I could do it then I think I might want to. But then again it's very hard to predict your own reaction in such a hypothetical situation.

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    Replies
    1. My wife needed a hernia repair a few years ago. I do those procedures regularly (and am quite good at it, I must say). But I had her see a colleague whom I knew to be also very good. I waited patiently (har har) in the waiting room like any other family member. The thought of incising my own wife makes me squirm uncomfortably.

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  6. This is a matter of objectivity - which goes right out the window when a family member falls ill. DocBastrad is right, treat a family member only at the utmost need.

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  7. I tended to "overdiagnose" family members' illnesses. Being an RN I'm not supposed to diagnose anything. I have no objectivity when it comes to taking MYSELF to the doctor. It takes a lot, and usually involves a productive cough with green sputum. I'll also ignore my 3-times surgically-repaired back for at least a couple of months. In the case of green sputum, it happens every spring with a nasty URI (I have asthma) and with the back, I know there's not a lot that can be done.

    Most recent example of overdiagnosis (or was it?): Hubby was crushed between two produce trailers at work. He came home for lunch and asked if he should go go urgent care. I said "duh, and you need to ask for an H & H along with an x-ray, with the H & H repeated early tomorrow at the latest." He did not ask me to go with him. He comes home 3 hours later, no labs, no x-ray, the only treatment being an employer-required urine drug test and a bottle of Tramadol, which didn't work. He went back 2 days later, in worse pain, and the treatment was to switch the Rx to Vicodin. Was I wrong to go off on the comp carrier?

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  8. I've seen so many situations where medically trained folks have either fallen apart in the face of their own family's illness or removed themselves smartly and allowed more detached staff to render care. We had one of our intensitist's elderly father come in with a dissecting AAA while he was on a short visit from the East Coast. We were not a trauma center so no surgeon standing by..ugh. I was frantically trying to get the vascular surgeon to respond..without much luck. The son, hanging out by the nurses station so as not to involve himself in dad's care, helpfully, assisted me in trying to round up the surgeon. He found him before I could, thankfully.

    I also had to bring my mom into the ED where I worked once. She had cancer and was there for a bone scan but was FAR too weak to wait for the test. I wheeled her to the ED and then begged them to let me get the scan while we waited for results. I knew something was wrong when Ben, the ED attending, called to have her brought right back. Turns out she was having an MI. Before I knew it they were trying to get her to the cath lab but with platelets of FIVE the cardiologist needed platelets.So I was pressed into service to coordinate the stat platelets with the blood bank even though I wasn't on duty. I think that was the first time the blood bank technologist ever has a weeping family member standing at her elbow while she readied the units. UGH. I think I still have PTSD from the whole ordeal.

    Mom survived the MI only to be diagnosed with bone mets from the scan we originally went there for. She lived only a couple of more months...

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  9. I'm sure your daughter understood - or will someday - that as both a doctor and her father you were doing what was best for her health.

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  10. Doc, think about another possibility: delivering a terminal diagnostic to the family member. How do you deal with the unintended consequence wrt that family member and other peoples in the family.

    Al

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