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.
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.