Sunday, March 23, 2008

Caring for Family

Dr Sid Schwab's recent post and the comments are the reason for this post. There is a question of whether doctors/surgeons should take care of family/friends. There's the question of guilt if something goes wrong. The flip side of that is how much guilt should we feel if we don't and something goes wrong. I personally think it depends on the situation. I think often it is a privilege, as with any patient, to be able to do so or at least to be involved in their care. I have not always been able to (usually due to schedule or distance) to be there, but here are some examples of when I was able.

When my niece, K, was 4 yr she had to have eye surgery. My sister asked me to be with her in surgery. Not to do the surgery, as my field is plastic surgery, but to be with her, to hold her hand, etc. I don't think it did as much for my niece as it did for my sister. I recall my heart breaking as I helped hold my niece down (This was 18 years ago and preop Versed use wasn't as good as it is now in children.) as anesthesia was induced and the IV started. I did the "hard" thing and did not give it to someone else to do. My sister had "charged" me with the task. I stayed with my niece until my sister could be back with her.

I was there when my niece K was born. My sister J had not gone through Lamaze classes with anyone. I was lucky enough to be back in Arkansas during a break. The labor department wouldn't allow my mother to be with her as she had not attended the classes (though she had eight children of her own). My sister's Ob-Gyn was a classmate from medical school. He over-rode the nurses (who were just obeying hospital rules) and allowed me to be there. I think I helped her by being there. Though there came a time when I "lost" patience with her and remember telling her to "quit screaming and push".

My niece T had to have her tonsils out. I happened to know the anesthesia group at the hospital, but didn't have privileges there. I asked one of my friends (anesthesiologist) to take care of her. He became my "stand-in". He treated her as if she were his daughter.

More than ten years ago, my mother had a ruptured diverticuli. She needed an exploratory laproscopy with partial colon resection. She was horrified at the thought of maybe needing a colostomy. Her general surgeon, my friend, allowed me to be with her. I helped the nurses get her settled on the OR table, held her hand as the CRNA put her to sleep, opened supplies an needed, etc. I hadn't planned on scrubbing in, but when he asked if I would like to do so--I jumped at the opportunity. I held retractors, etc. Simply assisted. She did not need the colostomy.

When my sister C had her hysterectomy at a hospital where I have privileges, I went with her. I held her hand as anesthesia was induced. I then sat up near the head of the table, out of the way. Her Gyn didn't ask me to scrub in and I didn't ask. I had already "picked" her team, asking scrub nurses and circulating nurses to be with her.

When my mother-in-law had her renal artery aneurysm surgery, I did not go with her to the operating room. However, after she "bounced back" a week after discharge with a hot gall bladder, I did. My husband was in the waiting room. I held her hand as her CRNA gave anesthesia, helped with whatever needed to be done. My presence made both her and my husband less anxious.

My sister S, had a broken patella repair in Arizona. It was going to cost her more to have the wire removed after she healed than it would cost her to fly to Arkansas and have me remove it. So I did so.

If one of my nieces or nephews needed a laceration repaired, I think I would want to be the one to do it. They bring their teddy bears to me for a "plastics repair" so I hope they would call me for their own "plastics repair".

I have never allowed my family to make me their "family doctor". I don't want to be responsible for their diabetes (Type II), their hypertension, etc. They have respected that though I am often asked "can't you get brother J to do this or that for his diabetes?" I can't make any of them do "something for their health" anymore than they could get me to give up chocolate.

As a physician and a surgeon, I try to remember I am no more perfect than anyone else. I try not to "beat" myself up when I have a complication. Notice the try. Some times I do better than others. I do review each one and try to learn from it, figure out what I could or should have done differently. Sometimes there are no clear answers.

8 comments:

Sid Schwab said...

"Being there" is one thing we as physicians can do for friends and family. When my son was having surgery, I went into the OR a couple of times and reported to my wife. I've operated on friends, and on family when it was very minor. For a while I thought my son had a hernia when he was a baby, and since I liked the way I did pedi-hernias WAY more than the way others did them, I thought long and hard whether I'd do it myself. Fortunately it became irrelevant. But there's an interesting balance between crazy ego and realism. I don't know where it is, but it's interesting...

rlbates said...

Dr. Sid, do you think that since we "even think about that balance" that maybe we might somehow find it?

mark's tails said...

rlbates wrote: do you think that since we "even think about that balance" that maybe we might somehow find it?

If you have the answer please, please let me know.

rlbates said...

Mark, I thought maybe you or Dr Sid would be able to tell me. :)

Femail doc said...

As you know, I am up to my ears in my mother's care. I think one of the greatest privileges of my medical training is the ability to be first responder to my family's medical needs. Since I don't do hospital care anymore, there's only so far that I can take it, but I am grateful that I can point friends and family in the right direction.

By the way, my mom's 'Grand Canyon' of a wound is now completely closed; knowing the right online plastic surgeon to consult was a medical blogger plus!

rlbates said...

Femail Doc, thanks! Glad your Mom is better.

SeaSpray said...

Wow! I think that is wonderful that you were able to be there for all of your loved ones like that. I surely would be more comforted if it were me or a loved one knowing that someone special was in there also looking out for them.

Was it weird to look inside your mother's abd cavity or at that poinyt was it surgery as usual?

You are so blessed to have all those siblings! :)

I enjoyed the post. :)

rlbates said...

Seaspray, it may be a "flaw" in me, that point with the drapes on, etc it wasn't completely surgery as usual but I didn't find it wierd.