Juggling Patients and Parents
I had been on overnight call in the Coronary Care Unit (CCU) every third night for the last two weeks. The days blurred. Weekdays and weekends felt the same. While checking patients’ alertness during morning rounds by asking them to tell me the date, I had to pause and double check my watch: I wasn’t sure myself. Then I remembered that it was Sunday.
Most Sunday mornings, I call my Mom for an extended chat. Even if I’m on a shift in the hospital, I usually find a minute just to say hi. It’s when she’s most relaxed, and the rest of the house is quiet. Growing up, we would wake up early together and sit at the kitchen table drinking our coffee together, while my Dad and sister slept upstairs. With my erratic work schedule these days, our chats are sometimes a quick, “Hello, I love you, I’ll call you later if I can.”
After rounds, I dialed my parents’ number. No answer. Unusual for Sunday morning at my house, but I didn’t make too much of it. I tried again that evening and after eight or nine rings, I hung up. Perhaps my parents had gone out to dinner.
The next day, I was on call again. By 9:30 that evening, I finally had a free moment and snuck away to the call room to try and reach my parents. Neither answered the home line or their cell phones. Finally, half an hour later, I reached my mother on her cell. Her voice sounded off – a little forced. She never tells me right away but I knew something was wrong.
And then it came out.
“Well, Dad wasn’t feeling well on Sunday. He wouldn’t tell me what was wrong, but then he started having chest pain so I took him to the hospital.” My mom proceeded to tell me that my father had had a small heart attack and had been admitted to the CCU. His cardiac catheterization had shown a blocked vessel. It was small, so no stent was placed. The doctors were in the process of discharging him from the hospital.
At first, I didn’t let it register. “When did he start having chest pain? What did his EKG show? Did they do an ECHO? Which vessel was it? How high did his enzymes climb? What meds did they put him on? What’s his blood pressure? Is the cath site okay? Where did they go in? Who is his cardiologist? Let me talk to Dad!”
My mother, an OB/GYN unaccustomed to dealing with heart-related issues and clearly stressed, was annoyed by my barrage of questions and passed the phone to my father. A cardiologist himself, he is possibly the calmest, most easygoing person I know. His voice on the phone was immediately reassuring: “Don’t worry. I feel good. Everything is going to be fine.”
But I needed to know exactly what happened. While I spent sleepless nights in my hospital’s CCU taking care of patients coming in with chest pain and massive heart attacks, my own father had been nauseous and “uncomfortable” over the weekend and was now lying admitted in our local hospital back home in New York – recovering from a heart attack of his own. I felt so guilty. Perhaps if I had been home or at least found time to talk to him more often, I thought to myself, this could have been prevented. I should have bugged him more about his blood pressure, cholesterol, diet, and exercise habits.
I sat down on the call room bed to think about what to do. How could I stay in this CCU taking care of individuals I barely knew while my own father was in a similar facility back home? What if those doctors hadn’t taken good care of him? What if his medications were wrong? What if he bled after the catheterization? What if his echocardiogram suggested that he might develop heart failure, and he was just telling me everything was fine so that I wouldn’t worry?
My pager went off. Another admission. Myocardial infarction (heart attack) from the emergency room. I wondered whether to page my chief medical resident and ask her to call someone to cover me, so that I could go home. I am fortunate to be in a residency program that is tremendously supportive to residents when we or our families fall ill. This might not have been the case a generation ago and might still not be the case at other programs.
I called my Dad back. “Are you really fine?” He laughed. I could hear him smiling through the phone. “I promise you, I’m fine. What are you going to do at home? You’re coming for New Year’s in a week anyway. Now go on and do your work.”
I told him that I loved him and hung up the phone. He sounded ok. I thought about the many complicated patients in the CCU down the hall from my call room. If I left now, explaining each one’s nuanced developments that day to another resident would take a long time. It would mean another transition in patient care. One more handoff and a fresh opportunity for error.
Would I want the physician taking care of my father to leave in the middle of the night, passing him off to another resident as a checklist of “to dos”? No, I would want the same resident to be present on rounds the next morning, clearly and confidently explaining his history, physical exam, and overnight events to the attending physician. My Dad sounded like himself. I was going home in a couple of days, and it didn’t feel quite right to leave a CCU full of sick patients, each with a family hoping that I was doing my best.
Yet as I walked back into the CCU, I still felt the weight of knowing what had happened to my father, acutely aware that I was here, in Boston, rather than at home with him. Residency is a tremendous privilege. It is a time during which patients allow us to learn from their illness and share with us the intimate details of their personal lives.
But, it is also a time during which I can’t help but feel torn between my professional duties and personal responsibilities. Though my family, close friends, and even my colleagues understand, that doesn’t make it easier. Had my Dad sounded the least bit unlike himself, I would not have hesitated to leave for home. But I could hear the conviction in his voice. We both know that although I am a doctor, doing my utmost to help the individuals in my care, I will always remain his daughter first.
The Boston Globe | January 27, 2012