MGordon_MD
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Jan 3, 2008, 12:54 PM
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By DR. MICHAEL GORDON
My 94-year-old father’s fall and fractured hip was a disaster waiting to happen. My sister Diane and I had taken steps after it became clear last year that he could no longer safely bathe himself and that his walking was insecure. We convinced him to accept bathing help, which with some gentle coaxing worked out well, and we bought him a walker, which, he agreed, improved his ability to get around safely in his Chicago retirement home not far from where Diane, who is his primary family care provider, lives.
One morning, the call came. “Daddy’s in the emergency department with a broken left hip. He will go for surgery, either today or tomorrow,” Diane said. It was a Friday. I was able to get weekend coverage and managed to get an evening flight and went straight to the hospital. He had been admitted to the orthopedic floor after a number of hours. The attending internist felt he was in good medical shape for surgery, but wanted clearance from the cardiologist who had looked after him during his previous heart attack and successful by-pass surgery.
The orthopedic surgeon explained his plan, which made good medical sense to me. It balanced the surgical options and the desire to have as short a procedure as possible with early mobilization. Having previously done a lot of geriatric medical consultations on orthopedic patients, I felt comfortable letting things unfold according to the outlined plan, and Diane and I felt confident in the surgeon.
The next morning, we arrived in good time to see our father off to surgery. Time passed and he was not taken to the operating room as scheduled. We were informed that the procedure was cancelled and eventually the orthopedic surgeon and internist explained that he was inadvertently given 10 times the stated dose for one of his cardiac medications. There was no real danger to his medical status, but it was felt that the surgery was better postponed for a day. The next morning, the procedure was done with no apparent problems. I returned home while my father was still recovering from his surgery, but was awake and could converse with me.
Since then, my challenge, along with a number of visits to Chicago, has been to balance my physician and family roles while assisting my sister with her observations without imposing my medical status on those responsible for his care.
At one point, when Diane and I felt the members of the rehabilitation team were failing to acknowledge and address substantial medical issues that were interfering with his progress, and were thinking of early discharge because he had reached a “plateau,” I put on my “medical” hat.
I wrote as diplomatic a letter as possible to the head of the department outlining our concerns about some aspects of the care my father had received and I expressed concern that many of his problems could be rectified if his needs were better addressed within a geriatric patient framework. It was a gamble, but I couched the letter with acknowledgement and praise of the team’s efforts, yet also pointed out areas where I felt there was potentially greater optimism for the outcome.
It seemed to work. The team’s response was positive and supportive. Gradually, many of the issues were addressed. Diane and I are hopeful that our father will return to a reasonable level of functioning, but we’re also realistic that he might require more daily care.
Balancing one’s professional role with being a loving child can be challenging, but if done well, it can lead to a positive outcome and a responsive reaction from the treating staff.
This article originally appeared in The Canadian Jewish News
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto. He is co-author with Bart Mindszenthy of Parenting Your Parents.
Parenting Your Parents is available in bookstores and online at: Indigo-Chapters, Amazon and Barnes & Noble. It is available in a US edition: Parenting Your Parents: Support Strategies for Meeting the Challenge of Aging in America.
For bulk orders email info@dundurn.com. Call: 416-214-5544 or Fax: 416-214-5556
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