A patient’s dignity and daughter-and a race

Dr. Donaldson is a urologist in community practice in Hendersonville, NC. He is author of the book "Urological Surgery & Lite Hauling," and host of "I'm Just Saying" on WTZQ FM 95.3 AM 1600 in Hendersonville. Urology Times blogs present opinions, advice, and news from urologists and other urology professionals. Opinions expressed by bloggers are their own, and do not necessarily reflect the views of Urology Times or its parent company, MJH Life Sciences.

I’m a urologist. I’m doing my best to care for the urologic needs of my community and not kill anyone in the process. Into my morning a woman with her elderly father bursts through our practice’s inner door. She is clearly upset. She leads her father by the hand as he stumbles, as if lost, as if he cannot see. He takes short, nervous steps and reaches for the walls to steady himself, as if inebriated. He does not speak despite his daughter’s desperate pleas.

I discover later he does not speak because he cannot speak and he walks as if he’s blind because he is blind, and all of this happened today.

I am a urologist, a surgical subspecialist, and I spend the majority of my days negotiating with patients. Like most doctors, the majority of my day is spent handholding, counseling, relieving anxiety, and otherwise dealing with problems that aren’t necessarily medical. Fact is, this is a point of disappointment and exasperation among physicians and it probably has much to do with the “burnout” being discussed in the doctor world.

I see this woman, with father in tow, enter room six. I ask my nurse, what’s the story? She has no idea, so I just walk in the room. Turns out, they had been in the emergency room all night. The father, age 80 and a bit, has been having small strokes over the past month or so.

Each time he has a stroke, the daughter calls EMS and they take him to the emergency room. In the ER, they do a CT scan of his head and some blood work. Every time, whatever symptoms he had, unable to move an arm or leg, all those symptoms resolve. It’s called a TIA, a transient ischemic attack, a small stroke that resolves.

Every time, after his symptoms resolve, he is sent home and every time the doctors say there is nothing else they can do. This time was different, as this time he was blind. This time, he lost his hearing and his ability to speak. This time, nothing got better and the emergency doctors had nothing to offer, so this time, his daughter left the emergency room and brought her father to see me.

I've known this man for years. I'm a urologist not a neurologist, but I am still a doctor and I can read so I call upon those human parts like compassion and empathy, even curiosity, and I read the chart. Turns out this man is having multiple small strokes and there’s nothing the experts in this area can do about it. He’s dying and nobody has told him, so I do, or rather I tell his daughter.

I say, “Ma’am, your father is dying and there is nothing anyone can do.”

She says, “What do we do?”

“We call hospice, and we allow him to leave this world with all the dignity that he has lived upon it.”

She looks at me, then her father, and she burst into tears and nods in agreement. You can feel and see stress leave the room.

“Tell me about your brothers and sisters. Will they agree?” I ask her.

This is always the touchy part. Those who are approaching the end of their lives rarely-like never-discuss their wishes with those they love the most. It’s like a chronic unspoken state of denial. And worse, there is always some kid somewhere who hasn’t spoken to Dad in 5 years because they never got along, had a big argument, moved away, married a crazy person, or got lost, but now their moment has arrived. Now, they will drop everything they are doing and fly in from somewhere far away and demand everything be done to save their father if for no other reason than to alleviate their guilt. Mercifully, not this time.

The daughter present calls her sister, who quickly arrives. They get on the phone with the third, and quickly everyone is in complete agreement. I call hospice; they will come to their house later in the day. During this conversation, the man who cannot speak and cannot see now cannot walk. The daughter, being that daughter who has to take care of everything, tells me she will drive her father home.

“How are you getting him to the car?” I ask. “You’re half his size and he’s not helping.”

“You’re gonna help me,” she responds.

“No, I’m not, plus even if I do, how are you getting him from your car into your house?” I say.

She persists and I insist, “We’re calling EMS.” Two young, strong EMTs load him on a stretcher and they’re off.

I finish my day. As is my practice, whenever I place a patient in hospice, I visit them at home. I drive a 1970 Ford F100 pickup truck which, with a few upgrades, is the same truck I drove in high school. The truck no longer runs on leaded gas, and it has power steering, power brakes, Bluetooth, and “Urological Surgery and Lite Hauling” stenciled on the door. The Bluetooth is more of a novelty; nobody can talk on the phone and drive that truck.

The family lives at the end of a long and winding mountain road. I knock on the door and they invite me in, surprised to see me as this visit is unannounced. The hospice nurses are there doing their deal, sorting through his medications and the family needs. There is laughter, tears, and more laughter. We have moved from a place of apprehension, fear, and anxiety to a place of peace and acceptance and remembrance and even, it’s hard to imagine, joy.

My patient’s bedroom is a short walk from the kitchen. Leaving the hospice nurses to their work, I walk down the hall. There is NASCAR memorabilia hanging on the walls and a shrine at the end of the hallway to the greatest driver of all, Dale Earnhardt, and his black number 3 car. I pause to take this in. My friend Andy Petree was Dale Earnhardt’s crew chief.

I walk into his room, the TV is on, and it’s a race-a rerun of a NASCAR race from years ago. From his bed, he looks over at me and speaks: “Doc, sit down, we got a race.” Turns out, somewhere between this morning and now, his sight had returned as well as most everything else. It’s called a transient ischemic attack because it only lasts for a bit of time and then gets better. Eventually, one of these TIAs will not be transient but permanent and will kill him-just not today. Today, at this moment, he feels pretty good and we’ve got a race on TV. So I sit down, propping my feet up. One of his daughters brings me a glass of tea. I’ll call this a pretty good day.

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