I haven’t blogged for a while. Many reasons.
Certainly when I started to write blogs I intended to produce them
uninterrupted until the end of time and maybe a little bit beyond. But there were the holidays, my many tasks,
the kids, etc. Those things are my responsibilities, joys or distractions, depending on the moment. The real emotional drain and time sink of
late has been the medical issues with my aging parents. Both parents are in their 80’s and time stops
for no one. The sand runs down the hourglass
and time’s conveyor belt moves along its circuit with no pause button. My mom had complications from a heart surgery
that have left her in skilled nursing care and I recently returned from Tucson
where my dad had an abdominal aneurysm repaired. Dad came through surgery and my mom is
stable and trying to recover. It is very
different for me being on the sidelines while medical care is provided. I spend my days presenting options and
being in charge of making things happen.
As my wife likes to point out, I don’t like it when I’m not in
charge. The veterinary and human worlds
of medicine are not so different. And,
they are worlds apart. Some things in
human medicine are better. Some
aren’t. The truths and our needs are the
same. We need to understand and
participate in decisions. Patients need
to have advocates. We need
hope. When we can’t have hope, we need
honesty. When we need honesty because we
can’t have hope, we need empathy and support.
In
watching my parents care, I saw skill, talent, empathy, genuine concern,
innovation, and efficiency. I also saw
indifference, rampant inefficiency, unnecessary roadblocks, resistance to
patient advocacy, narrow thinking, and system failure. Mom’s heart surgeon is the best. He is an older guy who worked under the
original guy who developed some of the first heart valve techniques in the ‘60’s. I think he did Moses’ pacemaker. As talented as he is, I’m not sure his team
tried to see how prone mom was going to be to complications. When things went south, the family was really
out of the equation. There was no one
specifically in charge. She was under
anesthesia/heavy sedation for more than a week with only a vague plan.
Medicine was in charge of this. Surgery was in charge of that. As good as everyone was at their parts,
they were individually reluctant to drive the bus. Without central responsibility, it was hard
to decide who to be mad at. Or, who to
direct the advocacy towards. Her nursing
staff was mostly fantastic and was the best at centralizing her decisions and
care.
My
brothers and I flew to Tucson several days before my father’s procedure to
spend time with him. We randomly cleaned
his garage. This had been his wife’s
idea so we would throw away, or give away, anything that could be used in a
task she considered dangerous. All
plumbing supplies, ladders and power saws needed to go. Had I known I would’ve brought a bigger
suitcase. When he looks for these things
later, everyone can share the blame for their absence or claim it was someone
else. I plan on phrases like, “Terry
must have given away your conduit”, “I think Tom put your outlets somewhere”,
and “Hmmm. I don’t remember seeing a
circular saw.” We also organized his
shop area, likely ensuring that he never finds anything again.
This was not intentional. The morning of the procedure my two brothers,
dad’s wife, and I waited in surgical waiting.
The chairs were right out of the inquisition on the comfort scale. The surgery went well. The doctor came out and updated us. And then we waited. Six hours later he final was transferred to
an actual room and out of the recovery area.
This was at least 5 hours later than we were told. It was not anything to do with his recovery,
they just didn’t have a room and family can’t come into recovery. My brothers had to leave for the airport and
didn’t see him. Surgical reception stonewalled
them and still said they couldn’t see him.
Dad’s recovery nurse eventually came out and took his wife back to see
him and I got to go back a few hours later.
His surgery was a success and we all agree that that was the most
paramount issue. But we have lives as
well and need to be kept in the loop.
Either make sure there are enough rooms for the day’s patients or open
up recovery to the family. The family
wasn’t an important part of the plan.
There was little consideration within the system for us. I can empathize with this
professionally. We never get too busy
for patient care but we can get busy enough to drop communication and for things
to be delayed. We all do our best but
this struck me as a system failure beyond just a busy day.
In
looking for the silver linings, watching medicine makes me reflect. Human medicine can do miraculous things and
has treatment modalities that we haven’t developed or we under-utilize. Directed specialization creates healers that
are exceptionally skilled and this allows so much care that wasn’t possible not
very long ago. But, it is too big sometimes. There is disconnect and things get moving at
a pace where they don’t stop and check in with the family and patient
advocates. We can do everything; we need
to ask ourselves if we want everything.
As veterinary medicine advances and we have more equipment and more
options, we need to keep to the things that got us here. The needs of the patient, not their disease,
should drive medical decisions. The
information needed to make those decisions should come through a doctor and
staff that know their patient with full participation of a patient’s
advocate. The doctor-client/patient
relationship is integral to medicine. Veterinary
medicine is far from perfect but I feel like as a clinic and as a profession we
strive to protect this connection. May we
never lose that.
I missed seeing such a relationship at work with my mom and dad.
Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)
Outreach Chairman, American Board of Veterinary Practitioners
