BMJ  2005;330:E342 (19 March), doi:10.1136/bmj.330.7492.E342-a

BMJ USA: Filler

The doctor, teacher, daughter

I wanted to cry as I walked into the hospital room and saw him lying there, too weak to even smile at me, but his eyes searching my face for help, hope, answers... Two days before my mom had phoned me, fear and panic in her voice, as she told me that he couldn't walk or swallow food or water. I told her to call an ambulance, and I'd arrange to be there as soon as possible.

My dad, who had just turned 90, had been slowly declining since his thoracic compression fractures the year before. On a recent visit home, a four hour drive away, I had noticed that he was moving slowly with small shuffling steps, his face devoid of expression. "My mind is blank," he informed me, his voice flat. Parkinson's, I thought sadly to myself.

Now just three weeks later, he lay almost motionless. I leaned over and kissed him. "How are you, Daddy?" "Thirsty," he whispered. I reached for the pink sponge-on-a-stick, dipped it in water and swabbed his mouth. He noisily sucked the water out and asked for more. At that moment I wished he were my patient, and I could turn around and walk out the door, my visit finished.

And if he were my patient... my internist brain clicked into action—was this dysphagia from progressive Parkinson's disease or a CVA? The head CT was negative, but it was too early to show an infarct. "Daddy, I'm going to check a few things," I said as I proceeded to systematically assess his strength, sensation, reflexes.

He motioned for the swab and like a dutiful daughter, I placed the sponge in his dry mouth while he gratefully sucked and tried to swallow. It reminded me of feeding my babies and Jesus on the cross getting a sponge filled with vinegar. Over and over, I dipped the sponge, knowing full well that he would probably fail a swallow study.

The next morning he was very short of breath. I pushed the call button. After waiting 10 minutes while my mother got more frantic, I tracked down the nurse to call his doctor to order a chest x-ray and oxygen. She was reluctant to bother him until I threatened to call him myself. "Look, my dad either has aspiration pneumonia or fluid overload and probably both!" She shrugged her shoulders as she stomped off... as if to say "Can't you see I'm busy? He's 90; what's the hurry?"

"He's not just any old GOMER!" I wanted to yell at her, "he's MY dad!" She returned with the news that his GP was on vacation, but his new partner would come around lunchtime.

At 1:00 pm, Dr. Dobbs walks in, looking like my residents, but much more rested. Sure enough, he's fresh out of residency and excited about his small town practice. After a few minutes of small talk, he gets a serious look on his face and asks if we can talk in the hall. I know what's coming.

We step outside the room for "THE DISCUSSION." I study his body language, verbiage, eye contact. He's got good bedside manner, I think, as I mentally plan the feedback I should give him. I'm not really listening to the content, or thinking about code status; I'd rather teach.

That night I call a friend and tell him how I can't stop being the doctor and the teacher, how hard it is to be the daughter. "Just be the daughter," he advises, and I know he's right. The daughter cries herself to sleep.

Medical College of Wisconsin, Milwaukee wangrm{at}shpo.ah.org

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