BY SABRINA AHMED
Four physicians in the family- two doctor daughters and two doctor son in laws. Every Indian parents stereotypical dream. I used to joke that my Dad whispered medicine to my sister and I in utero but in all truthfulness he just encouraged us to aim high and we happened to love medicine. Every doctor that came to his bedside would laugh and comment on how he was well cared for with four doctors around him. He would laugh and say that we all drive him crazy. But he also told me how thankful he was to have us to guide his care and take care of him and how he trusted me to do what was best for him. As the family doctor of the group, he often spoke to me about his conditions. Up until that moment it had been occasionally adjusting his insulin, rushing him to hospital when he had urgent cardiac issues and communicating with his multiple doctors. But as I watched him writhe in pain day after day plugged into a dialysis machine with rigors so severe the entire bed shook, I realized that I was not helping him. Nothing was helping.
How does a doctor daughter tell their father medicine has nothing left to offer. I hoped someone else would but his truly wonderful team of doctors were too busy looking for answers we desperately needed. How do you switch from endless daily tests, countless medications and the broadest spectrum antibiotics to nothing? A three month admission, endless specialist consults looking for an explanation for his fever and pain but his body was weakening while they searched. He had told me several months prior, just weeks after starting dialysis, that it was a mistake. He told me he was at peace with meeting his creator and that was when he was in his home but suffering side effects and exhaustion from the physical rigour of the treatment. "No Dad, it will get better. Look, you are better- you're not short of breath anymore." I was optimistic but he perhaps already knew dialysis was no miracle cure.
As the treatment for one illness led to another complication and that complication led to another, I watched hopelessly as the tower that held me up my entire life seemed to crumble. The powerhouse of a man weakening. In one sudden moment where I could no longer watch the suffering, I quietly walked over to the palliative unit with my husband. I felt morose telling this caring palliative physician, a colleague of my husband, that I don't know if my Dad wants this. Someone needs to talk to him. Nobody has asked him. He nodded and understood. He said quite simply, "Well, lets go ask him." He walked immediately with me to my Dad. I felt the eyes of the entire medical team watching me as we walked by. I felt like I had called the grim reaper into my Dads room. I wasn't sure what my Dads mental clarity would be in that moment- febrile and unwell for weeks, moments of delirium- but, in fact he was crystal clear. My Dad had always been clear, the voice of reason my entire life when I had questions. He guided me in every important decision I made in my life with such wisdom. So of course his answer was just as wise- I don't think dialysis is helping. I don't want any more blood tests. I only want dialysis if it gets me some improvement, if it allows me to go home and spend time with my family. He was tired but willing to fight if that fight led to something better. He decided to continue dialysis for a bit longer to see if there was any improvement. One week he said. I questioned whether dialysis could lengthen his time with me and his beloved grandkids. I wished it wasn't such torture. I prayed for him to get stronger and for healing. But then, over the next few days, I saw him further weaken, now struggling to lift his head, unable to get to the bathroom. This is not what he wanted. He had told me his wishes so many times, in so many ways. So this time, his doctor daughter spoke to him. I could see he was doing this for my mom and us, for the two doctors daughters who checked his labs multiple times a day and raced to meet the rounding team everyday and questioned every detail of his care. So I spoke. "Dad, sometimes medical treatment becomes torture. Nothing is working. If it's too much for you, it’s ok to stop Daddy." As a family of faith we took comfort in knowing when the doctors had nothing left, it was in the hands of the divine. " If you’re too tired, You can leave it to Him Daddy." He was so weak I wondered if he understood me. Did he think I was telling him to stop? That fear haunts me still. He told me that night, we will do one more dialysis tomorrow morning and then see. But that night, in the quiet solitude of his room, in some moment of what I like to think was a call from the heavens, he decided he couldn't continue. He asked to speak to the on- call resident and said he didn't want to do dialysis that morning, he was too tired. In fact, he was too tired for it all and when we raced to the room that morning like we had everyday for the last three months, we found him sleeping but this time he never woke. He had found peace. Seven days later, my father returned to his creator.
Being a doctor fundamentally changes how we experience illness and that of our loved ones. We have the knowledge to know and understand every complexity of the disease and also the knowledge to be acutely aware when nothing is working and especially when medicine is causing harm. We have the privilege to accompany our own patients and their families through these difficult moments but walking them with our own parent is unfamiliar and scary territory. The day after I spoke to palliative care myself, the team told me they didn’t bring in palliative care themselves as they weren’t sure how we would react, four doctors at the bedside, that we may not have been ready. They knew the direction this was headed I’m sure, but I understand that to tell the physician daughters and son in laws was difficult. But I knew, we all knew. Sadly, almost every doctor daughter will walk this same path with their parent. I have no doubt that sons go through the same.
But as I watch my own daughter smile up at my husband, I am reminded of how special the father daughter bond is, how she will one day care for him as he cares for her. Doctor daughters in the end are really above all just daughters. Daughters who in the difficult final moments know painfully too much.
My name is Sabrina Ahmed. I’m a mom of three and a family doctor from Montreal, Quebec. Thank you for the privilege of sharing this on the CWIM blog.