3272 This doctor is clueless

Dr. John A. Parrish, Harvard Medical School, writes about his 89 year old mother's death in "An unquiet death," JAMA Vol. 296, No. 21, Dec. 6, 2006. At age 89 his mother was imprisoned in an observation unit of a hospital (no bathroom, no nursing care) for knee swelling and agonizing pain. She had an orthopedic surgeon who was abrupt, superficial and no time to listen to Dr. Parrish's sister, who had become her mother's caregiver in this medical wasteland. Finally, his mother had had enough, and insisted on being taken home "to die." Her mind was absolutely clear when she talked to her daughter by phone. When the daughter arrived, her mother's speech was garbled and she was disoriented. Then in what sounds like a three stooges movie if it weren't so tragic and pathetic, the mother dies, alone and unconscious, in transit after a generous dose of morphine on the way to a non-acute care facility, which sends her back to the emergency ward. Now after her death, the loving caregiver, her daughter, is despondent and has sold her home which she shared with her mother, and can't stop crying.

John Parrish, who apparently never took time off from his busy academic schedule to do anything but check with his sister by phone, should have never written this essay, because he comes out looking not only like a bad doctor covering for other medical personnel, but a whiny, ineffective, uncaring son and brother. Read his list of rhetorical questions--you haven't even read the article, but I'll bet you'll be coming up with some snarky answers for him, as I was.

"With righteous indignation should I investigate and document every decision by every actor in my mother's care?"

"Am I obligated to use my mother's story as a case study?"

"Would my complaints help call the frequently unanswered question of who is in overall charge of a complicated patient hospitalized by a specialist managing an acute episode?"

"Should I feel guilty because I wasn't there?"

"Would my mother's providers have listened to a chaired professor at Harvard Medical School?"

"Would my discussions with her physicians and nurses have resulted in more communication among them?

"If I had been there, would I have participated in decisions about definitive care, assignment to a fully staffed hospital room, and regulation of pain meds?"

"Does my sister now having sobbing and shaking need an apology from a series of busy people?" [I can certainly think of one.]

"Should I focus on the benefits of my mother's prior health care--decades of caring physicians? Mastectomy, pacemaker, etc."

And this he doesn't put in the form of a question, but a statement: "My mother and sister were spared the stressful communications and difficult decisions required for end-of-life care at home. . . a dignified, calm death at home with loved ones is the exception because it requires so much decisiveness, planning and coordination with health care professionals. . .uncomfortable with the goals of dying at home."

I hope he's a better doctor than he was a son, but that final comment that we really can't expect a calm death because the medical profession is too clumsy makes me wonder.