I call my mother to say my plane will be on time, and she tells me “someone” will pick me up, as they’re taking my uncle to the hospital with a BP of 220/120 and a HR of 40. Upon my arrival, I am whisked off to the local hospital’s ICU, where the neurosurgeon is assessing my uncle for surgery for his bilateral hygromas. I ask who the anesthesiologist will be and am told, “it doesn’t matter.”
Right, I think. Duly noted. Receiving the message that, as a patient, who your anesthesiologist is does not matter, really gave me something to think about. As someone who was considering my options for areas of specialty training in medicine, that message didn’t sit well with me. In addition, the comment made me feel uneasy about such an unfriendly, unengaging response to a concerned family member.
Flash forward 10 years. I’m on ICU call while doing my training in anesthesiology at Stanford and my pager goes off at 6:00 am. It’s my mother, telling me she’s taking my father to the ED of the same local hospital—the one where I will be starting on staff in 3 months—because “something is wrong.” I drive the 20 miles and meet them in the ED. We find that he has a ruptured spleen (from his thrombocytosis-induced splenomegaly), and will need surgery. The ED physicians ask who we want to see him, and luckily our first choice surgeon is on call. My future partner, Dr. Larry Sullivan, is the anesthesiologist on call, and I start to relax—just a bit.
I certainly knew by this time that who your anesthesiologist is does matter. I believed it so firmly I had selected it as my specialty. I was also more aware of the inner workings of the emergency medical setting and could assist my family better by asking tough questions and simplifying information.
Flash forward another 10 years. My cell phone rings, and I’m told my godmother is in the ED at my hospital with a stroke. I arrive in the ED, go to the back and the physician taking care of her (the “new guy” whom I haven’t met) says to me “Oh, I should have waited for you to intubate her.” I was glad I wasn’t faced with that option—I know that I can’t be objective in this situation. She has had a significant hemorrhagic stroke and may need surgery after we reverse her anticoagulation. The following day she does go to the OR for decompression. I knew everyone on the surgical team and was able to reassure the family members that she has great medical care.
Each of these experiences was stressful, but for different reasons. In the first, I knew the issues associated with increased ICP and the associated risks of anesthesia, but I didn’t know anyone involved in my uncle’s care, and was just “that surgery intern.” In the second, I was extremely stressed, but Dr. Sullivan made me relax by introducing me to the OR, PACU and ICU staff as “our new partner.” In the third, I was the one calming down everyone else, and confusing the staff as to my role in the ICU, since I was “just family.” It’s a tough and insightful experience to be a physician in the midst of a family medical emergency.
Medical school and residency do not always prepare us well with respect to patient/physician interactions. Simulated encounters, as used more often now, help physicians learn how to talk with patients and their families. As in all things, some of us are better than others. But none of us are taught how to deal with being the family member, or even the patient.
As a physician and specifically as an anesthesiologist, I have taken home several lessons from these various encounters. The first is that it’s much easier to talk with patients and family after you have been in those tough roles yourself—and they will recognize that empathy. The second is that “hello,” “please” and “thank you” go an awfully long way to making things better (just like I was taught in kindergarten). The third is that family members really need things to be explained in concrete terms (not the least of which is how you as an anesthesiologist are an important member of their care team). I found that the biggest thing I did was “translate,” not just from medical terms (which most of my extended family know, being in the business themselves), but to short declarative sentences. I frequently had to ask questions in a way that a short sentence was the only way to answer. And the last thing is that your colleagues will automatically look to you to function as the spokesperson, whether or not that’s appropriate. Be prepared to redirect your colleagues if necessary. Ask the difficult questions for the family members who won’t.
I know that I will be the family member again some day. And while I may be stressed and upset, my earlier experiences will make it easier for my colleagues and me to navigate the care of my loved ones in the future.