Dad’s quality of life a family matter

Dear Dr. Gott: I enjoy reading your column on a regular basis for your practical and caring advice. As a nurse for 29 years, I believe patients must trust and believe in their physicians to receive the full benefit of their treatments and plan of care. My parents in Florida have been seeing the same physician for 20 years. I have questioned some of his practices in the past, but I feel it is my parents’ decision to see whom they are comfortable with.

In light of the scenario I’m about to describe, I’ve come to question the physician’s judgment. After suffering several strokes, resulting in left-sided paralysis, my 83-year-old dad has received total care from my 80-year-old mom at home every day for the past three years. He is essentially bed bound with the exception of my mom independently getting him out of bed using a Hoyer lift for about three hours a day. Just recently, my dad was hospitalized for 10 days with a urinary tract infection, vomiting, no output via colostomy and abdominal pains. He was treated with IV antibiotics and remained on a clear liquid diet throughout his stay. Needless to say, he became even weaker from this occurrence and his physician told my mom that he was “very fragile.” Prior to discharge, the physician voiced his concern regarding a lesion on my dad’s face, which he suspected might be a skin cancer and felt should be removed. My mom responded that she felt this was the least of my dad’s problems.

But he persisted, even dismissing the difficulty of mom bringing dad to his office by herself and suggesting she get a taxi driver to help move dad.

This is the most absurd thing I have ever heard of, as my dad is extremely fragile, never mind the risk and liability involved in asking an untrained person to lift and carry someone in such a state.

I would appreciate your feedback, as this incident has made me very angry. I would also like to get the word out to our seniors to speak out for what they believe.

Dear Reader: I agree with everything you said. Obviously, what you and your parents are trying to address is quality of life issues.

To that end, I see no purpose to be served by having the skin lesion removed immediately.

Rather, I encourage you to have a frank discussion with your parents (and siblings, if appropriate) about what their expectations are, how to handle medical problems in the future, whether your mother needs assistance at home, and – most important – how best to define what your father wants.

If your dad cannot make his wishes known, someone in the family should have power of attorney and what is called, in some states, a health care proxy that enables a person to make medical decisions about patients who are unable to do so for themselves. Involve your family attorney in the paperwork and actual legal documentation.

Then, when the family has reached a consensus, the documents should be presented to the family doctor for implementation. Perhaps this exercise will improve what you term are his “judgments.”