Daughters

When I was early in my career, I was working with a medical student and we walked into a patient room. This was my first day on rotation, picking up my list from a colleague who told me that the family was very needy, and patient was ready to go to subacute rehab in a day or two. Instead, when I walked into the room, there were two daughters seated bedside. They greeted me by saying, "How do I spell your name? I want to make sure we get it correct when we sue you."

Anyone who's worked in medicine for long enough knows the story of daughters. My nurse doubted me, but over the last several years, she has seen it too. Every hospice patient, every terminal situation, every tough cancer case, there's always a daughter in the room, demanding answers.

Rather than get defensive, I sat down with the two daughters and said, "Let's talk. Tell me what's bothering you." And I listened for thirty minutes about how they didn't have any answers, about how their father continued to worsen slowly and wasn't getting better, and finally about how their father had a solitary pulmonary nodule on the CT scan before and nearly died from an aggressive lung cancer. Sure enough, he was deteriorating. His mentation and cognition were dimmed from numerous acute medical issues, and he never recovered from the aggressive chemotherapy that sapped his body and mind. I listened, and I agreed. I didn't have answers. I didn't know what this nodule was. I didn't know if their father would ever leave the rehab facility.

By the end of that thirty minutes, I examined the patient, barely conscious, and then said good-bye to the daughters after going through the details of the plan that lay ahead. I hugged them both, and while they fought back the tears, they both thanked me profusely, telling me that I was the best doctor they'd ever met, and how that time spent with them meant so much.

My student was totally awestruck. He had no idea that such a chance encounter in the hospital could lead to such a profound moment for a family. We stepped into the nursing station for a moment while I talked to the patient's nurse about modifications to the discharge plan. While writing some orders, I turned to my student.

"I did nothing skillful in there today. I sat and I listened to two daughters who care very deeply for their father, and who desperately want answers. The lesson you should take away from this case is--"

"We should listen to our patients and their families?" my student suggested.

"What? No. The lesson is that if you go into a room and see daughters at the bedside, get yourself ready. You're about to get rocked."