What do you do when you have a professional “yikes” moment, a time when you realize you have behaved in a way you are critical of? How do you change a “no way” moment into an “Ah ha!” moment?

“I think I need to go to the ER.”

“Mom?” The clock said 4:30. My heart raced like I’d just finished a run while my mind lagged behind, trying to quickly orient itself.


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“I woke up and I felt funny. I took my blood pressure, and it turns out that it is really high. I think I need to go to the ER. Can you take me?”

“Mom?”

At 85 years old my mom is in good health, except for her blood pressure. Doctors call it idiopathic hypertension, meaning they don’t know have an explanation for why her BP is elevated. She stays slim, exercises regularly, and is usually cautious about her medications. She does all the right things but still her BP is labile. The idea of a stroke petrifies her.

“I’m on my way,” I said. Just our bad luck, instead of an empty ER it turned out to be one of those crazy busy times and was wall-to-wall with other patients. If she hadn’t been so frightened Mom would have left. When the triage nurse asked why she was there Mom said, “My blood pressure is up,” neglecting to mention the dizzy feeling she’d had or to admit she had stopped taking one of her medications because she thought it was what made her dizzy. On the way to the ER she told me, “I looked it up on the Internet, and it says it causes dizziness so I stopped taking it.” The nurse asked if there was anything else but she nodded no. So I did what I thought I should do. I started filling in the details.

“She actually passed out a week ago.”

The triage nurse raised an eyebrow.

“But that was from the heat,” Mom said.

Then, before I knew it, I took over. My desire for accuracy superseded her autonomy—at least that was how I justified it. In a busy ER, I knew she would only be allotted so much time to tell her story. So I jumped in, giving a detailed history, including the fact that she had stopped taking one of her meds. Mom is not a wall flower, usually she has no problem speaking up, but she let me take over. It was an odd shift of the daughter starting to mother her mother and the mother taking the role of daughter.

How this episode with my mother has impacted my practice is interesting. At the time, I was convinced I was doing the right thing and thought nothing more about it, until I witnessed a similar situation with Caitlin.

CASE

Caitlin is 36 years old and single. She had been out on her own with a satisfying career, two dogs, and her own condo. But her metastatic colorectal cancer robbed her of all that. She had to quit work and move in with her parents, which meant selling her condo and giving up her beloved dogs. Greedy cancer was consuming her physically and emotionally. When I first met Caitlin, hope loomed like the sun rising on the horizon. Two years and three chemos later it was sunset. She was dying and wanted to talk about it, but her father was not ready to have that conversation, he wanted to focus on what he had to do to help her get better. When we tried to discuss advanced planning, her father, heartbroken, was only willing to discuss her eating and how unsuccessful he was in getting her to eat. He was certain that if she ate she would get stronger and then could start one more chemo. When he talked of his hope, insistent and pressured in his speech, Caitlin sat in silence, her only communication was the tears that flooded her eyes. When she did object, “But I have no appetite;” he talked over her. “We need to find the right food, something with a lot of calories.” He spoke more than she did, interrupting or negating anything she said. Quietly, with no recourse, Caitlin stopped talking. She folded her hands in her lap and made no attempt to dab the tears on her cheeks. The meeting had devolved into a session for her father to gain support for his assertion that she needed to eat.