- Let Me Hold the Wheel, Daddy!
I have been in Family Practice for 30 years now, out of which 23 in the same office that used to be my grandmother's home. In spite of the rule that a doctor should not treat his family members, I do it all the time. Even before I graduated from residency, I wrote prescriptions for narcotics to help my mother who died of Multiple Myeloma at the age of 69. So when I opened my practice, in the same neighborhood where I grew up, it was only natural that other members of my family would become my patients. My father, my four children, my wife and her parents, my brother and two of my aunts, were all my patients, not to mention many friends, old and new, who live in the area.
My rationale for doing so was that I felt I was able to separate between my emotions and my professional knowledge, and I made sure I treated my relatives the exact way I would treat any other patient. And even if my family was under the care of another doctor, I would anyhow be involved in the treatment they received.
After my mother's death 28 years ago, my 71-year-old father continued to live the active life of a healthy man. He had been retired for 6 years from his job as a general manager of a large rubber factory. He kept a strict daily routine, maintained his home, went for walks at the beach or in mountain trails, and drove his car every day to one of his favorite restaurants for lunch.
Driving his car was for him the symbol of his masculinity and independence. He owned many cars in his lifetime, starting from a 2nd hand convertible Austin 7 with a manual starter, which he loved almost as much as his children, and did all the repair work on by himself. He remembered periods in his life by the car he owned at that time.
He rarely consulted me for medical problems, doing his best to avoid putting extra burden on me, since he always thought that I was under too much stress due to my work and family obligations. Luckily for both of us, he did not suffer from any major illness. Mild hypertension, benign prostate hypertrophy and biliary stones were his main medical problems. A suspicious skin lesion that I discovered on his flank turned out to be malignant melanoma, which was removed without further consequences.
When my father was 80, his urologist requested a PSA test. The result was 15—which is quite high, even for his age. A rectal exam performed by the urologist revealed a hardened area in the remaining prostate, which was most likely due to cancer. I decided to discuss the options with my father in the most open and direct way—since I knew how important it was for him to make his own independent decisions about his life. We discussed the need for a transrectal biopsy in order to make a definite diagnosis, followed by possible hormonal therapy, chemotherapy or radical surgery. We also discussed the option of not doing anything, not even a biopsy. My father chose the last option—he felt well, and did not want any medical test or treatment to render his freedom and independence.
I felt strongly that I acted in his best interest. He made it clear to me, in many occasions, that he would not desire any life prolonging procedures if he suffered from an untreatable disease. I knew [End Page 9] that prostate cancer at his age could be very slow growing, and that most patients die of other illnesses before the cancer spreads in their body. We checked his PSA level several times after that, but when my father noticed that it kept rising, he suggested that we stop measuring it, so we "don't get upset about it". I agreed.
The years went by. At my father's 85th birthday we organized a big celebration at the nursing home where his elder sister lived. He looked handsome and sharp minded as ever. He continued...