- My Father, My Patient
"Education is the only thing that they can't take away from you."
These were the words my father would utter innumerable times during my childhood and adolescence. Over the years I came to know the meaning of those words and why this conviction ran so deeply inside of him. A man who survived the anti–Semitism of pre–World War II Poland and then the horrors of the Holocaust deserved better than to suffer from a physician error that led him to become totally dependent on others for his daily care. How could this independent, strong and intelligent man who had survived unspeakable horrors in the concentrations camps, in an instant become, in essence, my third child?
Before this event, other than using my neurological specialty knowledge in movement disorders to manage his mild Parkinson's tremor, I had played mainly a supervisory role in his healthcare. My [End Page 22] mother, his wife of over fifty years, died six months earlier and my father had just moved to Chicago to be closer to his children.
Upon his arrival in Chicago, I arranged his visits to the primary care physician—mainly to manage the warfarin he was taking because of atrial fibrillation—and to an excellent dermatologist because of a new skin lesion. A superficial skin cancer was diagnosed. Despite my suggestions to the contrary, he informed me that he was going to Florida for the winter and would meet with relatives who would be there in a few weeks. He said he would have the skin lesion taken care of there. I wasn't happy about the decision since we didn't know anyone in the medical community there, but being the smartest guy I knew, I respected his autonomy.
I typically called my father frequently, but that day I could not reach him. This was unusual, and although I had my concerns, I hoped he was out enjoying life. I got the call that afternoon from a neighbor who relayed that he was found wandering in the parking lot of his building in his pajamas. That neighbor drove him to the hospital.
On a moment's notice my sister and I attempted to procure a flight to Miami that somehow we were miraculously able to arrange during this Thanksgiving holiday period. He was still in the emergency department when we arrived many hours later. I found him in restraints on a gurney in a hallway without supervision, fighting to get out of those "handcuffs" and entirely delusional. The tattooed numbers on his arm stood out like a neon sign, 160247.
I had seen these numbers all of my life, and it was painful each time I thought about how the Nazis held him down and put these numbers on his arm to mark him like cattle on a farm. Was he once again reliving that experience?
Previously, he didn't speak much about the details of his captivity and torture, and I didn't ask too many questions to spare him from reliving those memories, but I knew that the experiences he endured never left his consciousness. In my heart, I knew he wanted his children to know what happened so it would never happen again. I should have asked more questions, but I was afraid of hearing the answers.
As my gaze fell upon this disoriented struggling man, I thought how painfully ironic for me, his son the neurologist, to have his father suffer an iatrogenically induced embolic shower to both hemispheres and the midbrain, rendering him cognitively impaired, impulsive and delusional.
In the setting of atrial fibrillation, why was anti-coagulation stopped for a simple resection of this skin cancer? The surgeon's response was an indifferent shoulder shrug, and he began citing statistics indicating that the risk of stroke was minimal in atrial fibrillation. I replied that the risk was 100% for my father.
He walked away to continue his life as it always had been, but life would never be the same for us.
A multitude of ethical dilemmas arose for me during the next ten years of his life as I, de facto, became...