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The Other Side (Part I)

Contact Information

Email: kcms@me.com
Phone: 856-419-6856
Hours: By Appointment Only

Vital Stats

Kenneth Szwak, MHS, PA-C

Occupation:
Physician Assistant

Specialties:
Emergency Medicine
Family Medicine

State Licensed:
New Jersey
Pennsylvania

Board certification:
NCCPA

Professional memberships:

AAPA- Fellow member

SEMPA- Fellow member

Arcadia University
Faculty Appointment:
Clinical Preceptor

Drexel University
Faculty Appointment:
Clinical Assistant Professor

'Tis not always in a physician's power to cure the sick; at times the disease is stronger than trained art.  ~Ovid

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As health care providers, it may be many years into practicing medicine until we find ourselves on the other side of the doctor-patient relationship, either as the patient or a family member. It can be a strange feeling. It can be even more strange and daunting when it involves a critical illness requiring care in the Emergency Department. Consciously or unconsciously, it is possible to be at odds with ourselves and our role. Do we act like a patient or family member or do we keep the hat on of the clinician? We all learn that in those situations, we should remove ourselves from the role of the healthcare provider as our judgement in regards to ourselves or our loved ones will be clouded. While this most certainly can be true, it can also be easier said than done.

I was recently put in this position. While not the first time, this episode for whatever reason sticks out much more than in the past. I was finishing a meal out when I got a phone call from my Dad, “Kenny, I’m calling the ambulance for Mom. She’s in bad shape. She’s having chest pains and can’t breath”. Now, my mother has a significant history of Coronary Artery Disease with one stent, one episode of Rapid Atrial Fibrillation which she self converted after rate control, a pacemaker for 3rd Degree Heart Block, and episodic anemia due to AVM’s of the small bowel which have required blood transfusions on more than one occasion. Her symptoms can very well be from any of these issues. I calmly head to meet my parents at the Emergency Department where I work. One the one hand, I start to get a little apprehensive as my mother is also the prototypical parent who minimizes symptoms (aka doesn’t tell anyone) early on. She likes to wait until the symptoms get too severe. The clinical side of me starts going through the different scenarios of what is causing her symptoms and the anticipated treatment. It is nicely buffered by the fact I know she will get excellent care. Not just because my colleagues are caring for my mother but because my colleagues take excellent care of everyone. Yes, I know I’m biased.

I beat my parents to the ER adding a little additional apprehension by wondering if something bad happened to delay EMS’s arrival. The wait is not too long and they arrive with my mother looking quite well. I see that a colleague from my EMS days is one of the paramedics and learn she was in Rapid A-fib, did indeed look bad on scene, but improved greatly after rate control with diltiazem. After getting set up in a room, the ER physician sees her and is confident her symptoms are less than 24 hours. The plan is to check her labs and do a synchronized cardioversion. After an hour of waiting and joking with my parents and family, the labs come back fine except for her hemoglobin dropped several points from six months ago. My mother is still denying any black or dark stools. They proceed with the plan for cardioversion.

Now, I must take a moment to state we perform synchronized cardioversion in our ER quite frequently. It’s practically bread and butter for us. I’ve treated more than a few patient’s this way and knowing the proficiency of my colleagues, I would want no other group caring from my family. Despite all that, I have to say at this point the apprehension came back. As I said before, my mother cardioverted on her own the last time she had Rapid A-fib. So this was the first time when would experience this. I went back and forth in regards to whether I wanted to be in the room or wait outside. Staying out of my colleagues way while at the same time staying near to answer any questions, I ultimately decided to stay for the cardioversion. I took my mind off some of the action by talking with our student, giving her my mom’s background, and reviewing the in’s and out’s of Rapid A-fib. After getting everything set up, they were ready to cardiovert.

The first attempt did not convert my mother back into normal sinus rhythm. “No big deal” I thought to myself, this happens sometimes. It doesn’t always work the first time. However, while thinking this, I didn’t realize I was edging ever so closer to the bedside. That was until the nurse caring for my mother turned around and said to me, “OK, you have to be a son now”. She was was right. I was heading to far in the one direction. I could feel myself wanted to jump into the case. Message received. I went back out to keep my family apprised of what was going on. The nurse, who I also consider a good friend after years of working together, was not rude. She simply, quickly, and correctly realized that I needed to take off the health care provider cap for a while. She was caring for me as much as my mother. Again, I work with amazing people.

The second attempt at cardioverting my mother also did not take. After that, the ER physician thought it would be best to admit her to her cardiologist. My mother recovered from the sedation very well. She insisted that we all go home at that point as it was late and nothing else would be done. Over the next 2 days, my mother again cardioverted on her own, apparently mere minutes after we left the first night. Her hemoglobin dropped another point which initiated a blood transfusion and GI consult. She had another endoscopy which found four AVM’s, three of them bleeding, which where cauterized.

On her final day, her cardiology group expressed concern that my mother has paroxysmal A-fib and may have times she is unaware she is in the rhythm, putting her at risk for thrombus formation and stroke. Despite her history of GI bleeds / AVM’s, they still wanted to at least consider anticoagulant therapy citing several studies that stated it was safe after waiting 6 weeks. They did not need to make the decision that day. They wanted time to check her hemoglobin several times and have me review the literature on the topic before she followed up in the office and discuss it further.

And that’s when it clicked… There is a middle ground. As health care providers there is a middle ground when we or our loved ones are the patient. We don’t have to wash our hands completely of our medical training, we don’t have to be the clinician in charge of their care, but we can be the advocate. What better way is there to be there for our family? To give back to our parents? We can make sure the right questions are being asked (and answered), we can still have input when a care plan is suggested, especially when it’s not straightforward. We can keep on top of our family members to try and make sure they are being honest with their symptoms and when they are having them. We can still hold their hand, give them a hug, and just be there for them.

So, stay tuned for The Other Side (Part II) when yours truly goes in to have his gallbladder removed and gets a first person perspective of being the patient instead of the provider.

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