My Night on Call…Family Values

It was one of those nights. The resident called me down into the chaos of the emergency department to see a patient who had been brought in with a strangulated paraumbilical hernia. She was an elderly lady with multiple chronic illnesses, morbid obesity and limited mobility who lived alone and seemed neglected. She had already started to develop systemic signs of sepsis including hypotension, confusion and acute kidney injury. We resuscitated her, called the consultant and prepared to move her immediately to surgery. The nurse had called in her next of kin; a middle aged son showed up.

I stood at the side and listened intently as the resident explained to the son the critical nature of the situation, the indication and potential complications of surgery. If a resident is handling the conversation well, I usually refrain from interrupting unless they ask for help or trouble arises. Once she was done, she asked the son if he had any questions. He stared at her for a couple of seconds, blinked and then asked: “If I decided to go in for a sleeve gastrectomy to lose weight, would I suffer the same complications?” It is an understatement to say that we were dumbfounded.

As the nurses helped the patient change into a gown, her son rushed to receive his mother’s jewellery which the nurses had taken off; a thick gold chain and a couple of golden bangles. He stuffed them into his pockets and walked out of the room as the preparations continued. Not once did he attempt to communicate with or comfort his mother. By that time, his brother had arrived and they both followed us into the operating theatre. As their mother was being wheeled into surgery, and the consultant joined us, they decided shyly to bid her good luck. That is when she went into hysterics and started screaming,  “Get out of my face! You’ve never cared for me! You never come to see me! You’re never there!”

These were her last words.

She did make it out of surgery. In the early hours of the morning, she was taken to the intensive care unit (ICU). Unfortunately, with a delayed presentation and the surgery on top of her poor general medical condition, her physiology succumbed and she later passed away in the ICU.

Although this happened more than five years ago, I still find myself travelling back in time to that particular night on call. I am not here to judge the patient’s sons, but rather to reflect on my own life and relationships. As a surgeon, I have spent the majority of my adult life at the hospital, with many sleepless nights being on call away from home. In fact, as doctors, most of our lives have been spent away from our families, studying diligently at medical school and later labouring away at the hospital taking care of other people’s families. We too have  “not been there” for our loved ones. I cannot begin to count all the holidays, birthdays, special occasions and family gatherings I have missed over the years. It is one thing to miss out on a happy occasion, another to be absent during difficult times. We are guilty of both.

Whilst our families have been understanding and supportive of our endeavours to carve a career path in surgery, I know for sure that the time that has passed is irretrievable. It is on nights like these at the hospital, whilst observing other people’s family values that I start to examine my own. When I leave my family at the dinner table to rush to the hospital to see a patient, what are the last words we exchange?  Despite not being there a lot of the time, I hope to at least leave them on a good note.