Mom & Me Two Archive

..."Dr. Gold".
    My first contact with Dr. Gold was not under the best of circumstances. I'd been awake close to thirty hours at the hospital with my mother. I'd finally gone home after she was settled in her room napping through the end of her second unit of blood. Blood type A+, by the way, in case anyone should need to know that. I'd called MPS just before 0800 and asked her to call me sometime between 1300 and 1330 to wake me up. Then I'd crashed, phone by my head.
    I remember looking at my watch sometime during the call from Dr. Gold. 0945. Our conversation lasted for probably a half hour. After introducing himself and bearing with my fumbling through writing down his name with the correct spelling (which I got wrong), the first words he spoke were an invitation, not a statement. Doing himself one better, his first invitation was, "Tell me your mother's history." No elaboration.
    I did. As briefly as I could, I covered her entire four years from the fall of 2000 when she began treatment for type 2 diabetes through her hospitalization for a blood transfusion due to severe iron deficiency anemia. I summarized all her tests and treatments including those, like the colonoscopy, which I first opposed and then to which I relented. I summarized all test results, with which I'd refamiliarized myself the previous early morning in the emergency room. I even spoke my piece about my consideration that her anemia may be a blood chemistry problem due to her metformin use. I also remembered, relayed and recited my responses to all the suggested treatments thrown at me by three physicians prior to my speaking to Dr. Gold, who came on at 0700, June 9, 2004, as the floor staff physician.
    The only time during my litany when he broke his silence was to confirm certain pieces of advice I'd received in the last year and a half, including her hematologist's stern directive that, if it were his mother, he would not have a bone marrow biopsy performed; and that of the colonoscopist who pronounced my mother, after what looked like, on paper, to be a tolerable and successful though extremely long procedure, no longer sturdy enough to experience any more scoping of any kind as any less than "torture". Neither of these opinions surprised Dr. Gold.
    After hearing me out he commented, almost off hand, that I "...know [my] mother's medical profile pretty well.". Although I let this escape without comment I was shouting an internal, "Yes!"
    Dr. Gold briefly reviewed the status of my mother's case so far in light of this new development of transfusing blood. "My recommendation is going to be that her anemia be handled from now on with standing blood draws to check her levels and blood transfusions if necessary. No more scoping. No more other testing unless a sudden drop occurs." He went on to explain/agree with me that, although some of her lost strength is recoverable (and later wrote a prescription for "ambulation and strength training" physical therapy) she will remain from now on, probably, just this side of frail, if not actually frail, due to temporary health compromises. No more reason to try to find what is probably obscure intermittent bleeding. Time to address quality of life issues.
    Probably from exhaustion, I began sobbing on the phone. I thanked him for coming to the same conclusion I'd come to and had been trying to promote with my mother's physicians for about a year and a half. I believe at some point I used the word "overjoyed" to describe my reaction.
    He took my astonishment well. He asked me, for the record, if she has a Living Will.
    Yes, an old one, standard 1985 template. No matter, he said, "Do you know her wishes regarding whether to restart her if her lungs or heart fail?"
    Yes. Leave her alone. Keep her from suffering but let her go. DNR all the way, expressed often, I anecdotalized, when she watches "her doctor shows" and says in sidebar, "Don't do that to me," when someone is revived.
    I told him I'd be back at the hospital no later than 1400. By that time, he confirmed, she'd be done with her third unit of blood. This came as a surprise to me. He explained that her hemoglobin wasn't responding as well to the first two but not to be concerned. Although three units seems like a lot of blood it's about average for the circumstances.
    Later that day, when I ventured onto the Telemetry floor at exactly 1400, Dr. Gold was at the station completely available to discuss my mother's case. We both visited her. He asked about her smoking, called her "tough" (which my mother loves). Reiterated his intended recommendations while Mom dozed in and out of what I imagined was a maroon sleep. He told me that Mom's hematologist's partner had also seen Mom while I was, literally, out, and scheduled a bone marrow biopsy in his partner's absence which Dr. Gold, as I vigorously shook my head and begin a verbal protest, assured me he'd canceled.
    There was as well an order for a stool sample if the opportunity arose, which it didn't.
    He told me her hemoglobin was 9.9, a very good sign, no obvious rejection. He was still iffy about when we could leave, as I reminded him that "we have a life and it goes on up in Prescott". He said it was down to days now, rather than weeks, depending on successive blood draws.
    When I noticed, the following morning after negotiating her wild blood sugar, her developing bronchitis, her seemingly intractable dehydration, her feistiness and her skin tears, Dr. Gold looked me in the eye when I catalogued my grievances: "This would not have happened at home; this would not have happened at home; this would not have happened at home; this would not have happened at home." When I was done he agreed. Straight on. Within 2 hours of seeing him my mother was released from the hospital with some temporary and permanent prescriptions and two follow up appointments with her PCP and hematologist.
    The check-out nurse was a dream, absolutely amenable.
    Later, a friend of mine joked, "Yeah, they probably wanted to get you out of there as quickly as possible."
    To which I responded, "Good."
    I've been asked since why, having such immediate and high regard for Dr. Gold, do I not switch PCPs. I consider him one of two hero physicians on my side, the other being her current Mesa PCP. Our relationship with Mom's Mesa PCP is hard fought and hard won. I love his computerized brain and his outspokenness regarding his trust in me as a companion healer. We've had our battles.
    "I usually win," he's said.
    "Funny," I always think in response, "I thought I'd been winning."
    Mom's Mesa PCP and I know how to work together. He has come to an earned understanding of what I do on my mother's medical behalf and how effective I am. He's figured out how to guide me and how to sometimes let me guide him. He knows I have the tools to monitor her steadily and that I make good decisions about what to do on the fly; he's told me this in response to specific sets of circumstances and my response.
    So there's no need to change. I consider myself lucky and mysteriously blessed that I now have two excellent physicians, whose styles are completely different but trust me and read my mother well, at my mother's and my sides. I know who to ask for now at the hospital since my mother will probably always be going to "the closest" hospital rather than the hospital on which her PCP is staff.
    At any rate, Dr. Gold's primary ability par excellence is his ability to listen, which includes a displayed interest, both in his reactiveness during a recitation and in his ability to spit back what he's heard in context of what he'd considering. This is very refreshing. I can imagine, in today's medical establishment, he must always be pressed for time. I'm extremely grateful that he chooses to devote time to the sometimes slow process of listening to his patients and those who tend them. It is obvious that he considers what these people have to say important. His conceptualization of my mother's history from my point of view allowed him and me the option of considering compassionate care from here on out.
    She has been of very good humor throughout this entire Ordeal of Iron Deficiency Anemia and all the unrelated (and related) complications. I have no reason to believe her humor won't last. But, come on, guys. Let's not push it. Look how far she's come. Let's let her show us what else she's got in her without spearing her on scopes and needles unless something grave and most likely fixable occurs.
    It appears that Dr. Gold has internally adopted this attitude toward his patients. The mark of yet another First Class Healer.
    Later.