I’m on a flight to go visit my father in the hospital. He had significant SOB, had a TEE which showed significant mitral regurgitation. We’ve had end of life discussions so know his wishes, and he wanted to have a valve clipping done (given his age and PMH it was recommended he not have open heart surgery, and this was the other option given to him). This is a relatively new procedure and I do have some questions I want to ask (including why no palliative care consult yet, will this reduce readmissions, change mortality, it drastically improve quality of life, and what are the complication rates).
I personally am questioning how much impact will this procedure have on dad’s life – cost benefit or risk assessment I guess; given that I work with sick people, have read Being Mortal, and have seen sad cases, I’m a little hesitant about surgery for him. I don’t want to see my Dad suffer either way. How do surgeons decide when to counsel conservative management, something other than what they are trained to do? ( His previous cardiologist knew of this problem and had recommended managing symptoms, but my parents just moved last month and had to reestablish health care providers, so this is definitely a different take on the situation).
Better yet, do I do any better? As PT’s we hear and agree #getPTfirst or #choosePT – we know we can make a great impact on people’s function and quality of life We talk about avoiding surgery if you can and avoid opioids. I want to bring hope. I hate it when I have to admit that i can’t restore function, return the patient home, etc. Most of the time it is easy – yes or no. But in the gray area, how long do you spend working at it? The patient with a CVA. The patient who has poor motor planning that isn’t responding to everything you can think of to help with mobility. The patient with pain you can’t really touch no matter what you do. These are the things you want to know as a student, and even as a practitioner there are ones that stick in your mind – did I do everything? Would a bit more, or something different help? I want to give hope, and I hate it when I have to say I’ve done all i can and we need to stop. Even therapy can’t fix everything. To a man with a hammer everything looks like a nail – i have a bias toward therapy and I need be aware of that for the sake of my patients, their families, and even myself.