He's not my patient, he's my father

"Dr. Wirshup, your mother's on the phone."

I should have known then that there was a problem. In 17 years of practice, my parents had never called me at work. When I picked up the phone, my mother said, "Your father has some leg pain, dear. Can you give him some medicine?"

I immediately started thinking of differential diagnoses for leg pain: phlebitis, cellulitis, various musculoskeletal causes. After talking with my father, and listening to his description of his symptoms, I felt it was sciatica. But when I tried to explain my diagnosis, he began arguing. It was difficult for him to believe that the little girl he'd raised now knew more than he did, even if she did have a medical degree.

The following weekend, after consulting with my sister Nancy, who's a nurse practitioner, I drove to New York to visit my father. My neurological exam seemed to confirm my diagnosis of sciatica. But looking back later, I realize that he was sitting more than usual.

The following week, my father called to ask for more medication because the pain had persisted. I went into my "family doctor" mode, and started barking orders. I insisted that he see his own doctor for LS spine X-rays because he had a history of colon and prostate cancer. He did go, and the X-rays were negative. His doctor confirmed my diagnosis of sciatica. I felt relieved that there was no malignancy, and figured it was just a matter of time before he felt better.

A week later, when I called for an update, I learned that the pain was so bad that my father was now using a walker to get around. I told my mother that patients with sciatica don't need a walker. But when I told her to call his doctor again, she said they didn't want to bother him. She said my father had a follow-up appointment scheduled in three weeks, and they wanted to wait till then to speak with his doctor.

My sister Nancy called me at work the next week and told me my father had collapsed that morning, hitting his head when he fell. I asked her if anyone had called the doctor, but she said my parents had only called her. She told me not to call my father's doctor, or even tell my mother that she had called. When I protested, she said if they didn't want to see the doctor, that was their right, and I had to respect it.

While I loved and respected my father, by that point the physician in me worried about everything from a subdural hematoma to significant back pathology. When I called the next day, my mother told me he'd had a "little fall," but was fine now. My mother is an eternal optimist, believing that things will always be better in the morning. This time, however, things obviously weren't getting better. As for my normally "take-charge" father, I began to realize that his passiveness might be the result of his fear of cancer because of his previous malignancies.

The following weekend was Memorial Day, and I'd planned to visit my parents, anyway. So, I drove to New York again, welcoming the chance to assess the situation firsthand. When I arrived on Friday night, I found my father sitting in his usual chair, with no apparent pain. But when I examined him, I was shocked to discover that he had bilateral foot drop and paresthesias. When he stood up, he almost fell back because of the pain. Later that night, when I tried to talk with him, he said he was too tired and went to bed.