Doctor/Daughter/Caregiver: Would I Do It Again? | The Journals of Gerontology: Series A | Oxford Academic
Doctor/Daughter/Caregiver: Would I Do It Again? | The Journals of Gerontology: Series A | Oxford Academic
This presentation reflects on the profound journey of a physician caring for her aging mother. Blending personal experiences with professional insights, it delves into the emotional and practical challenges of caregiving and the lessons learned about empathy, communication, and end-of-life decisions. It highlights the delicate balance between professional duties and familial bonds while emphasizing the value of understanding caregiver experiences.
Doctor/Daughter/Caregiver: Would I Do It Again? | The Journals of Gerontology: Series A | Oxford Academic
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JOURNAL ARTICLE
Doctor/Daughter/Caregiver: Would I

Do It Again? î¤ î¤°
The Journals of Gerontology: Series A , Volume 79, Issue 11, November 2024, glae247,
https://doi.org/10.1093/gerona/glae247
Published:
03 December 2024
Article history 
Issue Section: The Journal of Gerontology: MEDICAL SCIENCES > Editorial
My name is Suzanne Salamon and depending on how you know me, you either know me as Dr. Salamon or as Suzanne, daughter of Lilly. I have worn these hats for many years. Sometimes these hats were worn with anxiety, insecurity, and even ambivalence. But one of them was pride. But this year, I was given the gift of merging these hats as my mother navigated the end of HER life. At the time, I didn't realize that this was a gift. But the lessons learned were profound and I believe they have made me a better doctor. And in recognition of caregiving month, I'm going to share my journey from daughter to doctor to daughter and momentarily back to doctor then finally to only her daughter. It has given me a glimpse of what my patient's caregivers go through. I have a much better understanding of what they need from their parent's physician. I hope that others will benefit from our journey.
My mom, Lilly, died on June 4, 2024, at the age of 101 ¾ . Since then, not a day has gone by that I did not question whether there was something else I should have done so that she could
- 1. Jeon SY, Yang HW, Son BR, Baek J, Kim JL. Caregiving-related depression increases neuroinflammation in spousal caregivers to individuals with cognitive impairment: a longitudinal study. J Gerontol A
have reached her 102nd birthday. I was her older child. I was also her doctor. And yes, I know 'they' say one shouldn't be a doctor to your own family, whoever 'they' are. But 'they' didn't know Lilly.
My mother Lilly was a feisty, no-nonsense, Holocaust survivor. Most of her family had been murdered during World War II. After the war, she moved to the United States with her new husband. They settled in as the only Jewish family in a small town in Appalachia. She was widowed twice and then lived independently in Florida until the age of 97. One day, while rushing to answer the door, she fell and broke her pelvis. This was August of 2020, at the height of the coronavirus disease 2019 (COVID-19) pandemic. My sister flew down to Florida and brought our mother home to New York where she lived. But soon after she arrived, Lilly declared that she wanted to move to Boston, where I lived with my husband. I had always felt that my mother and I really didn't understand one another. But she was pragmatic, and after all, I was the geriatrician of the family. So, Lilly came to Boston.
She insisted on living alone. She wanted my husband and me to live our own lives. We rented a place for her 5 minutes away. But then her apartment building 'shut down' because of COVID, so we all decided she'd move in with us, temporarily, until the pandemic eased. To say that my husband was not thrilled would be an understatement. At that time, she was still very independent. She walked everywhere with her walker. She made chicken paprikash. She was a ferocious reader. She also spent hours on her computer watching the stock market and speaking to her broker for at least an hour a day. She meticulously read grocery store circulars and made lists of sale items, which my husband was to buy on his shopping trips. She had so many friends who called her, that we finally had to put a special phone in for her. Lilly was a force of nature, and I was her daughter.
As COVID-19 progressed, I began going into the o # ce 2-3 days/week, leaving my completely remote-working husband at home with my mother. Ever so shrewd, she called him her 'concierge,' complimented him endlessly, and told me regularly how I wasn't feeding/caring/being nice to him. The only argument they ever had was when he brought home chicken that wasn't the on-sale chicken that was on her list. She demanded that he go back to the store to exchange it, and he refused.
When I started to set up medical visits for her, she was very clear that I should be her doctor. After all, I was a geriatrician, and this way we wouldn't have to bother anybody else. For a centenarian, she was pretty healthy and had very few complaints. In the end, her pragmatism won. It would be easier if I could just order her blood tests when needed and refilled her prescriptions.
After a few months, we gave up the apartment that she never moved into. Little by little, things began to change. We bought 'equipment'-a shower chair, a di $ erent walker, hearing aids, and a medical alert bracelet. She began to need help in the shower. She started 'leaking,' so I brought home at least 5 di $ erent kinds of pads before we found ones that she liked. She stopped being able to change the pads herself. I started to fill her pill boxes. She had trouble reading books, so we got her a Kindle and enlarged the words. She loved it. But the biggest change came when she stopped using her computer, either for e-mails or, more alarmingly, for the stock market. She also had a fall in the bathroom and fractured her elbow, although she still did not complain. Medical appointments became more frequent-eye doctor, podiatrist, hearing aid checks, vaccinations, and dental appointments. The doctor/daughter lines blurred.
She occasionally would hallucinate. She would see people sitting on the couch next to me who were not there. She would have
dreams about visiting her mother (who was killed in Auschwitz when my mother was 21). But after these events, she told us she decided to come back to this world and stay with us a little longer. During these episodes, I, as her doctor, did what I had told my patients we shouldn't do-I gave her antibiotics. Once she developed diarrhea, and I was kicking myself that I gave her Clostridium di ! cile . (fortunately, it cleared up on its own.)
In addition to tending to her increasing medical needs, I had the pleasure of watching her develop incredible relationships with my granddaughters; the older one was born just a few months before Mom moved in with us. I witnessed first hand the impact her grit and optimism had on so many people.
Still, as time went on, we felt the stress of being her caregivers. My sister persuaded us to hire a home health aide-just to give us a break. We found someone wonderful who came to us 6 hours a day during the week, to give her showers, change her clothes, take her for walks, and get her up in the morning. She, too, was charmed by my mother. Still, it was hard to find people for the weekends. Watching mom weaken was particularly hard. As a physician, I could see the inevitable progression toward the end. As a daughter, I could still deny it was imminent.
During the month before she passed away, there were clear signs of increasing frailty. Her skin was breaking down. I had to apply more and more silicone patches to keep her wounds clean. She loved to eat, but her appetite dwindled. She was coughing more after eating, sleeping more, and walking less. But her mind remained sharp. She told me every day how much she loved living with us and being with family. She had her favorite chair by the window that she called her 'kingdom.' She loved life, but she was very clear that she wanted no aggressive measures when it was 'time to go.' She did not want to leave our home. We filled out MOLST (Medical Orders for LifeSustaining Treatment) and DNR (Do Not Resuscitate) forms.
Our caregiver urged us to get mom a hospital bed. Despite the speeches I have given so often about how great Hospice is, I ordered Hospice very reluctantly. Why was I so reluctant? As a physician, I knew how much support Hospice provided families as their loved ones transitioned. But as her daughter, I did not believe that she actually could die. The initiation of Hospice meant that we may be inching toward a new phase of life. But mom was so clear about her feelings of end of life decisions that she made it easy. Her clarity helped guide me to know when it was time to set aside my role as a physician and assume my role as her daughter. I now know how important it is for caregivers to hear thoughts on these end-of-life decisions directly from patients. This allows caregivers to feel less guilty by realizing they were following their patient's wishes. My mother gave me the gift of telling me what she wanted.
The hospice nurse and social worker came to our house. They talked to me about what to expect. To them, I was the daughter, not the doctor. They brought their hospice medicine bag, with morphine and other drugs. I felt that I was humoring them just to get the hospital bed. She would not really be needing any of these medicines. Lilly was invincible and immortal. She could not die.
In the end, it was too late for the hospital bed. The day after the nurse and social worker came over, Mom did not want to get out of bed. She did not want to eat anything. She started to have labored breathing. Her oxygen saturation was in the 80s. I called my sister in New York and my son in Austin-who was on a first date-and put them on speakerphone. My husband, daughter, and I were with her at her bed, talking to her. This awful white stu $ that looked like cream of wheat started pouring out of her mouth, and my daughter ran to grab a bowl. Mom asked me how her oxygen saturation was, I did not want to frighten her. I told her it was 90 (it was in the 60s and dropping). I called the Hospice nurse in a panic, and she told me to give her a tiny squirt of morphine, which I did. It seemed to
help. Then I started to give another squirt, but my mother said, 'No more medicine-you and Alan (my husband) are my best medicine.' Then her eyes lost focus, and she was gone. It took a few minutes for it to sink in. I put my doctor's hat on and filled out her death certificate. This was the final task of being my mother's doctor. Then I became her grieving daughter. We had come full circle, daughter to doctor to daughter to doctor and back to daughter. It was a journey, sometimes surreal, but it was our journey.
Even as I write this, I can't believe she is no longer with us, at least in body. Did I do right by her? Would she still be alive if someone else had been her doctor? Did I give her enough morphine? Too much? Too few antibiotics? Too many? Did I spend enough time with her, or was I always rushing around, being busy? Did I give my husband enough credit for all the attention he gave her? Did I try hard enough to ease my sister's guilt for not being with her as much as we were?
This experience has changed me, personally and professionally. About a month after mom died, a 90+-year-old patient died. This woman was Irish, very tough, a retired nurse, and completely competent. She had a lot of little problems. Then she developed pancreatic cancer and died within 3 weeks, at home with her daughter. I called the daughter after her mom died. She was distraught. She also had been given the hospital bag. She also gave her mom the morphine and she was horrified that maybe she'd given her too much. I told her that I honestly understood and had the same fears about my mom. In the end, we were both there. We were the daughters who held our mothers' hands and helped them to transition into the next world. This daughter wrote me the most beautiful letter thanking me for sharing my experience and helping her move from guilt and anger to peace. I read that letter at least 6 times. She was as therapeutic to me as I was to her.
This whole experience has changed me. I am embarrassed. Previously I thought I was faking it when I said 'I'm sorry for your loss.' Truth be told, I had no idea what that loss felt like. I now understand. I now 'get' how stressful it is when one is caring for someone close who is debilitated, incontinent, nonambulatory, and hallucinating, whether at home or from a distance. Descriptions written by Dr. So Yeon Jeon et al. (1) about the psychological and physical e $ ects experienced by caregivers of frail older people, were not surprising. I lived them as Lilly's daughter. And then I became a better doctor.
I'm so grateful for the time Mom and I had together during these last 3 ½ years of her life. We really got to understand and appreciate each other. I now encourage people to talk more with each other about the importance of their relationships. I try not to sugarcoat this stage of life, but rather to share the wide range of feelings that come with it. Doctors are not immune to them. Mom taught me that, whether she meant to or not. Now, with our mother gone, I feel that my bu $ er between me and the 'world beyond' is gone. With the time I have left, I want to be more generous, spend more time with my family and friends, be a more empathic physician, make my husband happier by traveling more, smile more, and not sweat the small stu $ .
And, yes-I would do it again.
Conflict of Interest
None.
Reference
Biol Sci Med Sci. 2024. https://doi.org/ 10.1093/gerona/glae235
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