Wow, did I learn a lot today.
A Speech Pathologist was added to the mix of medical professionals tending to Pop in the hospital. “Why a Speech Pathologist?” I asked. “Don’t you deal with people who’ve had strokes and need rehab?” “Yes,” replied Heather. “That’s about ten percent of what we do. The other ninety percent is working with people like your dad.”
The pathologist came into the room this morning knowing that C.diff was overwhelmingly likely to have caused Pop’s loss of mentation (normal brain function), his odd motions while sleeping, his odd speechifying yesterday, and his overall agitation. He will always have C.diff – an infection of the bowel – which cannot be cured, but can be treated.
So the pathologist fed Pop some apple sauce with a spoon and as he chewed it, she felt under his lower jaw where she could tell that his tongue was moving well enough, but the muscles used for swallowing were not being employed at all. What he did swallow was aspirated – it went down the wrong pipe. One of the ways she could tell this was the way he coughed.
What does this all mean? Well, it means that Pop hasn’t received any nutrition for at least a week; and it means that I might have contributed to his possible demise by succeeding so well with feeding him lunch yesterday. It also confirms that Pop’s brain isn’t telling him how to perform the most natural of human acts; how to eat.
What’s the solution? A tube called a “Panda” inserted through the nose, down the esophagus and into the stomach. A nutritional mush is pushed through this tube along with medications. After a day, it is stopped, and the patient is x-rayed and tested six ways from Sunday to see if the nutritional and healing levels have improved at all. If they have, even slightly, another day of mush and meds and then they stop again for x-rays and testing, and so on until normal brain function is again detected which makes it possible to eat and thus to return to a more normal life (possibly even Assisted Living?).
If a positive result is not detected early in the process… well, that’ll be the subject of another post.
Now to the legal aspects of things. In 2005, Mom & Pop had their attorney draw up new wills with me as executor. There are also two Power of Attorney’s for each: a durable (financial, property, etc.); and a healthcare (living will, healthcare wishes, etc.). We’ve come this far with Pop now and I thought, yesterday, that it would probably be a good idea for me to review these documents. This I did last evening.
I’ve been exercising the durable Power of Attorney since written. But only today was I first asked to exercise the healthcare Power of Attorney. The timing of my reading couldn’t have been better. Here’s the situation: the pathologist described the placement of the Panda tube into Pop; an uncomfortable, invasive thing to say the least, and one to which he could not consent. I’d have to do it. Additionally, he would be given Ativan (to replace Vicodin) as a relaxer to reduce his agitation. And finally, his wrists would have to be restrained to prevent him from harming himself internally by yanking on these external tubes (the Panda and the IV). This, too, he could not give consent for; I would have to do it. Loss of dignity? In our world, sure. In his, not at all.
In my reading of the PoA’s last night, I noted the phrase “extraordinary means.” I had to contemplate what M&P meant by that, and recalled them saying at the time that it meant machinery (usually) which might prolong the dying process. How does that play against what was proposed today? It doesn’t at all. What we’re doing here is helping to determine if continued quality of life is still possible for Pop. If this process doesn’t prove that in the affirmative, then we approach the question of “extraordinary means,” if necessary.
I said ‘Yes.’ Had I not, Pop would almost certainly be dead within a week due to lack of nutrition. Because I did, he has a shot at continued life. Of course, only God holds the strings on that, and Pop could still be gone in a week. Or not.
So here’s a medical status report. Pop had been using two catheters to deal with waste. Today, one of those was replaced with a Foley and his output will be tested in the lab. The solid waste has been tested from the start. His white cell count is better, but his sodium is high, so the saline drip has been replaced with straight water. His kidney function is still not keeping up with output, so more water is needed. Pop’s blood pressure is good as is his respiration, though it frequently seems quite high to me.
The medical people at the hospital have always had a plan. Today that plan took a big change; one that no longer requires an advocate. Nothing taking place at the hospital now can be improved by my presence there. So I will begin to sleep in my own bed again with my wife who misses me, and without the required hospital gown and gloves. I will still spend time with Pop, try to be present for doctor’s rounds each day, and will, of course, report any progress.