CAROLYN'S COMPOSITIONS

February 29, 2012

Leap Year Day: Dealing With Life & Death Issues


LEAP YEAR DAY: DEALING WITH LIFE & DEATH ISSUES

Wednesday, February 29, 2012  

6:55 a. m. My husband Monte calls to me just as I emerge from my night’s rest.

     It’s Leap Year Day. We are going to the State University of New York Upstate Medical University Hospital, to see Monte’s older brother, Paul (not his real name), who is hospitalized for a broken hip caused by a fall. Paul celebrated his ninetieth birthday in May, 2010.

     Just for the record, Paul lives in upstate New York near the St. Lawrence River. Monte and I live southeast of Pittsburgh, Pennsylvania. We are staying at the James Street EconoLodge Motel in Syracuse, New York, where we registered early Saturday evening.

     During our time at the hospital, I keep notes on who the doctors/nurses are, what they tell us, and how Paul is doing.

7:40 a. m. I choose a sesame-seed/poppy-seed bagel from the hotel’s continental breakfast, and wonder Will I be taking a drug test any time soon?* We need to be at the hospital, so I take the bagel with me.

8:10 a. m. We line up at University Hospital to get our daily visitor ID sticker. We must present our driver’s license from which a photo ID sticker is made. It lists the floor, room number, and the name of the patient being visited.

8:24 a. m. I’m in Paul’s room. He rests, I take out my bagel, which, slabbed with peanut butter and cream cheese, is pretty messy. I struggle to cut it into pieces with a plastic knife.

     Monte is elsewhere, trying to contact the physical therapist who treated Paul last summer. He hopes she will help him in his struggle with a decision: Should Paul should be subjected to post-surgical physical therapy by having surgery to repair his broken hip? It’s a fifty-fifty decision that Paul might not be able to help make. He is out of it much of the time, due to the injury and the medications. Monte’s limited medical power of attorney puts him in the position of making this decision if Paul is incompetent to do so.

     Post-surgery hip physical therapy is pretty rugged. Monte is concerned about hooking Paul into this therapy if he isn’t a good candidate.

8:27 a. m. Monte returns to wait for a call back from the physical therapist. I start to drink my coffee and take my cardiac meds.

8:30 a. m. Monte receives a call from the physical therapy agency director—-she saw Paul once. He asks about Paul’s attitude and willingness to work with physical therapy in comparison to the average patient.

     The agency director said she saw a very good, willing, physical therapy participant. She noted that without surgery the prospects aren’t good for Paul. She shared that her father was ninety-two when he had hip surgery and the outcome was good. She considers Paul to be a pretty reasonable physical therapy candidate, and if he were her father she would allow the surgery. If he is a walker it’s logical to try it.

     Monte discusses the situation with me. I take notes. Monte has considered Paul’s lifestyle. Paul likes to walk and be out of the house. Without surgery he will be unable to walk, he will be confined to a wheelchair or bed. Although there is no guarantee, surgery can offer him the opportunity to walk again.

     Monte reviewed Paul’s house in his mind and considered some adaptations that could be made—a shower bath and hospital bed in the living room, for example.

8:45 a. m. Perhaps I can take my first sip of coffee now.

8:47  a. m. The physical therapist call came. I sneak sips of coffee while Monte talks, receiving confirmation of what he believed: Paul was a better than average physical therapy patient—very willing, and anxious to participate in the required work. Furthermore, a lot of postsurgical-hip physical therapy includes procedures familiar to Paul.

      Monte is leaning toward letting Paul have surgery, but it would be a terrible thing if it doesn’t work out.

9:00 a. m. We leave Paul’s room while nurses bathe him.

     As I pass the nurses counter, a staff member waved me to the desk to show me the two small miniature silver butterflies on her ring. Yesterday, when she wore a scrub with butterflies on it, I commented on it and showed her the rather large butterfly ring I purchased from the hospital gift shop. She had considered purchasing it but didn’t.

     A woman in the waiting room is crying. I go to her and say You look like you could use a hug.  She responds, telling me that she just had to let it out. She thanks me and I settle in.

     Monte said it’s really time to make a decision about Paul. He is inclined to allow the surgery, even though it’s risky and might not be successful.

     An Amish woman passes by the waiting room, babe in arms. Yesterday, a large group of Amish gathered at the information desk. I wonder what happened.**

9:12 a. m. Monte’s two sisters concur with his leaning toward surgery. One said that he’s been through a lot in the past and he may be able to do it again.

9:17 a. m. A staff member said they finished bathing Paul.  Monte returns to the room. I decide to stay put until I eat, take my meds, and finish my coffee.

9:18 a. m. Monte returns immediately to tell me the doctor is outside Paul’s room. I think Can I at least take my meds? I quickly swallow them, repack my breakfast, and proceed to Paul’s room. Eight doctors, including the attending physician, stand outside Paul’s room.

9:28 a. m. The doctors disperse without coming into the room. Apparently they weren’t conferring on Paul.

     Paul’s roommate, I’ll call him Sam, suffers a brain injury from some kind of accident. He needs help to walk and eat, and has full-time sitters. He was hospitalized here January 30th.  I watch the sitter help him eat.

9:58 a. m. Paul rests quietly. Monte said that earlier he was talking somewhat lucidly. I start drinking my now cold coffee while reading haikus written by a writer’s group member, Jan.

10:08 a. m. I begin to play hearts (card game) on my computer notebook. It’s difficult to concentrate on writing.

10:33  a. m. A member of the spine team asks Paul how he was doing. Not too good, Paul responds. Nothing has changed, since yesterday, he’s stable the team member says. Paul wears a neck collar for what is probably an old fracture. X-rays will be taken to determine its degree of healing.

     Monte tells the team member that the family consensus is for Paul to have surgery. The staff member says that he will contact the trauma team to inform them of this decision.

10:45 a. m. Paul is alert, asks to sit up. A nurse raises the bed for him.

10:50 a. m. Monte begins a clear, conversation with Paul, who is obviously lucid and clearly understands:

     Monte: How you feeling?

     Paul: Good.

     Monte: They want to do surgery. He explains the hip injury and surgery to Paul.   (to continue reading click on

      Paul: Do you think surgery is a good idea?

     Monte: I do, but it’s risky with your, heart. You might not survive surgery, but if you do, with a good bit of physical therapy, there’s a good chance you can walk again. If you don’t have surgery you’ll pretty much be limited to the bed and a chair. I was not willing to decide on surgery for you.

     Paul: I hate the thought of being crippled…I’ve lived a lot of years and it’s better to take that chance to (live well). I want the surgery.

     Paul appeared to understand all the issues involved in the choice.

     Monte: I think you’re willing to do the physical therapy.

     Paul: If I am alive I want to be able to do something. There’s trouble when you are in the chair.

     Monte: There’s bedsores, risk of pneumonia, breathing problems…I had kind of decided to do that (the surgery) if you couldn’t decide, and (your sisters) agreed. I talked to your physical therapist…she said she was pulling for you. Do you remember her?

     Paul: I remember.

10:56 a. m. Doctors ask Monte to sign a paper authorizing the surgery and possible blood transfusions. Paul, alert, says he prefers Monte to sign as anyone, an indication that he understood what Monte was signing.

     Staff arrives to draw blood. You’re not very giving today, one says. Here I thought you were going to be giving. We haven’t gotten anything. We have to call in the big guns, they do this all the time, it’s the only thing they do.

     Paul: They do have trouble getting blood out…

     Paul and the tech laugh.

     Monte: In my case they have a hard time finding a vein that looks real good.

     I told Paul Lots of people are pulling and praying for you, and named several names.

11:50  a. m. The x-ray team arrives.

12:15  p. m. The expert blood team technician arrives, says he never smiles. However, when Paul says he doesn’t know what he is being tested for (surgery) the tech breaks out in a huge fun-loving sincere smile.

     I say I wish I had the camera ready to snap a picture of the smile. The tech said you have to have clearance to take pictures. I think of the several pictures I’ve already taken—of several craft pieces at the hospital security desk at the entrance (permission granted by two security guards, including the craft creator) and of a painting of Saco River, N. H., on the hallway wall.   

     After the tech does a successful blood draw on his first attempt. I compliment him: I’m impressed.

12:45 p. m. Paul’s lucidness is diminishing.

12:52 p. m.  Paul is restless and yells out help three times. Monte is off making a business call.

1:23 p. m. Paul has visitors from his home town, two of his caretakers. One was on duty when he fell. We hear details of the incident—he arose in the night to use the bathroom, she stood outside the door to give him privacy, he fell.

2:10 p. m. Paul rolls down the corridor to the surgical holding room.

2:45 p. m. Monte signs another paper. He speaks to the anesthesiologist, and verifies the surgical decision made by Paul.

     During the surgery I play a couple of games of hearts on the computer and work on a post for my writing site.

4:00 p. m. Monte and I go to cafeteria to eat. A cafeteria worker, from Warren, Ohio, discusses the malls there. Another worker asks about the cost of Pennsylvania farmland.

4:50 p. m. We return to the surgical waiting room. The volunteer is preparing to leave. She said when the phone (calling from surgery) rings, someone in the room should answer it. I say the desk looks like a nice place to sit and she agrees, and shares that she had sat there when her husband had surgery years ago, before she became a volunteer. I sit there, answer the phone, and call out the family names being paged.

5:33 p. m. Our call comes. Paul is out of surgery, doing fine, and will remain in the surgical recovery room for about ninety minutes. The doctor will come to speak with us.

     I call my sister Nancy to update her.

6:50 p. m.  The surgical doctor updates Monte. Paul was doing well, was awake, when he experienced full cardio-pulmonary arrest. The recovery room staff responded immediately—performed CPR and sedated him to reinstate the breathing tube. He’s very sick, still at very high risk, Medications maintain his blood pressure.

     A second physician, the ICU doctor, consults with us. They don’t know why the cardiogenic shock occurred. Monte and the doctor examine the health care proxy, which basically bans medical procedures that serve only to prolong the condition of my dying

     I see Monte struggling, and I suggest he step back and look at the decision as if he were the patient.

     Monte tells them to take time to see if the blood tests will show if Paul’s heart is compromised due to the surgery.

     Monte: I want to give Paul a reasonable chance before letting him go… However, if, while in ICU, cardiac arrest occurs, let him go—there should be no CPR, according to Paul’s wishes as expressed in his document.

     They move Paul to the ICU to be maintained on the breathing machine for twenty-four to seventy-two hours, allowing time to assess his condition.

8:33 p. m. We are allowed to be in Paul’s ICU room. The nurse says Paul is stable, just receiving sedation, but may have to be temporarily back on other meds.

     That’s encouraging, Monte says.

8:39 p. m. The nurse says they spoke too soon, and he needed to be on a small dose of meds. Paul’s blood pressure dips dangerously, Monte says the nurse seems panicked, and I notice her working frantically. He needs the blood pressure support, she says after the incident.

     The completed lab tests don’t show why Paul experienced cardio-pulmonary arrest in the recovery room.

9:30 p. m. We leave and drive to the hotel.

NOTE: Monte and I want to commend the Upstate Medical Center’s staff for the care they provided for Paul. We appreciate everything they did.

~~~~~~~~~~~~

ADDITIONAL READING:

Baby Removed from Home after Mother Eats Poppy Seeds

February 25 to March 12, 2012: A Three-Week Odyssey

IT’S LEAP YEAR. WHAT WILL YOU DO ON 2008’s BONUS DAY?

Have I, a Caregiver, Failed??

How to Give Support to Caregivers

IT’S A WONDERFUL LIFE!!

REFERENCE:

**FedEx truck hits NY Amish buggy; adults, kids hurt    By The Associated Press

MASSENA, N.Y. (AP) ‘ Authorities say two young Amish children are in critical condition after their horse-drawn buggy was rear-ended by a FedEx truck on a northern New York road.

State police say to continue reading click on http://www.broadcastnewsroom.com/articles/viewarticle.jsp?id=1901693&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Bn-BroadcastNewsroom-news+%28Broadcast+Industry+News%29 

Update on Amish Buggy Accident                                 Monday Mar 5 | Posted by: Droopy Draws

Story Courtesy of the Daily Courier-Observer MASSENA – The four seriously injured passengers from last week’s Amish buggy accident in Massena remain hospitalized at Upstate Medical Center in Syracuse. State Police Inv. Andrew Gayeskie said troopers have remained in touch with hospital officials since the accident. “They’re going to let us know if anything changes,” he said. The accident at 3:25 p.m. Monday originally sent four Amish children and two Amish women to Massena Memorial hospital, with the two women and two three-year-old children being sent to Syracuse for treatment of more serious injuries. A nine-month old and four-year-old also suffered minor injuries in the accident. The accident occurred when a FedEx truck operated by Robert Williams, 28, of Gouverneur rear-ended the buggy on state Route 37 between St. Lawrence Center and Hebert’s Steak Ranch. Inv. Gayeskie said the investigation into the cause of the crash remains ongoing.   http://www.topix.com/forum/city/massena-ny/TSIQ8DUF3TCOS5V4R

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3 Comments »

  1. It was a rocky ride but Monte gave him every chance to make it, sometimes its simply out of our control. You were both there and thats what matters.

    Comment by Fran — March 15, 2012 @ 2:14 pm | Reply

    • Thanks Fran…you should know…you are always there.

      Comment by carolyncholland — March 15, 2012 @ 2:44 pm | Reply

      • Unfortunately it seems easier to make the elderly fight for life these days over the young!

        Comment by Fran — March 15, 2012 @ 4:28 pm


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