CAROLYN'S COMPOSITIONS

March 13, 2012

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


CAROLYN’S COMPOSITIONS

FEBRUARY 25 TO MARCH 12, 2012: A THREE-WEEK ODYSSEY

Medical decisions, sometimes made through Medical Power of Attorney appointees, are not always clear-cut. Medicine is not an exact science.

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     I want to thank all my blog readers, especially the subscribers, for bearing with CAROLYN’S COMPOSITIONS during my last month of erratic postings. During our travels I clocked only two hours of Internet time, and my other time was distracted from writing. 

     There is a more than reasonable explanation. My husband Monte and I were out-of-state participating in a life-and-death journey. And thus I write about that journey…

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     Early morning, Monday, March 11, 2012, the air is crisp and the ground is free of snow, very unusual weather for Northern New York near the St. Lawrence River. We enter our silver car, prepared to start of the final phase of a three week journey of life, death, and continued life. We will drive four hundred and some odd miles today, stopping in Buffalo to visit my sister Nancy. We will drive about the same distance tomorrow before arriving at the sanctity of our Southwestern Pennsylvania home on Tuesday evening. Upon our arrival we will reenter the life that was abruptly interrupted by a 5:45 a. m. telephone call that roused us from our slumber on Saturday, February 25.

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     My brother-in-law Paul (not his real name), ninety-one years old, fell in the wee hours of that Saturday morning. The telephone caller gave sketchy details.  He was in a local hospital, waiting to be transported to a city hospital, a teaching hospital, better prepared to deal with his type of trauma.

     We were on the road by 10:30 a. m., having packed sufficiently for any circumstance that might arise. After entering New York State we received a call that. Paul’s doctor wanted to talk to Monte, who was Paul’s medical power of attorney. The information enabled Monte to make plans. He decided to check into a motel prior to visiting the hospital.

     Last year I questioned the sanity of anyone traveling to Chicago during the first week in March. This year it wasn’t a question of sanity, but necessity, of traveling to a part of New York State that I normally considered insane. The problem is wintry weather. We were weather-lucky on both trips—it was easy driving until we passed through Ithaca. It wasn’t snowing, but previous snowfall left the road in a snowy/icy hazardous condition. We passed three vehicles that had slid off the road. Monte drove behind a truck for safety. We followed a truck that demonstrated skill in driving in these conditions.

     “It boggles my mind that someone driving a Walmart truck would know what they are doing,” he said, when the danger seemed over and a nice sunset was in view.

     We checked into the motel and visited Paul for a few minutes before returning to our room to recuperate from the day’s activities. We returned to the hospital early Sunday morning.

     Between Sunday and Wednesday Paul wavered between lucidity (mostly mornings) and dementia-like behavior—calling out to his late wife, his late son, and other persons; once about a dust pan being on the shelf…most difficult to listen to were his declarations I don’t know what to do, I want to get out of here, open the door, I gotta get up… I gotta go do something   no one will help me…

     Occasionally Paul would stretch an arm heavenward. I wondered if he was reaching out for the hand of his late wife or his late son. Or was he praying? Maybe he wanted to get out of bed or to exercise.

     Irregardless, Paul’s lucidity became increasingly absent during the next few days, either due to his deteriorating mental capacity, or, more likely, due to the medications he was taking.

     Meanwhile, Monte was struggling with, wrestling with, making a decision whether Paul should undergo surgery for his broken hip.  Surgery would offer him a chance to walk again, while not having surgery would condemn this active man to bed and a wheelchair.

     Other than the psychological factor of limited mobility, Monte evaluated physical factors: cardiac, orthopedic, psychological, post-hip surgery therapeutic, and Paul’s DNR (do not resuscitate) wristband.

     Paul’s medical history included major heart surgery in the mid-1990s. Could his heart withstand the surgery? Cardiologists cleared him for surgery after doing a cardiac ultrasound test.

     The major orthopedic consideration was his post-surgical ability for mobility, which was not guaranteed. Surgery might not enable him to walk.

     Psychologically, it had to be considered that Paul was an active person who wanted mobility. Inability to leave his bed and chair, he would be a true downer.

     Monte contacted Paul’s previous physical therapists, who confirmed that Paul was a person who was dedicated to and worked at therapy.     Either surgical choice would require therapy. However, post-surgical therapy could be grueling. Did Paul have the guts, or lucidity, to commit to the intense therapy?

     Although Paul requested DNR, that request needed to be rescinded during any surgery. It would be automatically reinstated after he left the surgical ICU.

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     Monte was reluctant to make the final decision. On Tuesday afternoon he said The big thing is, if I make decision to do surgery, he has to understand the commitment…the only thing we can do is wait to see if he can consent… I really don’t want to do anything until he can make a decision… It was, however, clear that Paul might not be sufficiently lucid to make the decision that now needed to be made fairly quickly.

     By Tuesday evening, after considering all the factors, including that Paul might not be lucid sufficiently to offer his opinion, Monte concluded that, knowing Paul, he would want to take the risk. Paul’s sisters agreed. He’s the eternal optimist, one said.

     Monte informed the orthopedist of his decision the next morning.

     Shortly, Paul experienced a period of lucidity during which he said 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 underwent surgery that afternoon. At 5:33 p. m. the doctor informed us Paul was in the surgical recovery room but he wasn’t out of danger yet.

     At 6:50 p. m. a doctor consulted with us. Paul had awakened in the recovery room, but then experienced full cardio-pulmonary arrest. They revived him, but had to re-sedate him to reinstate the breathing tube. Medication was maintaining his blood pressure and breathing.

     Prior to Paul’s move to the medical ICU a doctor and Monte thoroughly reviewed Paul’s medical power of attorney. Once Paul entered the ICU the DNR would be reinstated.

     We visited Paul in the ICU. Feeling he was stable we returned to the motel.

     Before we ate we received a call from the hospital. Paul had experienced cardiac arrest. We raced to his room, and stood by him at his end. The doctor recorded his time of death at 9:25 a. m.

     Once this chapter of our journey ended we traveled to Paul’s hometown near the St. Lawrence River, where Monte and one sister planned his funeral.

     Since Monte also is the executor of Paul’s estate, we remained at Paul’s home after the funeral, making tentative arrangements necessary to deal with his estate. However, no official action could be taken until Monte was legally named the estate’s executor. However, while at Paul’s home we were able to recuperate from a bug that was trying to invade us, and to rest from the journey we had taken.

     We were honored to have been a part of Paul’s last days, and we were relieved to be home to reflect on the experience.

     To everything there is a season, a time for every purpose under heaven…

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ADDITIONAL READING:

Leap Year Day: Dealing With Life & Death Issues: https://carolyncholland.wordpress.com/2012/02/29/leap-year-day-dealing-with-life-death-issues/

Have Visions. Dream dreams.

My Tinge of Irish Heritage: The Googins Family: https://carolyncholland.wordpress.com/2012/03/15/my-tinge-of-irish-heritage-the-googins-family/

Holy Week: The time from Palm Sunday to Easter

Random Acts of Kindness: Pass Them Forward

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2 Comments »

  1. Interesting observation regarding Paul raising his arm heavenward. When my father had his heart attack, he had been placed in a drug induced coma for several days. After he was weaned off these drugs and was awake, he still could not verbally communicate with us as he still had a respirator in place. His first day awake, he pointed to the ceiling numerous times. We never were able to figure out the meaning of this gesture, and by the time he could talk he didn’t remember having done it.

    Comment by Cynthia Lipsius — March 21, 2012 @ 12:37 pm | Reply

    • Thanks for your observations, Cynthia. Might he have been reaching for Mom? We’ll never know…

      Comment by carolyncholland — March 21, 2012 @ 4:48 pm | Reply


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