Taking Account While Taking A Count

So, it turns out the superstitions preventing me from completing my census form before April 1 were well-founded – Dad had to get EMT’d to the hospital on the current decade’s designated day of reckoning. Of course, since he was in the house for at least part of the day, I counted him as a resident – but I also checked the box indicating he sometimes lives in a hospital or nursing home. We journalist types can be very literal.

Fortunately, the stay was only for a couple of days. This visit was the result of yet another medication adjustment. New research from the manufacturer of Plavix – a must-have med if you’ve recently had a stent installed – indicates that taking Prilosec (aka, omeprozole) at the same time can cut Plavix’s anti-clotting capabilities by up to 50%. Now, since Plavix has the unfortunate side-effect of ripping your stomach lining to shreds, Prilosec is a frequent presence on a Plavix taker’s prescription list. The doc, on learning of the problem, switched Dad over to a different stomach-treater, called Protonix. A day later, Dad began complaining of abdominal pain. Two days later (Monday) he began becoming constipated. The next day, we visited the walk-in clinic where the physician’s assistant switched Dad temporarily back to Prilosec, suggested he take one dose of Milk of Magnesia that night, and also let us know that the nasty urinary tract infection was still around, meaning another round of Bactrim was in order. The next day (Wednesday) the visiting nurse came by and, with Dad still constipated, suggested one more dose of Milk of Magnesia that morning. About 8 hours later, both doses kicked in at once, beginning 12 hours of debilitating diarrhea – not always within range of the toilet. It’s a good thing I’ve had plenty of experience cleaning up after sick pets, because it helped me put my mind into that “let’s just not think about it” place when I had to pull out the mop and pail.

One blessing during the whole affair was the fact that my sister was here visiting when the worst of it all came down – or, rather, out. She arrived late Tuesday night. We spent the day Wednesday tending to Dad, who at that point was bedridden with the continuing abdominal pain and constipation. And Thursday morning, into the afternoon, it was wonderful to have her company in the ER, while waiting to see if Dad would be admitted, and then getting him settled into place and answering the nurse’s questions up in the ward. Then we took Dad’s credit card out for a very nice dinner. Terry and I had a great meal, and the credit card got some exercise, so we all came out ahead.

As I said, Dad was out by Saturday, in time to go to the Easter brunch  he’d been looking forward with great anticipation. But during his two days in the hospital, Terry and I talked a lot about the situation and my ability to cope with it – she expressing concern that it was getting to be too much for me, and me expressing my thought that putting Dad in a nursing home (there’s not really money for assisted living, and he may need too much a la carte care to make it feasible, anyway) would be the end of him in very short order. We even met with a representative of one of the local hospice groups to investigate that option.

Monday evening, with Terry set to leave the next morning, she and I brought the idea of hospice up to Dad. The hospice group medical director said he probably didn’t qualify yet medically, but I wanted to introduce the concept, with Terry around, and maybe de-scare-ify it a little bit. It doesn’t mean we all think you’re going to die tomorrow, and you won’t get bumped if you don’t die soon enough – that kind of thing. Mostly, we just wanted to help Dad understand that he had some control over any future medical interventions.

After dropping Terry off at the airport bus stop, Dad and I continued this talk with his primary care physician. The doctor agreed that Dad probably wasn’t a candidate for hospice because he was still responding well to hospitalization/rehab center treatment. But, he added, there might come a time when Dad might decide he just didn’t want to go to the hospital anymore, and it was valid at that point for him to make that decision. That’s when hospice could become invaluable.

Then,  when Dad said he just wouldn’t want to be a burden to me by not going to the hospital, the doctor said a really nice thing.

I stepped in first. “You’re not going to be able to make that decision in the middle of an event,” I said. “You need to make it when you’re well and we have backup in place – but hospice can help with that, and we can make it work.”

At which point the doctor added, “Chuck has been with you all through this, and he hasn’t stepped back from anything up to now, so I don’t think you have to worry about him handling anything down the road.”

So, we’ve started a conversation, and I think I see a little better how the situation might end up playing out. Already, just a little more than a week since he left the hospital feeling great, his blood pressure’s starting to fall again and his energy’s beginning to lag a little. I don’t like doing too much of my own prognosticating, for fear that my internal predictions might actually lead to a poorer outcome, but I’m guessing he’s 4-5 weeks from another event of some sort. He makes it clear every time I end up calling the EMTs that he doesn’t want to go to the hospital. Once it really starts sinking in that he can control that, our conversation about future treatment options may continue – and he may decide he no longer wants to be a periodic resident of a nursing home or hospital.

I wonder if the Census accepts do-overs.

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