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The phrase, “death by a thousand cuts” has been running through my mind lately, as I’ve been with Dad to multiple doctors’ appointments over the last couple weeks. Except, I’ve amended it for his situation to “death by a thousand specialists,” as each doctor we’ve seen seems to be delivering their own specific bad news.

Yesterday was a double-header, with a visit to the podiatrist and Dad’s new cardiologist. The podiatrist discovered a rather nasty ulcer on the tip of Dad’s big toe – if that’s not taken care of, infection could get down to the toe bone, which would require a rather large cut, I’m assuming, to remove said toe (see “It’s Ba-a-a-a-aack“). Now, as a result, I’m back to the hated toe-dressing routine on a twice-daily basis.

Then, with a break for lunch, it was onto the new cardiologist, to get his take on the echocardiogram taken a couple of weeks ago, along with a chest x-ray taken last week. On the positive side, congestive heart failure doesn’t seem to be a current concern. On the negative side, though, there’s sign of scarring in his lungs, called pulmonary fibrosis, which is a likely cause of his shortness of breath. Additionally, he has what’s called pulmonary hypertension, which means the side of his heart that pumps blood to the lungs has to work harder because of that scarring, and so has become enlarged. At least, I think that’s what I’ve been able to put together from what the cardiologist told us and what I found on Dr. Internet. So now, Dad’s scheduled for a procedure with the ominous name of “nuclear stress test” or, more commonly, a chemical stress test. I guess this will give the doctors more information about just how crappy Dad’s heart really is.

And, once this test is done, he’s likely to be referred to a lung specialist, which will, in all probability, lead to more tests.

I’ve written about this before (see “Decisions, Decisions“), but I’m just beginning to question the “why” behind all these specialists and tests. He’s 87. He has a hard time breathing. One of the treatments Dr. Internet suggests for pulmonary fibrosis – the scarred lungs – is a lung transplant. Do we really need tests to determine if an 87-year-old man, with compromised kidneys and heart disease, needs a lung transplant? Can’t we just get him one of those little oxygen tanks in a snazzy, nylon carrier and be done with it?

Instead, this system is geared to provide care at a level that seems to suggest an 87-year-old man with scarred lungs, an aging heart and failing kidneys could stay alive forever. Now, yes, we could simply say “no” to the tests and specialists – and, frankly, if the cardiologist suggests a consult with a lung specialist, I’m going to want some more information on the “why” behind that referral before we make the call for an appointment. But, still, there’s an urge to know and treat that is very difficult to resist, and the decision trees that sprout from each new test result often have at least one or two branches that leaf out with hopeful – or, at least, palliative – treatments at their very tips. And it’s only human nature to reach out to those hopeful, if not terribly weight-bearing, branchlets.

But I’m also beginning to see, not the end of the beginning, but, more probably, the beginning of the end. And, more sadly, I’m beginning to feel like Dad is having a similar vision. And it’s very difficult seeing that these tests, which, in a hopeful mind, lead to new opportunities, also, in a more realistic/less-hopeful mind also seem to place Dad in their cross-hairs. This is another reason why I question the need for yet another specialist – 999 cuts may have no less an effect than 1,000 to the outside observer, but, to the victim in question, there still may be a blessing in that one less violation of his mortal flesh.

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