Decisions
Sort of a surreal day today. I’m in Toledo on short notice because my father is in the hospital in intensive care. He collapsed Friday while getting a bronchoscopy to biopsy a spot on his lung, and has been on a ventilator since then and has suffered an apparent heart attack along the way.
He’s 79, has always been a heavy smoker, and had quite a withdrawal bout after being hospitalized, adding to his stress and leading to him being sedated. Meanwhile, they did a catheterization and determined that he has severe blockages in 3 cardiac arteries, which require bypass surgery. I took a redeye flight to Detroit Wednesday night.
After I arrived, and my brother and sister-in-law from Atlanta flew in, it appeared to us that there was no one person managing the case, and that we were being peppered with reports of “drive-by” specialists, each of which rendered an opinion on one of my father’s body parts. We knew that he was not the healthiest of individuals, and the feeling set in that he was analagous to a wreck of a car that stank and rattled and required all sorts of jerry-rigged finesse, but ran all the same. Place this car in Bobby LaBonte’s garage, and I’m sure his team of mechanics would find a year’s work repairing by the book all these idiosynchracies. We insisted on meeting with a single doctor, developing a chronology on his week in the ICU, and developing a treatment strategy, and were very happy to be introduced to a pulmonologist who had been treating him, and who satisfied all our information requirements.
We immediately deferred the idea of open heart surgery to perform the bypasses, as well as open-chest surgery to remove the mass on his lung, and concentrated on what needed to happen to get him off his ventilator, out of the ICU, and perhaps home, where he could decide on his own from the menu of radical treatments. They started ratcheting down his sedatives yesterday morning, and by last evening, he was conscious, recognized us and tracked our conversation.
Saturday evening, then, the partner of our go-to guy above was on call, and decided that dad’s ventilator tube should be pulled. This was a day or two sooner than we had expected, but we were optimistic due to events so far. Soon, however, Dad was struggling, and the doctor had gone home for the night. The nurse assigned to him, whom we’ve begun calling The Death Angel, chose that time to ask us if we wanted the tube to go back in if he wasn’t coping well, essentially asking us to make the life-or-death decision.
While I appreciate her bias for reality over sentimentality and her stewardship of the ICU resource, I think we all felt that this question should have been put to us by a doctor that felt that there was nothing to be gained by further delay, and not by a nurse about to go off duty. We asked for a conference with the doctor, and he came back in.
In our conference, he thought that Dad may not be completely free of sedation, and that if we replaced the tube, he may be better able to work with us in a day or two, and that’s what we did.
I called the ICU this morning (Sunday), and the same nurse is on duty. She said that Dad was holding stable “now that the tube is back in”, and I couldn’t help but notice the tone of accusation.
We’ll go down there today, but our position is that we’ll be ready to go “sink or swim” when a doctor says it’s time, but we need to steel ourselves, I think, for whatever air of disdain we receive from Ms. Death Angel.
