Monday, March 5, 2007

“On Borrowed Time”

I was almost certainly correct in my ‘chemical’ assessment last Friday. Well, more broadly, malnutrition (usually less than 200 calories a day, by my estimate; most people eat well over 1,000), insufficient hydration (sometimes less than eight ounces of fluid in a day) and certainly insufficient electrolytes significantly impaired my dad’s health. A three–day course of Pedialyte, which provides sodium and potassium, the two most essential bodily electrolytes, and glucose, the simple sugar on which cellular respiration depends (‘respiration ’ in this context refers to the intracellular oxidation of pyruvic acid, which is formed from splitting glucose molecules), has resulted in a noticable improvement in his alertness and coherency. No longer is he spending his days in a near stupor, eyes heavily lidded. But his overall health continues to markedly decline.

He has grown so weak that he can barely raise an arm. He is being tended to ’round–the–clock by the two Fijian women, now joined in shift rotation by the husband of one. They are taking great care of him and he appreciates them all. They are aided by a motorized hospital bed. By simply pressing buttons, he can be raised from a prone position or his legs and feet comfortably elevated. The bed has replaced the one in which my parents slept for decades, first in Illinois and then in Berkeley. My mother is sleeping down the hall in my sister’s room. My parents will never again sleep together. But at least my dad is much more comfortable and can be easily elevated rather than having to be physically [wo]man-handled and propped up with a bunch of pillows.

His activity has been harshly limited. He is unable to hold a book, unable to read, for which I feel very sorrowful. Reading has always been his greatest passion. The jammed bookshelves in his home and office are evidence of this love. He is relegated to simply watching television, looking out his bedroom window (granted, it has a broad, lovely view of San Francisco and the Golden Gate Bridge, in which beautiful sunsets are often visible) and chatting with whomever is available. It is a constrained and frequently tedious existence for someone who has lived such a life of the mind.

Last week, abruptly and with no warning, nor discussion of reasons and consequences with either of my parents, Dr. Canin, my dad’s oncologist at Walnut Creek Kaiser abruptly ceded responsibility for my dad’s care and turned it over to hospice care. That wasn’t by any means a bad thing. The nurse now supervising my dad’s care is a wonderful, pragmatic, forthright but very caring woman my parents and I all like and respect very much. Also, hospice supplied the aforementioned hospital bed and other equipment. But hospice is the last step, the point of no return. This was underscored as I sat by my dad’s bedside and listened to discussions of DNR directives (click on the link). All three of us were unprepared to learn that my father was beyond further treatment.

Further discussions with the hospice nurse have revealed that my father has far more serious problems than any of us knew. Such as a mass in his superior vena cava that, the nurse suggested, was forcing fluid out of the vessel which was then leaking into my dad’s arm causing the long—we thought—undiagnosable swelling. Okay, it’s not a definitive diagnosis but it is a reasonable one, which begs the question as to why Dr. Canin never even hypothesized it, let alone told us about the mass?

Now I know. Even though he is more alert, more coherent, more conversant, he is not going to leave that bed again. As my mother said this morning, as she and I walked together, he is living “on borrowed time.”

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