Tuesday, October 30, 2007

Rituals

I heard a great story today that I'd like to retell:

An elderly gentleman with dementia, living at a nursing hom e, started exhibiting some disturbing behavior. Before going to bed at night he'd shuffle up and down through the halls of the nursing home.  This particular place had pictures of all the residents outside each room, to help them all find which room was theirs.  AT each room this elderly man would pause, and then kiss the picture of the elderly resident. He'd wander up and down the halls doing this until the staff would loose patience and force him to bed.  What at first seemed cute, really began to disturb everyone working there, and even some of the other residents.  The head nurse called this man's family to discuss the situation.  The daughter listened to the story and then said, "I know exactly what to do to fix the problem, and I'm sorry I forgot about it".  The next morning she arrived, a picture frame in her hand.  As she placed a picture of a young boy next to her father's bed she explained, "This is his oldest boy, who died tragically at the age of 8.  All our lives, dad would kiss our brother's picture before turning out the lights to go to bed. I think he's been wandering the halls looking for his son's picture, to kiss goodnight"  Sure enough, with that picture beside his bed, he never wandered the halls again. 


Friday, October 26, 2007

Story board

Finishing up a week at the "house".  As I sit getting ready to leave for the weekend, I wonder who will still be here Monday.  Each room has such a unique story, with vibrant characters. 

Room 1.  80 year old woman dying of heart failure.  Her well dressed husband is hard of hearing, a "talker" with a scruffy voice like Louie Armstrong. "I guess I'm the biggest fool here at this place, not wanting to leave her side.  From the moment I left the Navy, walked off the boat and saw her, I've never been the same. I just can't be away. My kids told me I should go get some rest, but I woke up at 4 this morning with her on my mind.  She's not opening her eyes anymore, but I think she knows I'm here"  His booming voice echo's through the house. He pats her hand, his eyes well up, "I don't know how I'm going to make it with out her"

Room 17.  50 year old man dying of liver failure.  He is a skeleton with a sheet covering him. Eyes sunk back, mouth open, eyes glazed over. Soft classic rock is playing in the background. He was a drummer for a band and his friends say he lived a rough life: drugs, alcohol, you name it.  He's alone now.  He can't let go, afraid of what awaits him.  He had 40,000mg of morphine yesterday and is still not comfortable.  Fighting demons we can't imagine.

Room 20.  70 year old woman dying of breast cancer.  She's a big woman, Italian, still in her flower patterned night gown. Her three daughters are now all in town.  Big women, with big hair, each a different bouffant style.  Their loud boisterous voices and personalities seem to match their appearance.  The youngest daughter tells me "When I arrived, Mama's spark came back, her color's so much better..." The middle one at the same time, "She's really plateaued don't you think, doesn't have that same rattle when she breathes..." While the oldest chimes is, "Mama's going to surprise us yet, why, her temp's down to 101 from 103"  and then all three ask me, "What do you think, do you see the same improvements?"  While all the facts they stated are true, I have to still remind them that she's dying.  There loud chatter and banter with each other follow me out of the room.

People may think my job is boring- the outcome already known - Death.  But each room is such a colorful story that I get to enter into briefly, how could it be boring!? 


Monday, October 15, 2007

Dying at home

Another one for the books. When I was on call this past weekend I was involved in an extubation of a younger guy; 23 years old and a gun shot wound in the back of his head. He'd been at our hospital for 3 weeks on a breathing machine, waiting to see if he'd become brain dead. This is a case you'd say, unfortunately he didn't progress to brain death. He was trapped- not brain dead, but in a persistent vegetative state. Enough damage had been done from the bullet, that he was guaranteed never to wake up. Ironically, his 14 year old cousin had died at our hospital 6 months earlier with a gun shot wound. Having watched the ordeal his cousin went though, our patient was very vocal to family and friends that he'd never want to be alive if it was hooked to machines.

After 3 weeks in the ICU, it was time for the family to honor his wishes and take out the breathing tube. Over 30 people assembled after church sunday to meet one last time with us and give the final okay. We extubated him a little later, and not surprisingly, he began to breath on his own. As healthy and young as he was, it became clear that it would be days before his body actually shut down. His fiance', with 2 kids at home, was adamant she wanted to take him home to care for him these last days. We reluctantly made arrangements for this, and things started getting messy.

Police began calling. Evidently, there was suspicion that a family member was involved with his shooting. In fact, the bullet was still lodged in his brain, and would need to be extracted at autopsy for evidence. There was worry that the family wanted to take him home to die, to avoid the autopsy. (Destroy the body to protect the family?) We even had to have a last minute meeting with our lawyers on the legality of sending him home. Then this patient's fiance' started asking questions about sperm donation, wondering if it was possible to somehow extract some sperm for later use. (The answer legally is no, because he can't give consent). Just when we finally had everything arranged, the hospice home team started to fuss. It was too late in the day, they said, to go to this fiancé's neighborhood to meet him on his transfer from the hospital. The nurses worried, they'd be the next gun shot victim in our hospital.

What can I say? Isn't helping people die at home supposed to be easier?


Monday, October 8, 2007

Evil

Tell me if this isn't just evil.

We have a 50ish patient with ALS (Lou Gehrig's) disease. As his muscle's have weakened with the disease, he's been left unable to talk or move.  He's a brilliant mind trapped in a body that doesn't work.  His wife, however, is the one with the real problems.  We learned soon after he was admitted to our hospital, having now lost the ability to swallow food, that his wife was abusive.  She'd often leave him at home, alone, not able to call for help or even move. 

But the worst thing happened not long ago.  Upset for some reason, she started yelling at our patient.  Telling him how he'd ruined her life and such. In fact, there was no point living any more.  She grabbed a gun and shouted " I'm going to kill myself".  I can imagine his eyes widened with horror, but he couldn't do a thing- couldn't grab a phone, or yell to stop her.  She left his room and the next thing he heard was a gunshot.  Then silence.

She then sneaked out of the house, so he'd not know that she really was alive.  She left him in despair, thinking she lay in the next room dead, with no one to help. She didn't re-appear till the following day, with a sneer on her face for what she'd put him through. 

I can't fathom that type of emotional pain that he's experienced.  It's hard enough to cope with being trapped in a body that is loosing it's ability to work, let alone having the psychological torture he's had to endure. 

He's moving to the hospice house tomorrow, with only days of life left, we'll try to ease his suffering the best we can.