What a strange weekend. Yesterday I woke up to find the town I live in carpeted in snow, but I decided to go visit my brother anyway. It was kind of a hairy drive, because it was still snowing and they couldn't keep up with plowing the streets. But I got there, and I told him I thought I could take him out, but he was going to have to let me help him get from the door to the car. He declined, so we sat in the nursing home's cafe and had coffee. It was pleasant, he told me that he actually enjoyed living in the nursing home, that it was quiet in the lobby (the patients don't seem to use it) and he enjoyed reading the newspaper in the morning. So I took heart in that, and left to do other things the rest of the day.
This morning, Sunday, I was woken up by the nursing home, who told me that he threw up during the night and had fallen as well. I decided I better go over and check it out. When I got there, he was slurring his words and looked like half his face had fallen. This has happened before, and it's hard to tell whether it's a TIA or something worse. So I went and got the nurse and told them that they needed to worry about hydration. They gave him some kind of a screening test for strokes and said he was ok, and that the doctor was ordering some tests. He was barely responsive. I sat around for about half an hour, and then the CNT came in and took his blood pressure. It was 83/60, so I asked that he be sent to the hospital. I figured he just needed to be hydrated, but that if I sat around and waited for the nursing home to get going, he could start really crashing.
By the time the ambulance came, he was in the 60/50 range, so they started moving post haste. They started iv fluids and he immediately appeared to start stabilizing, so I asked that they take him to the hospital that is about 10 minutes away, instead of the bad one he had been in last May when the same thing happened and I was out of town. They agreed.
I was so surprised when the emergency room doctor came into the room and told me that it was much worse than I thought. He had serious pneumonia, and his blood pressure was dangerously low, and he also wasn't passing urine. They started asking me for living wills and whether or not to resuscitate him. After many worried looks from the staff, a catheter, and lots more fluids, his blood pressure came up and he started looking better. His blood pressure was still fluctuating, so they still wanted him up in ICU.
I was pretty calm during most of this (except for the discussion on DNRs) because I think this is the fourth time we have gone through this. I am pretty hopeful that he is going to be ok, but I also know he could crash at any time.
I am glad I was in town this time around. Also, I have realized that I have to put more thought into this living will stuff. As anybody knows who has been through this, these decisions are pretty case specific and you have to base the decisions on a lot of unknowns, like what are the long term results going to be because of extraordinary intervention: for instance, is the patient going to end up a vegetable, will they be in pain, etc.
I find it pretty interesting to realize that I literally have saved my brother's life several times now, and he has survived because of very expensive, modern medicine, all being paid by the taxpayers. Mainly what I think about is how strong the will to live is, and I will always respect my brother for his will to live.
I am going to sign off now before I start crying.
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