being mortal

I titled this posting Being Mortal because I'm reading the book by Atul Gawande.  It's terrific.

I'm reading the book because my brother has taken a turn for the worse since New Year's.  He started losing weight, and he's now lost about 20-25 lbs.  He has lost his appetite.  In March, there was a flu epidemic in the nursing home, and he caught the flu. His congestive heart failure started acting up, and then he got pneumonia.  He has never recovered, and can now walk about only 10-15 steps without having to sit down.  I am afraid, that unless things change, he is on his way to a wheelchair.

It was difficult to get him the proper medical attention in the nursing home.  There is a very good new nurse practitioner, but she was dealing with an epidemic in the whole nursing home.  The building was on practical lock down for several weeks, they had to stop all activities, and many patients were confined to their room, including my brother.

My brother has a new doctor, too, and the doctor was on vacation for 2 weeks.  After calling twice, I got his attention by asking if my brother was ready for hospice.  Since my brothers hemoglobin is dropping, the doctor suggested that I make him an appointment with a hematologist, which I have done, the appointment is this coming Thursday.  It took a while to have the in house cardiologist see him, he was supposed to come last Wednesday and didn't show up.  After several call, he showed up late on Friday, and then called me and told him my brother was fine.  I asked him why he thought that and it was because my brother told him he was ok, and that he could stand up from his chair.  He did not ask him to walk.  At least he ordered a electrocardiogram so we can tell how strong his heart is.  I am not impressed with this doctor, but willing to give him a second chance because ha makes house calls into the nursing home, which I think might benefit my brother.

There is concern that my brother has an ulcer or colon cancer, but his stool sample cam back negative for blood and cancer.  However, for the first time today, he complained that his stomach hurt.  The weight gain is my main cause for concern, if he continues to not eat, he will die fairly soon.

Back to Atul Gawande.  After reading just the first part where Dr. Gawande talks about the lack of clarity and planning for death, I am more committed to hospice, although that all depends, of course, on my brother's diagnosis.  But I had an epiphany that there is no discussion between the medical staff, patients, and families, about what the purpose of medical care is in a nursing home.  What are reasonable goals and objectives?  What does it mean when someone is confined to a wheel chair and loses mobility in a nursing home? Basically it means you are sitting in a wheel chair in one place 24/7 except for going to the dining room and sleeping  in bed.  In this case, should heroic measures be taken to continue life?  If my brother ends up having some kind of terminal condition, I am going to need to start thinking about all this.  For instance, if he has cancer, do I get him chemotherapy?  Does he have the emotional and physical strength for it?  It is a horrible responsibility to have to make these kinds of decisions for someone else's life.  I am going to seek the advice of experts in palliative care.

Meanwhile, for the first time in about 10 years, when he broke his foot, my husband and I took him for a walk in his wheel chair.  We went to Dunkin Donuts and he refused anything to eat, including coffee or a milk shake.  But I think the walk really cheered him up and I was very happy that we did it.