When to pull the plug? part one…

… the story of Grandpa Marv.

Just over two years ago I took a weekend trip to Florida — or, I thought it would be a weekend…

The purpose of the trip was to see my 92 year old Grandma Joy in the hospital.  She had surgery and it had been a while since I made the trip to the Land of the Mouse to see her… so, off I went.

By the time I arrived  both of my grandparents were in the same hospital.  Grandma was doing fine, Grandpa Marv was in the ICU.  My Grandfather had an aortic annurism  burst.  Until that day, he was a very healthy 90… riding his bike around the neighborhood and playing golf.  He suddenly collapsed, Mom (a nurse) knew what had happened and called 911 — a vascular surgeon happened to be available and saved Grandpa’s life… so, he made it to the ICU.

Suddenly a quick trip for Grandma and sunshine (it was February, after all) had turned into a family crisis and my mom and aunt were running ragged — Patty to the rescue, I suppose.

Over the weekend Grandpa held his own with small declines…we made plans for Grandma’s release and time in a longer-term rehab facility… I thought it would be safe to come home — until Sunday morning.

On Sunday two things happened, one — my Aunt Reggie arrived and took a good, hard look at Grandpa and his charts.  Reggie is a nurse as well and has experience in ICU — and her prognosis was grim…. it seemed pretty unlikely that Grandpa would return to his old, active self.

The other thing that happened was that my mom was accosted by Grandpa’s nephrologist — a perky, ambitious M.D. who implied that my mom and her siblings’ pending decision to withdraw treatment was, in effect, killing Grandpa.  Her evidence was that his kidney numbers (horrible to start with) were slightly better on one test….

All the other physicians on his team agreed that it was quite unlikely that he’d survive long and it was nearly impossible that he’d return to anything like his prior level of activity…. but Dr. Perky disagreed, or just thought it was wrong to withdraw treatment….

I could see the way this might play out and decided I needed to cancel classes the following week and stay in Florida.  It was one of the best decisions I hated to have to make.

On Sunday night I went back to the hospital to stay with Mom and my grandparents.  We conferred with their doctors and decided that barring any dramatic improvement, we should stop treatment on Grandpa — and release Grandma to the long-term rehab facility.

In a few days my Mom and her siblings went from having two relatively healthy and independent parents to having both in significant medical peril.  Oddly enough, I’ve already done “Dead Dad” — so, I was of some help.  Also, it’s just easier to plan your Grandparent’s funeral than  your parent’s… so, I stayed.

I also stayed because I wanted to protect mom from Dr. Perky.  It’s a good thing I did — Dr. Perky caught wind of our reach for Grandpa’s plug and accosted Mom again, this time in the crowded ICU waiting room.

Dr. Perky’s plan was to put my Grandpa on dialysis… and she wouldn’t say whether dialysis was painful, invasive or considered an “extreme measure”.  She just wanted to tell my mom that Grandpa clearly wanted to live because his kidney function was barely on the chart.

I let her go on — and on — and on… then I had enough and told her to stop — that I was a medical ethicist and I didn’t like how she was talking to my mother.  I explained that she was inserting her personal beliefs into the care decisions concerning my grandfather, that she didn’t know what he was like or understand the whole situation, so she should stop and listen to my Mother for a minute before she made her feel as if she was killing her own father.

Eventually Dr. Perky put her own ego aside long enough to listen to me and Mom… when she really listened, she heard the story of a vibrant, active man.  Someone who was always lively, opinionated and probably had undiagnosed ADD/ADHD.

Grandpa’s worst fear was ending up unable to communicate, but being able to hear what was going on around him.  He had a neighbor whose strokes left him unable to communicate except by small eye movements.  Grandpa used to bring music over to him, talk to him and read the paper to him — just so he’d have some input.

Eventually, Dr. Perky saw things our way….

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