Raising Parents - The Bar has been Lowered

 Remember when I mentioned during the Guide to Raising Parents that your phone is going to ring?

Yeah, THAT.

It feels like today it has rung/rang (?) every hour on the hour.  It's not even 5:00 pm and I am ready for bed now.  

What had happened was...

My father-in-law was in the hospital.  I had to call the ambulance for him Friday afternoon.  He phoned me and was short of breath so  I rushed down and he was throwing up and couldn't stop.  He said he was very weak, thought he was going to pass out and that's why he phoned me.  After some questioning, we decided to phone the ambulance. They were here very quickly this time, which is remarkable because the outside temp has been in single digits for days. I assumed it was going to take a little while.

Two of the paramedics had been here before, one that liked the sibling's dog and one that was out for my mother-in-law one of the eleventy times. In fact, he asked about her and gave condolences, which was very sweet.  "She fought to the very end, didn't she?" he stated.

I will say that he had sounded short of breath the day before on the phone but I didn't know what he'd been doing prior to the call so I didn't panic.  But then when I got there, he was short of breath again. So we told 911: shortness of breath, vomiting, weakness; which are all code for heart attack.

He has: 

• Pulmonary edema...fluid around his heart and lungs
• Chronic Heart Failure...exacerbated by the edema
• Dangerously low 02 levels...he was on more oxygen than mom was when she passed. Yikes.
• Dehydration (ironically)
• Kidney Failure

The hospital originally said that it would be about a three - four days stay, depending on how everything shakes out.  Saturday, he announced that the doctor said he could go home tomorrow.  To which the nurse looked shocked and said No.  To add to it, they couldn't give him one dose of the needed meds this morning so it prolongs his stay by at least one half-day.  So doing the math...maybe Monday but probably Tuesday.

Then...the nurse said on Saturday it would be a few days. The doctor phoned later that day and said Well, we're probably sending him home tomorrow.  Kevin and I both were like WHAT.  The nurse seemed very surprised as well.

We explained how he is going to be alone for the majority of the time and we have concerns.  We explained what happened almost exactly a year ago with hospitalization ending in a care facility. We advocated him staying as long as possible. For him, and for us if I'm being honest.

They did a physical and occupational skills test and he passed so they're sending him home and without support. Sigh.  What we finally figured out was that he passed at baseline, meaning he can mostly do things by himself versus being measured by someone my age who undoubtedly could easily manage on their own.  The bar to pass is very low. So, there's an adjustment of expectations for us.  Also, we were comparing to how he used to be versus now and they were just looking at now, objectively.

Kevin and I talked about how I cannot be responsible for him during the day.  I had just mentioned to Kevin that it's making me nervous that he's home alone all day and I can't easily check on him. (like I could when they had their house) And now HERE WE ARE. He is less and less able to take care of himself.  Easy things like the dishes or feeding the dog or even feeding himself.  He's showering less again. And if you ask him, he'll say he's FINE. 

Oh, I forgot a big part: he fell during the early morning of New Year Day and broke his little finger.  He went a week before getting his hand checked (side-eye to the siblings about that) and now he has a cast. On his right hand.

Then during his hospital stay, he mentions that he thinks this has been happening for A WHILE.  I cannot EVEN with that.   And like Kevin pointed out: he's constantly at the doctor so how was this not been addressed earlier?

Now we're caught up to today.  

When they discharged him, they wanted him to be seen by his cardiologist AND his regular physician.  I made the cardiologist appointment and held off on the other one.  It feels unnecessary for two doctors to see him for the same thing.  This is something to add to your list, if you're keeping track: doctors will want appointments and not consider the impact on the patient and or family.  You have to advocate for them to avoid that.

Meanwhile, I went to the cardiologist appointment and he was owly.  He was not in the mood for me or the doctor.  I'm not offended and I'm also not going to play that game.  I know he doesn't feel well and he was probably expecting to be 100% in the one day that he was home from the hospital.

I asked the cardiologist if she felt it was necessary or worthwhile to ALSO see his regular physician.  She said no, because everything that needed addressed will be done at the appointment with her. Also, the issues are purely cardiology issues.  Also, I asked if we could just stick with her ONLY for the next little bit as the issues are cardiology related.  She agreed and thought that "streamlining" was a good idea. (her word, not mine)  Then I turned to my f-i-l and said "So, for right now, we are NOT calling the doctor for any appointments. We are only calling the Cardiologist from now on."  He did not enjoy that decision.  I bet he breaks that "rule" within days.

Part of the reason for that decision is a medication change is what precipitated the whole hospitalization.  Between a med change from the cardiologist and a med change from the physician, it put him in pulmonary edema and no exaggeration: could have killed him.   For now only one doctor is changing prescriptions.  (add that to your notes: prescriptions are a NIGHTMARE for the elderly.  SO.MANY.OF.THEM and from Different.Doctors.Who.Don't.Talk.To.Each.Other.)

She did an overview of everything and timelines, she was really thorough as if solving a puzzle.  She mentioned that it looked like he had lost weight but that he hadn't.  She looked at me as she finished the question.  I quietly mentioned "FRAIL" and she was relieved that we saw it too.  She said he had a marked change physically in three months, which is concerning.  However, his blood work is good, the hospital ran every test available, and on paper he's "healthy".

Then we got punched in the nose a little bit.  She sighed and said "I think what we are seeing is a natural progression of the aging process..."  Meaning: he's winding down.  She then turned and reviewed his meds and decided that "We will look at paring some of these meds down as much as we can in the near future."  I was not ready for that.  

He's transitioning to palliative care. I had to breathe through that a little bit.  He did not understand what was said or happening and I think that's a good thing.  It also made me suck-it-up-buttercup because he wouldn't have understood why I would have gotten emotional.

He has an appointment in one month to re-re-evaluate everything.  If he continues on the decline, then she'll begin to pare back his medicines.  She also wants to schedule a procedure that would take him off blood thinners and make falling not such a panic situation. (still scary, nonetheless)

So that was done.  Next Level now begun.

Then I took Lucy to the beach because we've been cooped up for a week due to single digit temps and I needed AIR.  Wouldn't you know it, as I'm standing on the icy cold beach, the phone rings.  This time it is the hospital, checking in with us regarding his status and ensuring we've made his follow-up appointments.  

I let them know that we would not be seeing his regular physician and why; they agreed.  I explained that we are starting to look at palliative care and she didn't seem surprised.  This made me think of when my mother-in-law was in the hospital and the E.R. doctor then the E.M.T. both asked us "What are you doing?  She needs hospice."  It took them to Say It, otherwise I feel we would still be devoting our time to keeping her alive to this day.

Now mix into this calls between Kevin and I as he updates the siblings, has questions, and/or I've forgotten something. 

Also: I gave up on any sort of work today.  Hopeless.  

Because as I sat down to try to work this afternoon, the phone rang.  It's my f-i-l's physician's nurse, wanting to schedule the appointment that everyone else decided was cancelled.  Clearly, they had not seen the report from the cardiologist.

I explained The Whole Thing again and our reasons for not having the appointment.  The nurse says "Well, I think that Dr. Bal really wants to see him in the office"  I admit to a little trill of annoyance. I asked "Can you tell me why?  I'm not being snarky, I just need to understand why he would need to be seen when he was just seen by an entire hospital AND his cardiologist."  To this, the nurse was a little quiet.  I continued: "If she reads the report and the hospital report and Still has a compelling reason for him to travel to Another Appointment, then phone me back and the family will work on it."  She agreed and sounded a little downtrodden so I amped up my cheeriness so she didn't think I was the internet meme version of myself.

Nearly an hour later, she phoned again.  The doctor had read everything and agreed that there wasn't a reason for him to be seen. Thank you little 8 lb. 6 oz. sweet baby jesus.

Now we have to circle the wagons, again.  We won't make any big decisions until after the next appointment when we know the next steps.  Who knows, maybe he'll rebound and surprise us. Probably not but maybe.  We won't tell the cousins until we know.  Even with all of this, we have time.

Oh, and finally, this one last piece: he joined a gym about two weeks ago.  We were reluctant but "let" him do it.  Unbeknownst to him, I phoned the gym and gave them all the information I could and instructed them to phone me if something ever goes wrong.  He went three times then ended up in the hospital.

When I phoned them to let them know he wouldn't be in for a while, they were immediately and genuinely concerned. He's already charmed them.  They were relieved he was okay and was still planning on returning.  "He doesn't know when to quit!" they said.  In a "Wow, does he know he's 85?" kind of way.

I think today he knows he's 85.  I'm not sure if he knows to quit, either.