Thursday, October 16, 2008

Dear family and friends,

Jack here with an update about my Mom, Rae Russel. The would-be writer in me wants to go on about yesterday’s dramatic events, but since today’s events are tumbling forward, I’m off to the hospital and will be mercifully brief.

Rae did well earlier this week with her last (third and minor) surgery to put a GI-tube, a “peg” in. Now she can keep the irritating nasal feeding tube out. On Tuesday she was shipped from Kaiser Terra Linda (San Rafael) back to her rehab facility in Petaluma. The very next day, yesterday, she was struggling again, breathing heavily and running a temperature. Since the care at a rehab facility is not as thorough at a hospital they chose to call an ambulance—and get my Mom back into a hospital. (Laymen Karen and I were there and we agreed.) Petaluma’s Fire Dept. squad of paramedics arrived dramatically, packed Rae up and got her in their ambulance. Next step: decide WHICH hospital to transport her to; either back to Terra Linda (35 min. away), or nearby Petaluma Valley Hospital (PVH) (8 min. away), though PVH is not a Kaiser (medical group) facility. (Meaning she’d be new to them and we’ll have delays getting needed medical history and records.) Quick—what would YOU advocate for?…

Decision made: stay in Petaluma rather than risk a longer ride.

Flash forward: once there though, in the Emergency Room, docs new to Rae must assess her from the ground up (with our help) and determine the cause of this most recent distress and then a treatment. Two hours go by, and that’s a hunk of tale I’ll leave out.

Flash forward, past the (my) doubt and fear and, most challenging of all, the not-knowing. Add drama and worry and some tears. Leave aside as best you can (because we have) the anger over why she was transported out of Kaiser’s Terra Linda hospital in the first place just the day before. Come out the other side, to last night, with a(nother brain) CT scan and another round of blood and urine tests.

I must note that the doctors and nurses last night, and in this realm in general, are ordinary human beings who act extraordinarily. For instance, as the ER doctor talks with us to determine my Mom’s malady and a treatment, I realize he’s doing many things at once. He’s not simply assessing Rae as best he can, he’s also assessing our (mine and Karen’s) emotional states and determining how this affects the information we’re giving him. He’s also delicately giving us options for the amount of care we will authorize him to dispense. From his point of view, he’s just been delivered an 83-year-old woman who’s obviously sick and likely on the way out. Of course that’s not our point of view, or perhaps it’s more accurate to say that’s only one of our points of view.

caringly around us visitors who are under great stress. Drum roll please: my Mom now has a urinary track infection (UTI for those working in these settings). With this comes high heart rate (108 bpm) and fever of 104. I’d feel shitty with this and I’m 48, not 83. And I’ve not been in a hospital bed for over a month (last Monday was four weeks since the first surgery).

She received great care last night. She seemed to stabilize. Her heart rate dropped to 100; high but better than meteoric. Upon our insistent request she was NOT transported back to Kaiser’s Terra Linda hospital, but left overnight in Petaluma to fight her fight.

The really big questions we struggle most with are: What do you want us to do, Mom? How much help do you want here? After a month of struggling to get out of the hospital, with so many ups and downs,

And my favorite: Won’t you please just tell us whether you’re still in this fight to live, or whether you’ve had enough. We can only guess the answers. If my Mom does want to let go, then why is she still fighting mightily to stay alive? Is this just her strong body acting on instinct, staying alive at all costs by habit? My mother is nothing if not strong-willed; if she wanted to check out, she would have already.

I went home last night, got some food, hung out with my gal and then got some sleep. I woke to messages that today, Thursday, she is “not doing well.” Meaning her heart rate is still high, though her fever is done to 101. I don’t even know if this is an improvement or a decline. The numbers don’t tell me as much as I quickly assess from being at her bedside. So I’m off to the hospital, feeling more and more like she’s NOT going to make it.

And that’s not the worst of it, really it’s not. Rae is 83 and went into the hospital saying, “If I die on the (operating) table, it’s okay; I’ve had a good life.” I’m getting a crash course in end-of-life dramas that lay ahead for most of us, either with our parents or for ourselves. Our kind neurologist Dr. McCarthy, still available to us by phone because he cares, has explained the meaninglessness of the common term, “no extraordinary measures.” Isn’t what Rae is going through right now “extraordinary?” She’s getting food and liquids and oxygen and meds pumped into her, urine pumped out. She wasn’t able to talk yesterday. Is this ordinary? Each time she takes a turn for the worse like this, staff asks us, as they must, what degree of care (“comfort” and “palliative”) do we want to provide?

My immediate response is to pull out all her tubes and wheel her out onto the surrounding lawns with their sprinklers running, birds chirping and sun shining to allow her a few final minutes in the nature she loves as much as I do becomes increasingly tempting, however crazy. No wonder the “steal the corpse scene in “Little Miss Sunshine” had such appeal.

I’ll meet Andy at the hospital today, and report back in later.

My only request is to think of my Mom today and wish her well, whatever her choice.

With love,
Jack