Bit of a mixed message today.
On arriving, Nurse left us with impression that aside from the swallowing reflex that Dad was improving nicely.
Doctor later informs us and Dad (as he was awake) that Dad faces three choices (or us, if he falls below competency) going forward:
1) Extubate, with re-intubation if/when he has an obstructive breathing episode.
2) Extubate, and if an obstructive breathing episode occurs, allowing Dad to pass.
3) Tracheotomy, with a feeding tube implanted to the stomach through the thoractic wall.
Dad has not yet successfully communicated a decision to us. We have not come to a decision regarding treatment path. The doctor tells us he cannot give us odds on recovery of the swallowing reflex as regards "if", "how much", "when", or "ever". Dad appears mentally present, and we were very graciously asked to leave by the nurse as his blood pressure went up as Dad tried to communicate with us, failed, and grew frustrated.
We are being urged to come to a decision in the next few days, as the unstated option (leaving Dad as is) also has risks including pneumonia.. Option 1 risks repeated aspiration along with resultant pneumonia, potential of damage during or due to a delay in crisis re-intubation - on the upside it has a built-in "change your mind" feature. Option 2 is more dangerous, and in my understanding, constitutes simply a rather elaborate form of letting Dad pass without saying that's what's happening. Option three offers a significantly reduced risk of aspiration (but no guarantee) and brings quality of life issues to the forefront.
As I said, we are at this time unsure if Dad is capable/willing to select from this rather gloomy menu (though it seems like someone is clearly still home, the microphone is off and the etch-a-sketch is broken), and are not blessed with a terribly informative prognosis beyond "hey, if he can just re-learn basic swallowing, things will be a whole bunch better".
Both Mom and I took this rather hard, and it hit Little Brother as well, though he is doing surprisingly well, leading one to wonder if he was brought by the Stoic rather than the Stork. We are beginning to enter some of the more difficult "what if" conversations, however, at least now have some guidance from documents Dad had placed in the Safe Deposit Box over the years.
On arriving, Nurse left us with impression that aside from the swallowing reflex that Dad was improving nicely.
Doctor later informs us and Dad (as he was awake) that Dad faces three choices (or us, if he falls below competency) going forward:
1) Extubate, with re-intubation if/when he has an obstructive breathing episode.
2) Extubate, and if an obstructive breathing episode occurs, allowing Dad to pass.
3) Tracheotomy, with a feeding tube implanted to the stomach through the thoractic wall.
Dad has not yet successfully communicated a decision to us. We have not come to a decision regarding treatment path. The doctor tells us he cannot give us odds on recovery of the swallowing reflex as regards "if", "how much", "when", or "ever". Dad appears mentally present, and we were very graciously asked to leave by the nurse as his blood pressure went up as Dad tried to communicate with us, failed, and grew frustrated.
We are being urged to come to a decision in the next few days, as the unstated option (leaving Dad as is) also has risks including pneumonia.. Option 1 risks repeated aspiration along with resultant pneumonia, potential of damage during or due to a delay in crisis re-intubation - on the upside it has a built-in "change your mind" feature. Option 2 is more dangerous, and in my understanding, constitutes simply a rather elaborate form of letting Dad pass without saying that's what's happening. Option three offers a significantly reduced risk of aspiration (but no guarantee) and brings quality of life issues to the forefront.
As I said, we are at this time unsure if Dad is capable/willing to select from this rather gloomy menu (though it seems like someone is clearly still home, the microphone is off and the etch-a-sketch is broken), and are not blessed with a terribly informative prognosis beyond "hey, if he can just re-learn basic swallowing, things will be a whole bunch better".
Both Mom and I took this rather hard, and it hit Little Brother as well, though he is doing surprisingly well, leading one to wonder if he was brought by the Stoic rather than the Stork. We are beginning to enter some of the more difficult "what if" conversations, however, at least now have some guidance from documents Dad had placed in the Safe Deposit Box over the years.
1 comment:
Damn Ray, I hate that you're faced with these decisions.
Prayers and good wishes coming your way, man.
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