No right answer for things.

Today, a daughter and mother had to decide whether to give the unresponsive elderly father a feeding tube through his abdomen into his stomach or whether to bring him to hospice care. Before coming to the hospital he had advanced dementia but would sing songs to his family. When he came to the hospital he has been sleeping and has minimal brain activity. The mom, elderly, only speaks Italian and during the family meeting today we weren’t sure if she didn’t understand the situation or if she wasn’t absorbing it. The daughter, who is the health care proxy, was at one point made it very clear that he was full code. But today, crying, she thought perhaps keeping him alive for as long as possible no matter what may not be the best decision. I remember the first time I saw the patient in the emergency room. His elderly wife next to him, so little small and seated in the plastic chair, waiting for her firey daughter to finish reprimanding the medical team for not keeping her in the loop at the start so that her daughter could translate everything that was going on to her. When everything had been smoothed out with the attending and the daughter, the attending asked if the daughter or mom had any other concerns. The mother reminded the daughter of something and the daughter translated that the mother was concerned because her husband, hypoglycemic and unresponsive, still hadn’t had his flu shot. I felt so sad that moment.

How doctors die

An article shared to me by another friend in med school.

How Doctors Die

I’m not sure about CPR doing more harm than good (no references), but it’s something to think about when it comes to doing “everything” possible to extend someone’s life; in terms of quality of life, financial strain on the system (and families), and even the actual extension of life.

It’s not funny.

During today’s 8am Clinical Skills and Physical Diagnosis lecture, the professor was demonstrating various gaits and the class would guess which gait he was performing.  There was the hemiplegic gait (one foot sweeps out and around, kind of like a dragging on the floor), the Parkinsonian gait (stooped over, short shuffling steps), the paraplegic gait (scissor gait, criss-crossing legs) and the sensory ataxia gait (i.e. drunk gait, wide steps as if your feet are magnetized to the ground).

Maybe it was because it was 8am and a poorly attended lecture.  Maybe because we all looked disinterested and he was feeling desperate to get us to pay attention.  For whatever reason that seemed good to him at the time, after demonstrating Parkinsonian gait he joked “It looks kind of like a retard. Do I look retarded?”

My grandma died the winter before I started med school from complications of Parkinsons.  It was a slow but dramatic decline that spanned over a decade.  I remember my mom and my aunt arguing with my grandma about why she needed to take her medications.  My grandma didn’t want to because she was afraid of the side effects.  I sided with my grandma because she seemed so upset, and told my mom maybe she should leave my grandma alone because she really didn’t want to take the drugs.  I was about 11.  When I was in high school I went with my mom and brother to see my grandparents off at the airport to Hong Kong.  My grandma was put in a wheelchair for the first time and my grandpa told me and my brother in Cantonese that they loved us.  It was my first time hearing that from them.  They never came back to Toronto.  We finally sold their house this year.  For the last few years before she died, my grandma could no longer shuffle “like a retard” and was completely bedridden.  Her mind was still sharp but she spent her days staring at the ceiling of her bedroom or choking on food during meals.  She had told my mom she wanted to die, and had nightmares every night – another complication of her Parkinsons.  After my masters me and my brother and my mom visited my grandparents in Hong Kong, just as she started bleeding profusely from her GI and was hospitalized.  We spent our mornings and evenings sitting in her hospital room with masks on.  Sometimes she chanted Buddhist prayers under her breath and waved her skin-and-bones arms, sometimes she stared at the cartoons flickering on the TV in the corner, but mostly she slept.  They went in to scope her GI and found food and crushed up pills stuck in her oropharynx.  My grandpa, with his OCD tendencies, could barely get himself to visit her in the hospital because he was so afraid of germs.  She died with my mom, cousin, uncle, grandpa and my grandpa’s secretary in the room.  Me and my brother were outside joking around on my mom’s computer.  I was making a cartoon about him.  My mom came out and said “Paw Paw died.”

She was totally different when I went in to see her, just a body.  I was so acutely aware that her life was gone.  It was scary to look at her.  I thought she might jolt up, zombie-style.  I kept thinking “This is now an object.  We are just objects.”

Ten minutes after calling the Parkinsonian gait “retarded” the prof made a joke about Schizophrenic patients wanting to tear up and eat a sealed and stamped envelope, rather than mailing it like a reasonable person (part of the mental assessment test for judgement) and people in my class who are studying to look after people of all illnesses mental or physical, laughed.

I visited my grandpa last summer, just me.  It was my first time visiting him without my mom there, and he opened up to me about my grandma’s death.  He told me how she was the love of his life, that they were together for 80 years and that she had dropped out of high school to marry him when the war started and he needed to move to Macau to run the family factory.  He told me after she died his heart has been broken and he thinks about her every hour, 24 hours a day.