2001-05-09 - 11:18 p.m.

Death Sentence

One of the most frustrating things about my Dad's stay in the hospital is that we really don't know exactly what's going on with him. Why did he have the congestive heart failure? What's the matter with his lungs? It is related? When is he slated to go home, wherever the hell that is?

The trouble is that he's been bounced from room to room so much that every time I visit there he's been assigned a different nurse. They can't answer any of my questions because he's only been their patient for a couple of hours. So, I decided to call Dad's primary physician, who also happens to be my diabetes doctor. If anyone would know what was going on, it would be him.

Of course he is a busy guy and I couldn't talk to me directly - I called his office, left a message with his secretary and he called me back later in the evening.

I have talked about my doctor before. He's got an unusual speaking style - he uses the editorial "we" a lot, but he keeps slipping out of it, like a shoe that's too big for him. When he has something difficult to tell he may tap dance around it, or he may just blurt it out.

What happened was that my father had some congestive heart failure, and some fluid in his lungs. This is why he wound up in the Intensive Care Unit (he was already in the hospital). What was really worrisome was that the day after he got out of the ICU the first time he stopped breathing for NO REASON AT ALL. His lungs were clear, his heart was okay. He just stopped breathing. What was scary about this is that if it happened once, it could happen again.

It was the doctor's theory that whatever disease that was causing his brain to get hazier and hazier had moved to the hind brain, the part that controls your body. When the complicated circuitry up there starts to give out, the end is near.

So, just like that, the death sentence is pronounced. My father is terminal.

His heart is damaged, he has a pacemaker. His lungs are giving out, his brain is becoming unreliable. It's only a matter of time before there is another crisis.

We have some decisions to make about how much medical care Dad is going to get. Actually, there is no "we" here. I'm the one making the decisions here.

When I was in college I was a Philosophy major, and I took a course called "Medical Ethics." The course dealt with subjects like abortion, and euthanasia and so on. Some of the arguments were kind of abstruse, but I never believed that I'd actually be faced with a question like that in my real life. It's a lot easier to make pronouncements in abstract or about stories in the newspaper.

My doctor was frank, in terms of quality of life, Dad is not really worth saving if he has another episode. Even when he was at Hotel Happy he was a wreck - now he is even worse. He barely understands what's going on. What's the point of carrying on the existence of a near-vegetable? I would certainly not want to live like he is.

My doctor explained to me that this is what things are like in medicine now. Often times, people don't die, you DECIDE when they die. Thanks to the machines and the procedures we have now a body can be kept alive long after the mind is gone.

If this had been twenty years ago, Dad wouldn't have survived the first episode. If he hadn't been being monitored in a hospital he sure as hell wouldn't have survived the second one.

There is an order you can sign, it's called a "DNR." It means "Do Not Resuscitate." If Dad stops breathing they don't stick a tube down his throat again, they just let him be.

What would Dad want? At this point I'm not sure. He has very little brain left - he's like a two year old, or less.

A while back he signed a health proxy which essentially gives me the right to decide what to do here. From reading the document, it's pretty clear that the main objective is to keep Dad comfortable, but not to prolong his life with extraordinary measures. The thing is, I bet Dad didn't know what the document meant, even when he signed it five years ago.

So again, the decision is up to me.

I have not signed a DNR order yet. I want to talk to Dad's lung specialist before I do that, but he seemed pretty gloomy when I talked to him at the beginning of all this. However, he seems hard as hell to get a hold of.

I knew this day would come. I just didn't think it would be so soon. And I didn't think it would be so damned hard.