Friday, 17 August 2012

By on August 17th, 2012 in Barbara

08:02 – Barbara’s sister called at midnight to say that she was on her way over to their parents’ house to meet the 911 responders. Their mom had called 911 because their dad was breathing strangely and their mom couldn’t wake him up. At around 12:45, Frances called back to say that Dutch was awake and responsive, but they were transporting him to the emergency room. Barbara quickly dressed and left to meet them at the hospital. She got back home about 6:45 and said they’d just admitted him, finally. He’s in no immediate danger, but for someone aged 90 this whole sequence of events over the last two or three weeks isn’t good. Barbara got almost no sleep overnight. She’s sleeping now, finally, with Colin curled up next to her on the bed.

For the last ten days or so, Dutch has been on outpatient IV vancomycin to treat a drug-resistant S. aureus infection, with Barbara and her sister administering the drug daily and taking Dutch in daily to be tested for serum vancomycin levels. Our main concern at this point is that his levels have remained elevated, which indicates that the vancomycin isn’t being eliminated, which in turn suggests that Dutch may be in renal failure. At the same time, they’re concerned about Dutch’s persistent edema and congestive heart failure. He’s now simultaneously water-logged and dehydrated. The dehydration causes confusion and unresponsiveness, but hydrating him would increase the edema. Conversely, they can’t treat him with lasix or another diuretic to reduce the edema because that would dehydrate him even further. Everyone, especially Dutch himself, is exhausted and under extreme stress.


25 Comments and discussion on "Friday, 17 August 2012"

  1. bgrigg says:

    So sorry to hear the continuing news about Dutch.

  2. Chuck W says:

    Unfortunately, I have been in the circumstance of being near the end with somebody close. My one suggestion is to rotate who is giving attention, as I learned that everybody lending a hand at the same time, exhausts everybody. Rotating the primary companion gives others a chance to rest and be more hospitable on their shift.

  3. MrAtoz says:

    Does anyone know why the Social Security Administration needs armed special agents? Do they blow away welfare moms who defraud the system? Perhaps certain seniors need more lead in their diets.

    http://cnsnews.com/news/article/social-security-administration-explains-plan-buy-174000-hollow-point-bullets

  4. Chris Els says:

    Thinking of you, hope he gets well soon.

  5. brad says:

    It seems that every federal agency feels the need to have it’s own stable of law enforcement officers. Highly redundant, of course, but how else is a bureaucrat to build an empire?

    A serious answer: I expect that the SSA investigates cases of fraud, for example, when someone continues to collect grandma’s check after she has no more need of it. When they discover a case of serious fraud, an arrest needs to follow. Why they need their very own officers to do this is a different question.

  6. Robert Bruce Thompson says:

    Thanks.

    I’m trying to get Barbara to pace herself and to convince her sister and mother to do the same. At least they’re starting to understand that they can’t have everyone there all the time. The next thing I’m going to try to convince them of is that they don’t need to have anyone there sometimes. Dutch is in the hospital. They’re taking care of him, and there’s no need for Barbara or her sister or mom to be there at all times. He’ll be sleeping much of the time anyway. I’m trying to convince them that each of them can visit every day, and call him on the phone to fill in between visits.

    Unfortunately, unless Dutch just dies suddenly, I’m afraid this is going to end up being the new normal. Even if they get him well enough to go home, I suspect there’ll be another 911 call and emergency room trip in a week or a month, and even while Dutch is at home Barbara and her sister will be run ragged taking him on doctor and lab visits, running errands for them, and so on. They’re going to crack under the stress, and I told Barbara this morning that if she thinks it’s bad now, just wait until one of them ends up breaking under the strain.

  7. brad says:

    Yes, definitely space it out. I remember this from my Dad, when he was seriously ill. Very stressful, but if you can parcel it out, no one will “crack under the stress”. Daily short visits. He’s not likely to have the energy for more, and when he’s asleep, just hanging around does no one any favors.

  8. Lynn McGuire says:

    Thank goodness that Barbara has a sister to spell her. It is tough to have a loved one in the hospital. Some people deal with it by hanging there 12 hours a day until a change. Other people refuse to go because they do not their mental picture changed of their loved one.

    And yes, this is probably the new normal until he either gets better or drops into a coma. You might want to be checking out hospices nearby if your MIL will allow it. My maternal grandmother was adamant that she did not want to go to hospice and died in her own bed with her 3 daughters taking 24×7 care of here for the last 3 months of her life. It was exhausting. And then when she passed, they waited for 4 to 5 hours (to be sure) before calling the EMS so they would not take her to the hospital. The local JP showed up with the coroner and had a inquest right there where I actually had to testify that my grandmother had passed away on her own.

    I had one grandparent pass at 60 years old and the other three passed at 87. It seems that making it out of the upper 80s is very difficult for the human body. Of course, I maintain that the design life of the human body is 45 years and anything that you get after that is just ducky.

    I’m 52 and falling apart more by the day. I just noticed that I can no longer read with my right eye (I’m left eye dominant). Visited my ophthalmologist and found that I have a very large floater dead in the middle of the eyeball (most go to the side) and a starter cataract. The combination took my corrected 20/20 right eye to about 20/200 or so. Nice. And I have to get off my blood thinner medicine to have lens replacement. Nice.

  9. Robert Bruce Thompson says:

    Yeah, where’s Heinlein’s rejuvenation clinic when we need it?

  10. MrAtoz says:

    Another two service members die in Afghanistan after recruiting a villager as a policeman. He turned his weapon on them. Story on AP. Why are we still there?

  11. SteveF says:

    This is where the wisdom of my method shows itself. Marry a strong-willed woman (read, spoiled princess who grew up to be a demanding fishwife) and you’ll long for death well before your body wears out. Yep, “Steve Furlong, Marriage Adviser” has a nice ring to it.

  12. SteveF says:

    Why are we still there?

    Because to leave would be to admit defeat. Think of our national pride!

  13. Ray Thompson says:

    They’re going to crack under the stress, and I told Barbara this morning that if she thinks it’s bad now, just wait until one of them ends up breaking under the strain.

    At some point a nursing home may have to be considered. Some people don’t want that and I understand. A nursing home has the resources and facilities to take care of people that require nearly full time care.

    Visited my ophthalmologist and found that I have a very large floater dead in the middle of the eyeball (most go to the side) and a starter cataract.

    The cataract surgery is trivial. No blood. I wonder why you need to be off blood thinner. Perhaps just in case something goes awry. You may also want to inquire about having a vitrectomy on the eye as that will get rid of floaters. You will have to be referred to a retina surgeon by your ophthalmologist. In my case the results were stunning.

  14. Lynn McGuire says:

    Hey, Heinlein never talked about the failure rate in his rejuvenation clinic. As I remember, Lazarus Long almost did not make it out his 3rd? 30th? 300th? time. Who knows if the failure rate was actually 90%.

    I would rather have the rejuvenation sarcophagus in “Stargate”, even if they are addictive.

  15. Robert Bruce Thompson says:

    Well, I’m going the cloning route anyway.

  16. ech says:

    Concur on the pacing/rotation.

    I didn’t have that option with my dad and after 6 months, when he died, I was exhausted from dealing with him and working 50 hrs/week on a shuttle project.

  17. Miles_Teg says:

    MrAtoz wrote:

    :”

    Does anyone know why the Social Security Administration needs armed special agents? Do they blow away welfare moms who defraud the system? Perhaps certain seniors need more lead in their diets.

    http://cnsnews.com/news/article/social-security-administration-explains-plan-buy-174000-hollow-point-bullets

    Our social security doesn’t have guns that I know of but have to be on their toes because the “clients” can get very unpleasant if things don’t go their way. Here they just have their fists or a knife, probably. In the US they could easily have guns hence the requirement for your social security people to have guns.

    I still remember arriving at LAX in 2003, and even the passport control guy had a handgun on his hip.

  18. OFD says:

    I hate to say this but I suspect it was easier a hundred or a thousand years ago, without the hospitals, medicos, insurance companies, etc. You got old, you got sick, you died. Nothing much could be done. They waked you for three days and then buried your sorry ass.

    If we could work up a system where people are just made as comfortable as possible when they’re reaching terminal status, whether because of advanced age, illness, gunshot, whatever….and then let them go. The present setup seems awfully unwieldy and uncomfortable for all concerned and once again we ask that ancient question…cui bono?

    I don’t say that modern medicine hasn’t worked wonders for us, etc., and most of us are better off for it during our first half-century-plus, but other times it seems a bigger burden than it has to be, not only for patients but their caregivers and families.

    Dunno if this is making any sense; just got outta work and the commute home dodging homicidal/suicidal cretins in driving rain, on a wet road surface with frequent pools of standing water, and thick fog. No one slows down, few bother with lights or turn signals, and some just cannot, to save themselves, leave off the goddamned cell phones.

    So anyway, Bob and Barbara; our best wishes and prayers; we have a pretty good idea of what is involved.

  19. OFD says:

    Oh, and from a link at Lew Rockwell’s site just now:

    http://thesurvivalmom.com/2012/08/16/3-survival-novels-you-should-read-a-video-review/

    I hope Jerry is still getting fat royalties from that.

  20. Lynn McGuire says:

    Hi OFD, hospices do exactly what you are talking about. The moment you get there, if you do not have a morphine drip, you get one. That will usually take most people out in a couple of weeks since it shuts down your bowels. Unfortunately, some people will linger and I have no thoughts that I am willing to write down on that.

  21. Miles_Teg says:

    This really pisses me off:

    http://www.abc.net.au/news/2012-08-18/beard-debate-delays-us-fort-hood-shooting-trial/4207406

    I just wish they’d just let him keep his beard so they can terminate him and stop his $72,000 per year pay.

  22. brad says:

    @OFD: Yeah, the modern system is pretty mucked up. My dad was chronically ill, and had just had enough. He explicitly placed DNR (do not resucitate) in his file. At one point, he had a heart failure, but the hospital was so worried “does he really mean it”, “will we get sued” that they revived him anyway. He was absolutely livid when he found out. Another year of misery for everyone followed. Simple comfort-care would have been a far better option.

    That said, he was in some respects a selfish bastard. He refused multiple opportunities to buy life insurance, even though it was always clear he would die relatively young. He didn’t think anyone ought to “profit” from his death, so he left my mother with basically nothing.

  23. Chuck W says:

    MrAtoz says:

    Another two service members die in Afghanistan after recruiting a villager as a policeman. He turned his weapon on them. Story on AP. Why are we still there?

    I am in complete agreement with this. What is in Afghanistan that is so damned important? If a Russian army without a conscience could not shape up Afghanistan, there is no way the US military is going to gain ground at all. I thought that before we went in.

    But beyond this is the matter of the American conscience. Geez, my generation had no tolerance whatever for Vietnam and even demonstrated somewhat against our actions with Cuba. What happened to all those people? Were they only protestors when they were in college and had time and no job responsibilities? Did they lose their scruples as they got older? Where is the outrage that we are in unwinnable wars in both Iraq and Afghanistan? Actually, Vietnam WAS winnable, IMO, but we abandoned it just as we were winning. Which is just as well, I suppose. Nobody understands that Communism (specifically the collectivist part of it) is unsustainable in the long run, and there is no need to spend any effort fighting it at all. It dies by itself. New Harmony, Indiana proved that back in the 1800’s.

    Before we got into Iraq, there was a guy in Michigan at one of the educational institutions there, a Middle-East expert, who got a lot of press, because he opposed aggression in Iraq and predicted that we had no idea what to do with Iraq once there. But now that his predictions were realized, why is he never heard from? Who in the media presents any view that is against our involvement in Afghanistan?

    I was involved peripherally with a test group to determine how people feel about a company that announced a change that affected stock that many people owned. The company did one of those ‘if you don’t opt-in, they you are automatically opted out’ routines. Only problem was that what they did subsequently was to lock out former shareholders that did nothing, while company management, who was gifted with shares in the company by the changes they were instituting, saw their stock rise to astronomical prices. Two groups were tested: one with mostly people well into their 50’s or slightly younger; another group with people predominantly in their 20’s or slightly older. Now before telling the groups that there was legal wrongdoing in how the company proceeded, the older group was quite concerned about the former shareholders, and how the company appeared to be purposely ripping off former stockholders to enrich new executive shareholders in the company (executives were formerly not allowed to own shares in the company, as it was a mutual company). The younger group had the exact opposite attitude: unrestrained capitalism is the best system in the world, and if the company did something wrong, then the laws should be changed, because anything a company wants to do is should be an automatic right ‘in a free country like ours.’

    It is scary to see this. An incredible about face in 40 years. No doubt this younger generation sees nothing wrong with being in Afghanistan. BTW, the company in question was taken to court, found guilty of wrong-doing, and ordered to pay former shareholders around $100 million. Problem is, this kind of stuff goes on all the time, and the punishments are just a cost of doing business and added to the consumer’s price at the marketplace.

  24. OFD says:

    No one among our civilian lords temporal bothers to read history, or if they do, I guess they ignore it, like the history of the British and the Soviets in Afghanistan. And the military does what they’re told, for the most part, and careerist officers and lifer noncoms go to get their tickets punched. So a few women and kids and noncombatants get wasted, fuck ’em, I guess.

    Timothy McVeigh, the mass murderer, had been a good soldier and went over there to the first Gulf War all gung-ho and then discovered, lo and behold, these are human beings over there, just like you and me and him and why the fuck are we there blowing them away? I got nothing against them and they got nothing against me? WTF? So he came home and then got all messed up in the head, surprise, surprise, and eventually went off the deep end, with a little help from his friends, which conspiracy we saw blown off and never investigated further.

    So we’re still there for the Incumbent’s political reasons now, and every day more people are getting killed and maimed. Where is all the protest? Well, they shut down the only major political figure who continued to bitch about it. And the kidz now are much more worried about jobs and money, seems like, not interested in all the wars. Where have all the flowers gone, indeed.

    What a country!

  25. Robert Bruce Thompson says:

    My feelings on Afghanistan and the rest are summed up by a comment I made IIRC on or soon after 9/11. “Never send a man where you can send a warhead.”

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