Dr. H is off the case. It wasn't easy. The nursing home wanted me to contact him directly. I balked - told them I didn't choose him, they did, so why task me with getting rid of him? Then reversed myself, tried to reach him and couldn't (he doesn't seem to have an office and didn't call me back after I reached him on cell). So I finally faxed my authorization letters to the nursing home - one removing Dr. H, the other engaging Dr. M - and left it at that.
I have to say that this has been the first major glitch in my nursing home experience. It's not surprising that something should go wrong. All the same, it strikes me as an odd protocol that you transition a patient to hospice, but don't assign him to a hospice physician. It's even stranger that you keep him assigned to a physician who's actively opposed to hospice.
But maybe this is more common than I realize. In my mother's case, things were different - when we moved her to hospice, the hospice was in a different physical location and had its own fully dedicated staff. So it was a given that the hospice physicians took over his care. Here it's more ambiguous - he stays where he is, and the hospice isn't an institution - it's an outside agency that comes in alongside the nursing home staff. Nevertheless, it seems like they're missing a step. The hospice experience should be a hospice experience and nothing else. At minimum it should be conflict-free to the extent possible.
As far as my father is concerned... we're now at the 48-hour mark, that is, 48 hours since Dr. H told me he'd be dead in 48 hours unless IV antibiotics were started. To my knowledge, everyone is still alive. I realize that predictions are an inexact science, but I could have lived without the extra grief.
As of this morning, oral antibiotics were stopped as well. I haven't heard any updates, but I wouldn't be surprised if my father pulled through this episode. As I've said, he's fundamentally strong.
If he does pull through, I'm thinking that a treatment conference might not be a bad idea. I get to call them whenever I want to, and given that we've got an almost entirely new crew on the job, it might be useful to have everyone sit in the same room and talk about where we go from here.
Will go arrange that now.
LATER: Dr. H finally called me back. He left a long voicemail, telling me that it was really important to insert a gastric tube - "He's still not eating, and if we take him back to the nursing home the same thing is going to happen again." I had a few seconds of confusion - where exactly is my father and why does he have a gastric tube? - until I realized that Dr. H thought he was talking to someone else about another patient. I called him back and he confirmed that, and I told him I was bringing in Dr. M and we wished each other well. He told me he knew it was difficult and said "God be with you" and I said, "And also with you." I don't think he liked that but in any case, we're done.
Treatment conference is now set for Tuesday morning.