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.
You were confused? And Dr. H. is considered competent? Can't remember which family member is connected with which patient? Just when you think it can't get any more bizarre, it does.
Posted by: Nancy Frank | January 14, 2010 at 09:55 PM
Oy!!! Sending you good thoughts.
Posted by: Shu | January 15, 2010 at 02:58 PM
I've been avoiding your blog since I read this post a few days ago. Even now I had one eye closed and one partly opened in case you had posted sad news.
I know you want it to happen, and I understand that. I will want it when my mother gets to that point too.
What's odd is that it's supposed to be easier to read about other people's problems. Maybe not so much when the problems are a road map for your own loved one's journey.
I'm thinking of you and your father and I hope you are able to spend as much time as you need while this is happening.
Thank you for sharing so honestly Alan.
Posted by: K Lee | January 17, 2010 at 08:28 PM
K Lee - thanks, but per my latest, we all seem to be still here, at least for the moment. Not sure how quickly things will develop but my guess is, much more slowly than it seemed like they would a week ago.
Nancy - yeah, the healthcare "system" continues to perform up to par. But at least some of the individuals in it are good.
Shu - good thoughts received. On, now, to the next crisis...
Posted by: Alan G. Ampolsk | January 19, 2010 at 05:48 PM