Osteopath Out; Hospice Doc In

Today I met with the ALF and hospice people about my dad’s future.

It was a good meeting. I had feared that they were going to battle over dominance, but it turned out they were united against my dad’s primary care physician.

My dad’s PCP in Miami was a very prominent cardiologist with his own pavilion at the university. After that, we ended up with a Chinese cardiologist up here, at a local clinic. He left and handed us off to another Chinese cardiologist, and she refused to be his PCP. She was willing to be his cardiologist, but we were referred to a local osteopath for PCP care.

I’m fine with osteopaths. My PCP in Miami was an osteopath, and I thought he was great. On the whole, I feel more secure with MD’s, but you have to look at the individual, and many MD’s aren’t very good.

In this county, you generally end up with doctors who didn’t do very well in school or who went to school overseas. It’s unusual to have a doctor with a name like Schmidt or Flynn. We have a Karavadian, a Luo, a Gaya, and another guy whose name is too complicated to remember; I think it has a lot of A’s in it. Doctors don’t want to work in rural areas, so incentives are provided, and they attract people who have no hope of working at M.D. Anderson or Sloan-Kettering. My dad’s PCP is an American, but he’s a D.O., so there’s still a compromise.

A D.O. degree is a back door into medicine for people who didn’t make it into MD programs.

My dad doesn’t need House, M.D. He has very common ailments with well-known treatments that don’t work very well no matter who prescribes the pills. I think the D.O. is doing a fine job, given what he has to work with.

Anyway, as of this week, it has become too hard for me to take my dad to appointments, and the PCP’s mindset is conflicting with that of the hospice and ALF people. Medicare may start refusing to pay for things the D.O. has ordered. Because my dad is in hospice, he’s not supposed to get life-extending treatment. I’ve written about this already.

The PCP referred him to a neurologist, and the neurologist ordered a CAT scan to see if he had normal pressure hydrocephalus. The hospice people fear that Medicare will see this as an effort to cure him, and that would be correct, but it would not cure him of the thing which is going to kill him. It might clear his mind somewhat and improve his mobility, but it won’t fix congestive heart failure.

Anyway, I got the hospice people to assure me that their doctor would look into it and advise us. I said I was happy to make her his PCP and allow her to do all the referring from here on out. Now everyone is happy, except for the PCP, but he seems to have a very busy practice, so he’ll be fine.

I made everyone understand that I wanted them to speak bluntly and talk about death. I wanted to put them at ease so they would tell me the truth. They spoke freely, and they seem to feel that the problems he’s having indicate that he’s in his final decline. Now we all understand each other.

The subject of resuscitation came up, and I learned something amazing.

They do not want to resuscitate him if he dies at the ALF. They said they will have to do CPR and load him into an ambulance even if he’s dead and cold. Then the doctors at the hospital will put tubes in him, and they’ll wait for me to make my decision. It would be a mess.

I had been under the impression that my dad wanted to be resuscitated, because he said so when I took him to get his advance healthcare directive written. I told the people at the meeting that I had to go by the book, and that as far as I knew, he wanted to be resuscitated. I said I would check his directive and get back to them.

I looked at the directive, and lo and behold, it says he doesn’t want to be kept alive artificially. This is the amazing thing I referred to, above. My best guess is that when he spoke to his lawyer alone, he told him something different from what he had been telling me orally. I didn’t go through it carefully later. I should have, but I was stressed out. I assumed I knew what was in it.

I used to be okay with choosing resuscitation. Because I thought he didn’t have a DNR, I thought he had some extra protection. I thought that if he found himself facing death, he might be kept alive long enough to receive salvation. Now he’s saved, so resuscitation would only cause unneeded misery. I was comforted by my erroneous belief, but now I’m comforted to find out I was wrong.

He’s not doing well physically. He didn’t say anything delusional today, but he fell asleep a few times, and his lips seemed bluish. He’s comfortable, though, and his future is assured.

I took my action camera and shot about 20 minutes of video. It wasn’t Oscar material, but it serves to capture a few precious moments, and it also documents the changes in his condition.

We prayed together, as always. That’s the one thing we absolutely must do during every visit.

Things are going well, taken in their entirety.