The Year in a Word Cloud

Diagnosis

This is a Daughters in Medicine post.

(which really does describe me - I'm a third-generation doc. And that is and isn't relevant to this post.)

When my grandmother was in the last years of her life, she fell out of bed. They took her to the ER, where she was Xrayed, pronounced intact, and sent home (where she lived with my grandfather, the retired internist, and a full-time caregiver.) The next morning my mother called me and said "Your grandfather is upset because your grandmother refuses to get out of bed." This was in the 1990s, before digital radiology and Nighthawk came along. I said "Tell him to call the hospital and ask for the radiologist's interpretation of the film. She might have a non-displaced fracture that the ED doc didn't pick up." Mom called me back several hours later and said - in a deeply suspiscious voice - "How did you know that?" I said "You sent to medical school. I learned stuff."

It's now 25 years later. My mother is the one with dementia, living at home with 24-hour care. No retired internist in sight; my father died nearly ten years ago. Last week Mom fell. The caregivers thought she was OK; a few days later, the pain was worse and she was refusing to bear weight. I said "She needs Xrays; she might have a nondiscplaced fracture." And sure enough. She sent me to medical school. I learned stuff.

Mom doesn't need surgery, thank heavens; we'll get equipment into the house and she'll stay in bed most of the time for a while. She's not having any pain.

But I know what it means when someone with moderate to advanced dementia breaks a hip. I'm a palliative care doc. I know where we're going. She sent me to medical school. I learned stuff. And some days, that stuff breaks my heart.

A Year of Change, and a New Sandwich

I rang in 2016 with visions of change. Change for the better. Growth. Development.

Well, 2016 is going to be full of changes alright. I’m trying to finalize my divorce, considering joining the dating world again, finding new feet after being partnered for such a long time. So, why does the tenor of this post not hold all the hope and light and optimism it should? My move mostly across the country for medical school, residency and career was not coincidental. It was therapeutic. Right now, my self created bubble is being tempered by reality.

I knew I’d be the child to take care of my parents. Neither of them have planned for golden years. Both have made poor financial decisions. I’ve tried to learn from their mistakes. Many of the decisions I’ve made in my life are a direct result of trying to exactly the opposite of what either of them have done. I’m the only child between them. Their other children, my half-siblings, are in no position to help.

I did not estimate that by trying to learn from their mistakes and deliberately making other decisions, I’d put myself in the supreme position to catch them when they fell. Of course, I love them deeply, fully. They are my parents. They supported me emotionally through my journey to get here, they brought me life, they gave me the genes to create the synapses that allow me to make the decisions I make which hopefully translate into quality patient care and contribute positively to the world. They have loved me, advised me, chastised me, praised me. They were fully responsible for me for seventeen years of my life… that means I’m responsible for them, right? Not now, right?

My dad has been diabetic for about twenty plus years now. It ran in his family. He was overweight. He knew it was coming. He ignored the polydipsia, polyuria, fatigue, headaches, weight loss.  When he finally presented to his physician with the aforementioned constellation of symptoms, they confirmed the diagnosis. His response: Eat a gallon of ice cream and drink a two-liter bottle of Coke. He tows his own line and nothing is going to happen unless he’s ready for it to happen. No one knows his diabetes better than he does. He knows how it “feels” to be 245. He also knows how it “feels” to be 120. He’s got this.

Visited for my youngest brother’s graduation from high school. I was in residency at the time. That’s the first time I saw my dad have a low. Pale, diaphoretic, eyes glazed over, tremulous, almost myoclonic jerks. Orange juice spilled from the corners of his mouth as my adrenaline coursed through my veins, heart pounding. He finally came around. My ex-step-mother rolled her eyes, sighed in disgust. My brother sighed in relief. I was stunned. They had seen this before. They were well versed in dad, the brittle diabetic. I went back to residency and my life and put my dad’s hypoglycemic episode in a compartment. I went back to my other life. You might recall my compensatory compartmentalization if you read my first post,  The End... and the Beginning. 

More recently, I visited my dad’s town for a conference, took the little one and my mom (my dad’s first ex-wife) came to visit as well so as to spend time with the grand-baby. We all stayed at my dad’s house. I wake up around 3am to my mother screaming with surprise as my once again diaphoretic, hypoglycemic father, confusedly tried to crawl into bed with her. They’ve been divorced since I was two. She’s got not medical background, has no idea what’s going on. Here’s my internal monologue over the next 5 to 10 minutes:

I know he’s low. Don’t freak out or your mom’s going to freak out. Give her a task. Tell her to find his glucometer. She doesn’t know what that is. Tell her to find his shaving kit. There’s a little blue plastic machine inside. And a plastic container with strips. Tell her to look for the glucose paste. God, I hope he doesn’t wake the kid up. I’ve got no idea where his glucose paste is or whether he even has glucose paste. What’s in the fridge? Kiddo’s juice boxes. Great. Sit down dad. Sit down. Oh, super, your legs don’t work and you won’t cooperate. This is excellent. Drink the juice box. Seriously, Dad? Just swallow.Crawl into bed with mom and scare the shit out of her? Thanks for that. How much did you drink last night? How much sugar is in one of these organic reduced sugar things? How many is this going to take? What else is in the fridge? How much insulin did he take? He’s not drinking it fast enough. Shit. I’m an ER doc and I can’t fix my dad. What in the absolute fuck?!? What’s his renal function? More juice, Dad. Tell Mom to get a chair. Put it behind him. We have to make him sit so he won’t fall. Ok, Dad, you’re not sitting down… I’ll sweep the leg, just like Karate Kid. Great, now you’re sitting. This is taking too long. He’s not turning around fast enough. He’s not swallowing. He’s going to seize. Fuck it. Tell Mom to call 9-1-1. Tell them you have a diabetic who is hypoglycemic and you need help.

The paramedics arrived and by then, my dad was starting to come around. “I know exactly what happened,” he said. “I took my Humalog and forgot to have a snack. No big deal. I’m all set. No, I don’t need to go to the hospital.” Sure Dad. You know exactly what happened.

One of my dad's best friends asked me for my number that visit. He said "just in case I need to call you for something." He said there'd been times he'd supposed to meet my dad for golf and he wouldn't show. Then he'd come to my dad's house to find him in a hypoglycemic stupor, "sweaty, turning the lights on and off, not knowing where he was or what he was doing." So, it seemed this was not an infrequent occurrence. 

Ultimately, I didn’t think I’d be taking care of one of them now. My father who’s made some poor decisions has run out of options and was in financial dire straits. My dad was going to be homeless. He came to visit for my kiddo’s 4^th birthday. He’s not the picture of health. He’s stubborn and manages his diabetes between 6 packs of beer, packs of cigarettes and takeout food, often, unintentionally double dosing his insulin, or so he recalls when he comes out of a hypoglycemic episode. He finds himself in a diaphoretic, near seizure stupor which until this last year, I was mostly, blissfully unaware. Sure, I’d been to visit and he might have a low, scare the crap out of me, lead me to feel woefully ineffective as a physician, then he’d confabulate that of course he knew exactly what happened.

He asked if he can come live with my little one and I. I took a deep breath, clenched my jaw, said “of course.” He's my dad. I've got to take care of him. That's my duty as his daughter, right?

My dad's been alone for a long time. He's lived the bachelor life for a long time... probably close to 15 years or so. He doesn't take good care of himself. He doesn't eat properly. He doesn't exercise. I had this vision when I invited him to come live with us that magically some switch would flip and he'd suddenly be inspired to focus on his health and well being. I envisioned he'd start eating properly, start exercising, maybe catch up with old friends who are local, find a job, find his spirit. 

He's now been living with me for about three weeks. He's had at least 3 hypoglycemic episodes so far. I say at least because those are the one's I've witnessed. He drinks too much. Thankfully, he's not a mean drunk, but I do believe he is an alcoholic. I have observed his behavior, listened to his conversations with me, watched his interactions with my kiddo and I wonder if he's actually developing some dementia of sorts. Not sure if it's from repeated hypoglycemic episodes, some sort of microangiopathy due to his health, or if he's showing signs of Wernicke-Korsakoff. There's definitely some confabulation going on.

What I believe I've learned in this short time is that I had no clue what I was getting myself into. So many of his behaviors and attitudes and coping strategies mirror those of my ex, which makes this whole thing even more challenging to swallow. I do know that I cannot be his doctor, his therapist or his best friend. I cannot control his behavior or effect the changes I believe need to be made. He is likely clinically depressed, though this is clearly complicated by his alcohol use. It was naive of me to think by some magic that he'd do a 180 by coming to live with us. I'm trying to encourage him to seek the care he needs both for his psyche and for his health. I can lead the horse to water, but I cannot make him drink... Why can't I make him drink!?!?

Permanent cohabitation is not going to be an option for me and my well-being. I have to make sure that my little one and I are taken care of and that my child's environment is safe and stable. Friends have suggested that I impose rules upon him with the threat of kicking him out. Trouble with that is I won't kick him out. I'm not going to put my father on the street. I'd rather find a way to get him his own living space so he does impinge on mine. How does one make rules for their own parent?