Adventure 521: The Story of George

George, January 2019

The end of July marks George's fourth year in Spokane. Up until February of this year he has lived independently at Harvard Park. Almost immediately, he struck up a romance with Vina Mikkelson. They maintained a relationship that bloomed into late life love for both of them. George, in fact, was adamant they get married. If the financial considerations had been different, I'm sure they would have. Instead, they became constant companions. Over the past four years, George has battled chronic UTI infections. His dementia has also steadily increased as demonstrated by a loss of memory, a loss of awareness, and confusion. Still, until his last UTI attack, he was managing to remain independent. Judy and I, as his central care givers, tried to maintain his independence for as long as we could. In the past year, this meant being at the ready to put out small "fires". We also contracted a home health nurse service to maintain his catheter and check for general health. We've been greatly influenced by Atul Gawande's book, Being Mortal. We both agree with the premise that a person should be able to live a prideful and self-determined life as long as possible. We've strived to make that happen. However, we're realistic as well. A year and a half ago, I did the leg work to move George to the Veteran's Home in Spokane when the time came that he'd need twenty-four hour care. We had that application in place when George suffered his life threatening attack in February. When George was still cognizant, we discussed what he wanted for end of life condition. He was the primary care giver for his mother, Rosa, who lived well into her nineties. She was physically healthy, but her dementia at the end made her completely vacant. At the end, she didn't even recognize George, let alone any of her other children. George was adamant that he didn't want to end like his mother: clueless, wheel chair bound, and incapable of making independent decisions. We devised the end of life POLST instructions to reflect that. The bottom line last February is that the emergency doctors ignored the POLST, which clearly indicated no antibiotics, no recessitation, and the like, and had I understood their working vocabulary (The definition of "heroics"), George likely would have passed as a result of the last attack because I would have refused treatment. He entered the emergency room with a heart rate of 154, a breathing pace of over sixty, low blood pressure, a blood sugar count of 590, and he was septic. Ignoring the POLST, the emergency doctor on call administered three highly potent antibiotics, pumped in an insulin drip along with two and half liters of fluid in less than a half hour. Several doctors came to me, all of whom were deciding the best course for him: the ICU ward, Hospice, etc. Had I understood what "Heroics" meant at the time, I could have honored George's wishes to let nature take its course. Instead, the Lord decided he wasn't ready to take George, and decided to change his name to Lazurus. Fortunately, the plan we had in place worked smoothly, so now George, wheel chair bound, and pretty clueless, is safely but unhappily housed at the Veteran's home. Among other confusions, he constantly asks when he's getting out of the place. He's tried to escape a few times. They have him on a wheel chair monitor, so if he gets up an alarm goes off. We've indicated that he receive only comfort care. No longer able to walk, (Although he thinks he can), he's had one fall. Judy and I have mixed feelings. We hate to see him unhappy, but we also realize that he needs this full time care. It's difficult, especially considering we thought we understood the rules. Not so much. If I have any advice to anyone, it's to clearly think through this period. Understand definitions. The emergency doctors are trained to perform heroic deeds, so they can't be faulted. It's also very possible that an on duty nurse will decide to ignore our further instructions. For example, after George's fall, the nurse informing me said that if he'd have suffered a laceration, they would have been duty bound to call for the ambulance. It's frustrating on many levels, not the least of which is that this is not what George wanted. We had a family dinner a couple of weeks ago. We brought George to our house for dinner. My son, Steve, loaded the wheel chair and George, and brought him to the house. George thought he was moving out. He had all of his clothes, his photos of Vina, and was sure he was being "sprung". Needless to say, these times are difficult. My only solace is the knowledge that I'm not in charge (as much as I'd like to be). So, we'll see what God has in mind.

 Sleeping it off in the hospital.

 First day at the Veteran's Home.

 Before long they had him on an exercise program.

 The Spokane Veteran's Home is a state run facility, where the care is quite good. The workers tend to stay on the job for long periods of time because of benefits and such. It means the turn over rate is low. That translates into people well versed in their duties.

 Many days, George sits outside his room just watching the activity. He was happy on this day because Vina had just visited. She's comes twice a week, which makes him happy.

 Leticia, our best care giver, seen here giving George a massage.

 She also trimmed his nails.

I think George's body language here indicates he's not really willing to go back to the Veteran's Home. All we can do is take him out for regular outings. Time will tell otherwise.