Random Pensées

An Episode

NOTE: I wrote the below post on Monday, July 11, at around 9:00 in the morning. Internet is down at work so I can’t post it.

An episode. What an innocuous word, episode. It might just mean that the next installment of whatever vacuous television show currently in vogue is due to be aired. Or it might mean something far worse. It might mean a sudden and unexpected incident or manifestation of deterioration.

The latter meaning is what I am referring to. Or rather, what the doctors were referring to when my grandfather was hospitalized again this weekend. The medical types attribute it to an episode. All by itself, that word means nothing. It certainly doesn’t function as a word should. It does nothing to explain or elucidate. Indeed, if anything, it invites further words, questions, demands for understanding. I suppose, as words go, it is a flag word in the medical community. By flag word, I mean a word that should stand up on the page and look like a big flag waving and telling the reader, hey, stop and inquire here.

He slumped over into his lunch on Saturday. He was confused. He has, in the last six weeks, lost 10% of his body weight. He lacked the strength, all of a sudden, to keep his head up. This from a man who played fullback on the Harvard Freshman team in the 1930's. He didn’t know where he was. He told people, when asked, that he thought he was in Texas or Boston or Norway. It’s like he’s already gone. My uncle E was with him. E is a psychiatrist and lives in California. Lots of business for shrinks in California, I gather. E is a lovely man, very bright, very compassionate. I’m glad he was there to ride herd on things.

E dined with us on Sunday night. After dinner was over, he pulled me to one side and he told me that my name appeared on certain legal documents for my grandfather. I didn’t know what he was talking about. E is my grandfather’s health care proxy and also holds his durable power of attorney. E explained that I was selected by my grandfather to be the backup on both of these documents. Upshot? If my uncle is unavailable and there is a question about whether my grandfather is to be intubated, that decision will be mine to make. When my uncle asked my grandfather if he had discussed this with me, my grandfather told him, no, but that “RP is incorruptible�. I gather that is a reference to the fact that with a durable power of attorney, I could sell his house if I wanted to.

I was and am flabbergasted. E pointed out to me that this decision by my grandfather, taken some time ago, might be regarded as very sensitive in the family and was otherwise not generally known and maybe, unless circumstances required, might be better left unknown. I couldn’t agree more. My grandfather has three children and six grandchildren. I think it would cause hard feelings if it was known that I was picked instead of, say, his other son. On the other hand, I feel immensely honored to have been so trusted by this man who I admire above all others. There isn’t much more to say about that. Except, maybe, that I am nervous about ever having to make a decision about whether, say, heroic measures should be used to preserve my grandfather’s life. We’ve never spoken about it, he and I. I wish he had initiated that conversation since he had picked me to make that decision, under certain circumstances. I wish I knew more about his wishes. Especially now, when my uncle tells me that my grandfather lacks the competence to make these decisions or to even have the conversation.

That’s not to say that he doesn’t have moments of heartrending lucidity. Saturday night, in the middle of his “episode�, he reached for my uncle’s hand and said to him, “E, it is very hard coming into this world and it is equally hard to go out of it�. I cried, just a little, when my uncle told me this. It was like the curtain got pulled back for just a moment and my grandfather was able to peer out and report back. And we were able to get a glimpse of how it is on the inside for him, said with his usual devastating understatement. He’s dying, or at least thinks he is, and in that moment communicated that he knew it. It must be a terrible thing to be able to contemplate, at a leisurely pace, your own mortality as something more than a distant philosophical construct. To lay there and review your life, weighing the good and the bad, the happy and the sad, and consider its cessation. No more kisses from children and grandchildren and great grandchildren. No more responsibility to provide, to protect, to act as pater familias, to be the head of a family.

Of course, because of the dementia, I gather that these moments are few. But I guess that while he does have them, he puts them to good use, as evidenced by his comment to my uncle.

I’m glad that we went over on Friday night with my parents and my children. Four generations in his room at the rehab facility. We gathered, at my suggestion, to celebrate Shabbat with him. My wife brought candle sticks and matches and I bought challah. He sat in his wheel chair and joined us in the prayers over the bread and the kindling of the Sabbath lights. He ate his piece of challah. My dad made him.

The eating thing, or not eating thing, according to my uncle is a combination of three things which suppress appetite: pain; pain killing medication; and depression. All of which lead to weight loss and to muscle loss. This leads to loss of mobility and makes him more suceptible to infection and less able to fight off an infection if it comes. According to my uncle, this is what could end his life.

Still, hope is not over. My mother says that while she is hopeful, she is not optimistic. She spoke to him this morning and he told her that he’s ready for this bad luck to be over. If that’s true, maybe he hasn’t given up fighting. My uncle thinks my grandfather is at the point of no return, or close to it. They are going to put in a feeding tube to bring his weight back up. If they can, and he has the will to come back, it might work. As my mother said to me this morning, if he doesn’t want to come back, they won’t be able to bring him back.

I’m glad we saw him on Friday night. I’m glad I picked up my son and held him so that he could give my grandfather a kiss goodnight. Thinking about that now, actually, is making me choke up. So, I think I’ll stop writing now.

I have my fingers crossed. I just don’t know if it will do any good.

By the way, assuming you went this far, I am not re-reading this before posting it. I don’t think I can, frankly.