Letters

dear Patient family,

this letter is in reference to your request for a status update on the current condition of Patient Gonna B Deadsoon.

you family member does not have current good health, their health is deteriorating, and the outlook for the future is bleak.

despite days of bumex (a med to 'wake up' kidneys) including a bumex drip, Patient Deadsoon's kidneys have not woken up. currently, even though we are performing dialysis for 5-6 hours on a daily basis, the urine output on average has been less than 50 mls per day. also, the BUN and creatinine clearance (lab blood work numbers that indicate kidney function) continue to go in the wrong direction. this glaring lack of kidney function, at this age, is a good indicator that the end is (or should be) near.

and yes, to address the query you made about the possibilities for a kidney transplant.

*sigh*

where to begin?

Gonna B Deadsoon is currently 96 years old. Ninety-six. also, on admission, it was understood that the patient did nothing more all day before admission to the hospital than sleep a lot and sometimes nod his/her head. occasionally. it is not as though this turn of events was sudden.

not only is the advanced age of your family member a concern for transplant, but the list of co-morbidities Patient Deadsoon has is too long to list here. shall we try anyways? COPD (lung disease) CHF (heart disease) Chronic pain (necessitating pain meds which has led to this current state of massive constipation, bowel distention......which has led to this aggressive bowel motility regime.....which had led to numerous blowouts to the ankles and poop dripping off of the bottom of the bed thing.....) and the fragile skin from the steroids for the lung disease) portal hypertension (which, coupled with the bowel distension from the constipation, has led to a fairly impressive distended midsection).........need I go on? did i mention the seepy weeping anasarca?

your family member is currently intubated, and sedated. there is a tube in the throat, two in the nose, 4 in the chest, one in the urethra, and we may have to place one in the rectum. despite our best efforts, the fragile skin is starting to break down. a machine is breathing for the patient (lungs, old and bad). Another machine is filtering the blood (kidneys, old and dead). medicine is maintaining the blood pressure in a state compatible with life, and another drip is keeping that heart in a good rhythm (heart, old, bad and dying). notice a pattern here? the pattern is dead, dying or trying to die. it's like theme party, and all of the organs and organ systems are coming. no matter what we do.

yet another machine is dripping pain medicine into your family member all the time for the chronic pain, and then there. is. the. constipation. which we are fighting which has led to the explosive diarrhea. explosive diarrhea. uncontrollable, explosive diarrhea.

remember what you said about knowing that the patient DID NOT WANT TO BE 'KEPT ALIVE ON MACHINES'? i think we are currently totally, 'on the machines.'

so unfortunately, your family member is most totally probably really seriously not kidding even a little bit NOT a good candidate for a kidney transplant. or a liver transplant. or a lung transplant. even from other family members. tolerating a transplant procedure or the following immunosuppresant treatment that would have to follow to prevent rejection.......not likely either. really.

did i mention your family member was 96 years old? hasn't it been a good run?

oh what's that you say? what about what the doctor said?

yes, ahem. i can address that as well. Dr Cure Ebrryboddy tells every patient and every patient's family that they are getting better, and things are looking up. something about his religion and his idea about sanctity of 'life' (using the term 'life' as a very very very loose descriptive term here borrowed straight from him- you'll have to speak directly to the good doctor as what that means to him. ps, don't bring up the words 'quality of life' with him, or mention them together in the same sentence), that precludes him, despite his many years of practice in this field of staving off death, from ever akshully telling a patient that modern medicine has reached the end of it's rope. sometimes his stubbornness and dogged determination to hang on no matter what is refreshing..............and sometimes it's not.

so, to recap. outlook, no bueno. future, bleak. chance of full recovery, none. doctor, mistaken. transplant, of any kind, from any source, NO.

sincerely, nurse j.

disclaimer-

*yes, i may very well be a cruel heartless bastard,

*but these are the thoughts that may or may not run thru my pretty little head at 5 in the AM when i notice poop dripping off the end of the bed for the 5 time in a 12 hour shift, and the fourth time in the last 3 hours. yeah, the sennakot, colace, lactulose, reglan, gastrogafin, nistigmine, ethylene glycol are working now. promise. i almost could NOT shower enough when i got home.