Communication

I didn’t get up so early as I would have liked yesterday.   It was already 80 degrees by the time I left for my run.  I took a short-cut and made it an even 13.2 miles – up and down the “heartbreak hill” marathon route.  There isn’t enough water along the route.  Hundreds of runners up and down Commonwealth Avenue.  No water fountains – even in public spaces like Newton City Hall.  I found one near a baseball field by the reservoir, but there really should be more.  I thought that a “Running Water” crowdsourced mobile app would be fun to make.  People would identify public water locations on a map, so we could plan running routes around them.  My Simple water bottle is wonderful, but it only holds 13 ounces – enough for 5-6 miles of hot city running.

When I got back, dad was playing cards with A (my wife) and M (my brother).  M landed at 5 AM from San Francisco but looked pretty chipper.  Dad looked weak and pale but was enjoying the card game.  He wanted to go swimming at the sports club, so M brought him over, while I brought mom to the supermarket.  I needed to get her out of the house – to do something “normal.”  The fridge was full of rotting food that (my sister) S had bought the previous week.

I was trying to move through the market efficiently as the dog was in the car and he didn’t want to be cooked.  Mom paused at the avocados to choose one.  I got mushrooms, asparagus, tomatoes,  peppers and lettuce and then looked around for mom.  She was still trying to choose an avocado.

I didn’t realize how global her paralysis had become.  I fought the urge to just choose one for her, felt my impatience grow and then subside as I let my empathy bubble back up to the top.  She chose an avocado.

We rewarded the dog for his brief stint in the car with a diversion to the dog park, where he romped gleefully with new friends large and small.  I asked mom what she understood about dad’s “hypercalcemia” plan, and whether they had discussed it yet with the hospice folks.  His idea is that, untreated, the calcium will rise rapidly at some point soon, and he’ll smoothly and quietly slip into a coma and then away ..

But of course there is no certainty.  No certainty that the calcium will rise quickly.  No certainty that it won’t rise to 14 or 15 (at which point he’ll be confused but not comatose) and sit there for days or weeks.  No certainty that it will happen this week .. or next .. or next month.

I asked him what his plan was and he told me that he hadn’t yet discussed it with mom.  He smiled at me with the wry smile that says so much.  “I know your plan, ” I said.  “No more zoledronate.”  The wry smile again.  “I think Tom Brady did it.  He’s lying about deflategate.”   I told him to talk to mom.

I’m worried that in an hour, a day, a week .. his calcium will start to rise and we won’t have a plan.  So we’ll have confused dad and no plan.  Last time his calcium went up, I knew that he wanted us to treat it so it was easy.  We got him to the hospital and he was better in 12 hrs.

As Atul Gawande wrote in his book, making these decisions isn’t hard for family, physicians, and others.  Really.  These decisions are easy.  But we need to know where an individual’s priorities lie.  Dad doesn’t want to be remembered as a weak, dying man.  That’s VERY important to him.  Mom knows this, but they’re still not talking about it.  The hospice social worker was there last Friday.  It really opened things up.  I called her today and asked her to “check in” with them.  Maybe she can provoke some more communication so they’re not still waiting for the “perfect time” to talk to each other.

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