Wednesday, September 2, 2009

Another Miracle

I have written about an hispanic man who is my ward (or, I am his court appointed guardian), who made miraculous progress after 3 years in a coma, and who was discovered to be able to point to letters on a large page, and so communicate his real name, his birthplace in a middle american county, and through that, with the help of the consul from his country, locate his local family here in the US.

Today, we leapt over Mt. Everest.

Since that last story, I have battled with hospital doctors to try to get them to put him on an antidepressant and some antipsychotics. They made it to the antidepressants, but never the antipsychotics. After over 2 years in the hospital, some overseeing angel found a way to get him paid for in a nursing home and he was moved.

The nursing home doctors were a lot more understanding and cooperative and immediately did the psych eval to determine whether he needed medication. Answer, yes. This addressed the psychological underpinnings to ease him into a more cooperative mood, so we could work on his physical issues.

He had been on a trache and ventilator as well as a feeding tube ("PEG") for over three years. He kept pulling out the PEG, being sent back to the hospital for reinsertion and then returned to the nursing home. His family, meanwhile, were telling me that he wanted to eat and that they brought him food and that he could eat and swallow, despite the tube down his throat.

When I visited the last time, he had progressed so much that when the doctor was told he had pulled out the second trache, he said leave it out and see what happens. He was able to talk, and greeted me with a very clear "son of a bitch" pointing with squinty eyes at me. He was getting better! One can't take these sorts of things personally, on the contrary, he was communicating. So, I asked him whether he wanted to eat. He nodded yes. I asked whether he wanted chocolate milk, YES. Steak, YES. So, I went to the care team and asked whether they could get him some chocolate milk. They had to call the doctor. Doctor said clear liquids only. Took them half an hour to get two little containers of frozen apple juice. I took it to him, but he turned away.

I persuaded the care team that since he wasn't cooperating with the nursing home staff on passing a "swallow test" that we could have the family come in, bring food, and staff could watch him eat and confirm that we could advance his diet. The doctor agreed and the nursing home director thought it was a great idea.

So next day (today) I meet his mother and brother. They had brought superb smelling soup filled with chuncks of celery, carrots and tortillas. I called the "speech therapist" who had agreed to come to witness. By then he was chowing down the tortillas like a champ. The speech therapist was troubled because the nursing home protocols weren't being followed and she herself couldn't certify that he could eat or recommend that he be moved from being tube fed to removing the tube and eating. But, she would note that she had seen him eating. And that the next steps would be to remove the feeding tube and order regular meals.

Here was a man for whom I had four times recommended we put him on hospice and let him not be fed by tube if that was what he wanted. Now, I am looking for the day that he is sitting in an electric wheelchair, can go home to his family and I can terminate the guardianship.

Hard work over three years. But what a result. !! I am flipped over the moon.

My work is fun and gratifying!