Friday, February 4, 2011

Miracles happen slowly

Back to my miracle man.

Quick reprise: Four years ago, he was brought to a local hospital in a coma and quadriplegic. Today, he is living in a nursing home and he talks, eats solid food, breaths on his own, is very angry, and is -- I hope -- on his way eventually to being able to sit up on his own. He can use both arms and his upper body is robust.

Yesterday his psychiatrist agreed that we needed for him to not dislike himself so much. This was the last piece of (my) plan: adjust the meds (more on psychotropics below) so he isn't as combative and impulsive. This will allow him to work more effectively with the various therapies. His percutaneous episomething gastrosotmy tube (peg or feeding tube) was removed today. Next, they are to sew up the hole left from his tracheostomy tube. Then, they are to work with him to hold a urine bottle in his hand so he can pee on his own. And after that, learn to both ring a bell to be helped to the bathroom to have a bowel movement and to use a bed pan for the same purpose. After that, work on sitting in a wheelchair. If he has to be restrained into sitting up because of weakness, then put a belt on that complies with the law against unlawful restraints. Finally, I am going to get him some porn magazines. The psychiatrist heartily agreed that we needed to help him with a sexual outlet. If he can hold a urine bottle he can hold his penis and masturbate.

A number of these measures aim to redirect his anger and his impulsive behaviors. He hits and kicks people. Reduce his frustrations from the PEG and the hole in his throat. He drags nurse's hands to his penis. Help him masturbate on his own. He is angry. Give him options for progress. He has made great progress in the last few years from his quadriplegia and coma.

I will work with his family to support these next steps by encouraging him to work with staff. Let go of fear that he is being poisoned. And hope that someday he can go home to a relative.

There are so many details behind each one of the elements above. Too much to tell; too little time.

On psychotropics. There are two options. Put people who have potential and a desire to live out in the world, but who live inside a body tyrannized by an out of balance psyche, in restrained living quarters or medicate them adequately so they can integrate into a socially and personally growthful state. I prefer the latter. A recent post on our estates and trusts (elder law as well) list serve asked what to do with a man living "in the community" but who has diabetes and who is "not mentally ill" but who wanders around town all day and doesn't take his insulin the required 3 times a day. The common answer is that he is mentally ill and that he is a danger to himself and that he should be put in a locked alzheimer's ward. My heart feels a dagger through it when I read that advice.

I would -- and this takes a lot more work for the guardian -- rather keep him in the community, have a mental health team take him on, get him on some serious psychotropics that will allow him to comply with his health related medications and preserve his ability to go out and about into the world. The world obviously means a lot to the guy. He can only continue to access it if he complies with his medical meds. The only way he will comply with his medical meds is if he takes just enough psychotropics to reduce his hostility and rejection. You do need a caretaker for that. And someone making sure that when things go off the rails, which they will, someone will make sure he gets back on. More work but better human.