A different kind of care

The good news is that the behaviors we have been seeing over the past few days continued to grow. My dad abducts his shoulders more often and becomes agitated when we leave the room. His arms are as strong as they were before, and explore his tracheal tube. By all accounts, the recovery that was interrupted by morphine (because of his tracheotomy) has recovered the trajectory it was on.

The bad news is that we have not seen the sort of qualitative improvement we have been looking for. Though dad’s movements show increasing muscle strength, they do not show willful muscle control. That is, his hands explore the tube but don’t try to pull on the tube — his hands push down but do not try to get out of the cloth restraints. He recognizes our voices but, aside from moving his head closer, does nothing. The recovery has not shifted into something where dad explores or communicates through his environment.

The other news is that, after another EEG, another CAT scan, and physical tests, two neurologists see evidence of severe brain injury. When dad’s eyelids are lifted he does not track objects. He folds his hands in a way typical of those who experience serious head trauma. His brainwaves are erratic, and the chances of an acceptable recovery are “extremely low.”

The final news is that, with “aggressive treatment,” we could raise him to what the chief neurologist described as the “Terri Schiavo” level of functioning. (Both dad and Terri suffered from “anoxic-ischemic encephalopathy” following a heart attack.) Terri died in a persistent vegetative state, and there was evidence (the shoulders abducting, the sleep cycle, etc.) that dad is entering one, or is in the early stages of one. More terrifying, especially given dad’s thoughts on the matter (separately expressed to my mother, my brother, and myself), the chances of an unacceptable recovery (the “best” that could be hoped for, where he would be confined to a nursing home) may be as high as 5%.

With this news, our care of dad is now centered on making sure he is not, and will not, be in pain.

The various monitors that tracked his heart rate, blood pressure, and saturated peripheral oxygen have been removed. Other things have been removed as well. He is on morphine.