Wednesday

MRSA, AIDS...the fear


photo by Jessie McClain
My Dad died a few weeks ago. He was 85 years old. He had heart disease. After bypass surgery in his seventies, he took a baby aspirin daily and did well for many years. But these last few years of his life, he took coumadin and various other meds to control the symptoms of his disease. Six months ago he was hospitalized with congestive heart failure and kidney failure. He recovered and went home. But in January he went to the ER and was diagnosed with a urinary tract infection and sent home. The next day he went back to the ER with low blood pressure, admitted to intensive care, and then diagnosed with MRSA, methicillin-resistant Staphylococcus aureus. He was put in isolation and those who visited him had to wear gowns and gloves. He developed pneumonia and the infection targeted his heart. He was put on IV vancomycin (6 weeks of IV vancomycin is standard) and other antibiotics. Early in the infection, he started seeing bugs on the ceiling, having delusions, and wanting to go home. He was put in restraints and when things got really bad he was sedated.
Eventually his delusions lessened, but the dementia demon was always lurking in the late afternoon. He got somewhat better after 4 weeks in the hospital and was sent to rehab, where he spent about 5 days either lying in a bed or sitting in a tinkertoy wheelchair (he was 6 foot 4 inches and this particular rehab center couldn't seem to find him a wheelchair that fit). Day 5, I found him collapsed, ashen-faced in the tinkertoy wheelchair. When a nurse finally came, his blood pressure was 70/35 and his breathing was barely visible. He was taken by ambulance to the hospital and diagnosed with another urinary tract infection-e.coli. More antibiotics and then another infection called c. diff. (An infection that is common in hospitals) Antibiotics, like vancomycin, kill off the good bacteria that could inactivate c. diff. This infection causes an unrelenting diarrhea. The delusions came back in full force. He had quit eating and drinking and lost an enormous amount of weight. Some of the physicians believed that with their medical miracles that he could live another year. Some of the physicians felt otherwise and expressed their belief in hints and in generalities. Eventually my family requested hospice. He spent his last two weeks on earth in a hospice care center. He started to recover or so it seemed. He was eating and drinking. The meals were made and served by volunteers. The appetizing meals and loving care he got helped stimulate a recovery. His dementia started to lessen and at times he seemed to be his old self. He actually recovered enough so that we had plans of taking him to my house. Instead, he had a massive stroke and died at the hospice center before we could implement the plans of taking him to my house.
I can't say I understand the medical community and its response to infectious disease and death. I don't understand how my Dad got MRSA. Nor do I understand why he was MRSA positive, then negative, then positive, then negative? Why the gowns and gloves and then no need for gowns and gloves? How interesting that an environment like Hospice can change the outlook of a patient? One would suppose that entering Hospice would be about doom and gloom. Instead my family found an environment full of caring and love. He died because his heart was weakened by MRSA. He never wanted extraordinary means to keep him alive. My Dad had left hospitals AMA(against medical advice), he had refused an ambulance after collapsing and recovering at a meeting, and he had walked out of an ER after feeling better. After his bypass surgery, he had told the family never, never again would he go through that kind of surgery. He annoyed his heart doctor because he refused another bypass surgery. That doctor wrote that he was non-compliant. And because of his non-compliance this specialist threatened to dump him as a patient (but relented later).
My Dad at one point during his hospitalization and in a very lucid moment, said to me that I ought to write about his recent "adventure" of hospitalization. I am not sure what he meant--from his eyes, from mine? Should his "adventure" be a personal story? Do I even know what he felt during the last two months of his life? Should I write about facts? For instance, the CDC reported in 2007 that more people died from MRSA than AIDS.
Should I write about how fear impacts quality of life? How fear of death, fear of infectious disease impacts medical care? How hospitalization dehumanizes a life? How personal belief effects health care professionals assessment/prognosis of patients? Is fear a basic component to sickness? Why are we expending so much governmental money on AIDS, when MRSA cases have doubled in five years?
Copyright 2009 Valerie W. McClain

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