Sunday, September 13, 2009

Worsening condition

My Mother called me yesterday sobbing on the phone after she had visited my father at the hospital. She reported Dad was in the worst condition that she had ever seen him in, describing him as unable to walk or communicate, all the time laying helplessly in his bed. 

On Thursday, Dad was released from a local hospital back in to the care of the nursing home. Fearing Dad would be a liability to their other patients, the social worker had him admitted to another geriatric psych ward on the other side of the state. This precautionary measure came after the hospital staff reported him as stable. In fact, a staff nurse told my sister Dad had spent most of the previous evening happily folding towels and holding hands with her.

On the new geriatric psych ward, Dad was caught wandering into another patient's room, which warranted staff to administer a punitive sedative to him. Considering that pacing is symptomatic of Alzheimer's Disease, Dad's behavior seems like a minor infraction, worthy of gentle redirection than sedation.  Since the onset of his disease, he had become an incessant pacer, sometimes taking off multiple times a day for long walks when the confines of the house became oppressive. 

It's probably fair to assume Dad was still under the influence of the medication four hours later when my mother and sister arrived.

Complicating the situation further, the staff doctor has taken him off Namenda, which has been Dad's primary memory medication, as a base line to determine what medication might be triggering his violent outbursts. Obviously this approach has not deterred staff from administering him sedatives at their convenience. 

Although Dad has been cognitively incapacitated for a long time, my family and I still hold value in his presence. As a result of our historical relationship, we continue to perceive a glimmer of who he was as a holistic person and at times cannot distinguish it from his current condition. This may occur when framing the medical choices made for him by hospital staff.  As his past self has  largely been erased for those who never knew him before the onset of AD, the hospital staff who treat him never have to negotiate with any perception of the patient as fully functioning, and therefore can solely administer "care" based on symptomatic behavior;  hence treating his wandering with quick and efficient sedatives.

For Dad and his cognitively challenged comrades, the overarching question remains whether institutional care functions to accelerate their decline or to administer the most efficient means of control to subdue any dissent and disorder? Has Dad become a disposable vessel into which the medical establishment he encounters would rather inject a toxic cocktail than address his symptomatic behavior as part of a larger condition? I would say yes. Regardless of his state, he is fully human and deserves care that treats him with dignity and in a holistic manner. 

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