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Monthly Archives: June 2010

Dad, heading out to his stand.

By now, a lot of you that know me know that my Dad -Dootnie- lost his battle with cancer this morning. That little gem -“lost his battle”- is one of the fancy, but palatable, ways we use to say “he died.”  I (we) now have a better appreciation for the grim details that are covered by that euphemistic patina. At 10:45, he went to be with his Lord, to a mansion that was prepared for him. Our family is sad to be without him, but we are encouraged about where he’s gone and about the prospect of seeing him again – one day. To some folks, it may seem a little cold, or crass, for me to be writing about his passing this way, in this venue, so soon after his death. It’s what I need to do – it helps me to process what has happened. This post picks up where I left off on Friday, when things looked (on the surface, anyway) a little different.

Be careful what you wish for

You just might get it.  I’m speaking of information, that is.  In my last post, I grumbled about the lack of comprehensive information about Dad’s care. We just didn’t know what was going on. That stuff all seems trivial right now. Thanks to some comments from folks here, and on Facebook, we were able to find the right person to ask all of our questions. That person was very helpful, and my sisters Kim and Shannon were able to get a lot of answers.  By that point, Dad was not just not improving, he was going downhill fast, so the answers were not at all what we wanted to hear.

Acute renal failure

was the principal culprit. The stress on his kidney from the colon surgery was tremendous. The dialysis that they started a day or two earlier wasn’t helping. Because Dad had “metastatic disease” (Stage 4 cancer), a transplant is out of the question.  Pneumonia, and the persistent infection were continuing to take their toll on his body.  By late Friday night, it had become apparent that we were going to be making tough decisions very soon.  The doctor confirmed to us on Saturday morning what we hoped were wouldn’t hear (for a long time, anyway): Dad’s condition had declined to a state where he would not survive without life support.

My Dad has expressed, on numerous occasions, that he had no desire to be kept alive on machines.  Now, they were the only thing standing between him and leaving this world. My mother and my siblings gathered to discuss what we needed to do.  I think, at that point, it was more of a joint acknowledgment that the end had come, and we must agree together to assent to Dad’s wishes.  My brother was not with us in Richmond yet, but we discussed it on the phone: tomorrow, when he got into town, we would have Dad removed from the life support mechanisms, and say goodbye.

There a million questions to ask…

when you’re going to have your father removed from life support. Will he feel any pain? Would he be able to speak with us, and hear what we had to say? We had this romantic notion, however briefly, that we’d have him brought up out of sedation so that “he could see and hear us, if not speak to us.”  But then we worried if this would cause him even an instant of additional suffering.  I wanted no part of that. If his sedation is changed, and he regains consciousness, and they took out the breathing tube, would he even be able to speak? The nurses couldn’t say for sure.  It was a moot point: the nurses changed the type of sedation on the chance that we’d want to try to speak to him – he did not respond to the change. That settled things, really – the nurses would remove the breathing tube, and the other machines, and we would say goodbye.

On Sunday morning, we gathered at the hospital, and asked the doctor to begin the process of removing the life support. Dad was an organ donor, but the fact that he had cancer disqualified him from donating any major organs. They would be able to harvest his corneas; we were happy that someone would have the gift of sight from Dad. The end came mercifully quickly. About 45 minutes after the machines were removed, he was gone. My brother and two sisters stayed with him until the end.  I understand why they did it – they wanted some of his family to be there with him at the very end; I could not see him any more like that.

Going back to Cellar Mountain, one more time.

Copy of PB260654

Dad and hunting party, near the Blue Ridge Parkway marfdrat via Flickr

My Dad had, as my Mom puts it, “no desire for the accouterments of death” – no fancy casket, or headstone, no viewing or open casket. They used to joke about the fact that they both wanted to be cremated.  If Dad went first, his ashes were to be taken to Cellar Mountain -one of his favorite hunting spots-  in the Big Levels Game Management Area of the George Washington National Forest. It’s out near Stuarts Draft, Virginia; we hunted there for many years. If Mom went first, my Dad would “fire her from a couple of shotgun shells.” It seems a little irreverent, but their beliefs are grounded in the idea from the Bible of “absent from the flesh, present with the Lord.” If they’re already gone, there’s no earthly value in making a big show of preserving and displaying their earthly remains in a gilded box, and then putting that box in the ground.

And that is what we’ll do: take him to Cellar Mountain. There’s no hurry; there are endless details to attend to this week. But, when it gets a little cooler -perhaps when hunting season comes around- we’ll take him there: from the Blue Ridge Parkway, to Bald Mountain, by the Green Pond, and the head of the Stony Run trail, out to Cellar Mountain.  We’ll leave his ashes in a place that he loved a lot.

And we’ll remember my Dad.

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An update

Dad
Dad at Pine Forest, Christmas 2008

Last night, nurses informed my sisters that Dad was off of both of the vasopressors (the drugs that raise blood pressure), and that he appeared to be regulating that on his own.  They also said he was being fed through a tube – this would be the first food he’s had since they took him to the ICU. That’s a good thing, since he needs nutrition if he’s going to heal.

About mid-day today, Kim told me that he’s back on one of the vasopressors.  I guess one is better than two, but I don’t have enough information to make any sort of judgment on that.

Speaking of information – why does it have to be so hard to get?

Kim and Shannon are camping out at the hospital with my Mom, and trying their best to corner every medical professional that has anything to do with Dad’s care, to try and piece together enough information so we can figure exactly where he stands.  It is proving to be difficult; too difficult to suit them, and me.

Maybe this is standard operating procedure for hospitals – I haven’t been around enough of them to know. Some of the folks are more helpful than others, and some are almost no help.  There’s a lot of this:

“Dr. Soandso is responsible for that aspect of his care.”

“Okay. When does he come around, so we can ask him about that?”

“I don’t know.  I don’t keep his schedule.”

They got one answer from a doctor today that was literally as bad as that – he said, and I quote: “I don’t know – I can’t read his mind.”  My sisters are not imbeciles, so a reply like that to a seemingly intelligent question is insulting.  Yeah, I know you’re a doctor and all, but maybe you could work on your bedside manner a little? An ICU nurse spent a lot of time answering questions for them last night, and seemed genuinely concerned that Kim and Shannon get all of the information they asked about.  We were (and are) appreciative of that sort of effort.  Today, however, was a different story.  Apparently, they hit some unadvertised limit for questions, and today’s nurse (a different one)  just decided to pretend like they weren’t there anymore. Consequently, with this sort of two-stepping going on with doctors and nurses, we are getting frustrated about being able to ascertain where we are.

What, exactly, is the plan?

We have gotten lot of generalized answers about what needs to happen for Dad to improve, and, ultimately, get out of the hospital. He has pneumonia, is fighting an infection (type still to be determined), is on a respirator, and needs to heal from the surgery to remove part of his colon. Oh yeah, and he has cancer.  So, answers like “he needs to breathe on his own” and “he just needs to get stronger” are not helpful. Also, knowing that he is “comfortable” is good -we certainly don’t want him any more uncomfortable than he has to be- but they keep people “comfortable” in long-term care facilities. People that will, most likely, never come out.  Our goal is that Dad leave the hospital, walking.  I assume that is their goal, too, but we don’t have any specific information about how their medical team plans to accomplish that.

We want to know what the PLAN is. Consequently, we have specific sets of questions that we’d like answered (this is a sampling):

  1. In order to breath on his own, the pneumonia needs to be remediated – how does that happen?
    1. What specific steps are being taken TODAY to move toward that goal?
    2. In similar circumstances, how long does it take for this to happen?
    3. Are there specific drugs or treatments that are given to take care of this?  If so, what are they, and are they being used now?
  2. What, exactly, does get stronger mean?
    1. Vital signs of a certain description?
    2. Ability to perform certain actions?
  3. Walk me backwards from the day he checks out of the hospital.  What are the milestones that must be accomplished for this to happen, and what are the specific steps, as of right now (we realize everything can change, but there has to be a baseline plan to move forward), to move toward these goals?
  4. He was put on dialysis (ostensibly temporarily) because his system was under such stress that his remaining kidney couldn’t perform its work. What needs to happen for him to come off of dialysis, or is this something that happens on its own, as his body starts returning to some kind of normalcy?
  5. On the administrative end of things – if the doctors and nurses are too busy to answer questions from us, who can we go to to understand what is happening with relation to the PLAN for his care (that we presume to exist)?
  6. Who is the quarterback, or project manager, or team leader (or whatever you want to call them) that is coordinating the activities of a surgeon, an oncologist, a pulmonologist, a urologist, a palliative care specialist, and nurses and other staff? Someone must be coordinating all of this, and has the manager’s view of the activities, right?
  7. Who, in the hospital administration, is responsible for making sure that the families of patients get the answers they need?  Dad can’t make any decisions right now; he’s sedated.

Perhaps, getting information of this specificity is expecting too much.  If it is, that would disappointing to know.  Still, knowing that would be better than what we know now. It would be nice if someone in administration, or somewhere, could set expectations for us. Then we’ll know whether to stop asking stupid questions.

Can you help us?

Maybe you’re reading this, and you know the answers to some of our questions, or you know who we should ask.  I’d appreciate it if you left a comment here to pass along any useful information.  Thanks

Image of Franklin L. Reid from Facebook
Image of Franklin L. Reid
Note: I’m writing this series of posts for two reasons: to fill the gap left when Dad couldn’t write on his own blog anymore (privately followed by our family and friends, it was his way to communicate what was going on with his chemotherapy treatments); and, because I can’t think of anything else to do right now – everything that’s going on right now is completely out of my hands.  I want lots of folks to know about, and pray for, my Dad.

One – Where we are today.

The ICU is a cold place

Literally, and figuratively, it is cold. It feels like a walk-in refrigerator; and you start to get a chill in just a few minutes, because you’re in short sleeves and have been sitting in a relatively warm waiting room.  I don’t know why they keep it that cold; that seemed like one of the least important questions to ask.  Like a macabre Rube Goldberg contraption, it monitors, detects, and responds, but feels nothing. Blood pressure and oxygen monitors beep and hum, and sound the occasional alarm. The respirator whirs and hisses, and the air tube jumps with each pump of air expelled.  The gastric tube inserted to his stomach retrieves angry green bile, because the patient’s  stomach won’t process it. Wheels spin merrily to the beat of  tiny castanets as the dialysis machine does its ceaseless duty.

Image of Johann Reid from Facebook

The Reid Family

In the middle of all of this activity is the patient: my father,  my Dad,  Franklin L. Reid, Sr. He is the son of Fred and Irma; brother to Fred Jr., Raymond, Gerald, and Donald; husband of 50 years to Johann; father to Butch (that’s me), John, Kim, Stacey, and Shannon; grandfather of nine; servant of God, and friend to many. He was called Dootnie as a child, by one of his Aunts.

It is hard for me to see him like this.

He is helpless; not a position into which he would reluctantly be dragged, and certainly not willingly venture – unless he thought, by doing so, it would help someone else.  If he could, he’d get up and walk out.  In two week’s time, he has spiraled down in dramatic fashion: from feeling pretty good (chemotherapy side effects notwithstanding) and taking a trip with my Mom over to Virginia’s Eastern Shore, to being tended by the macabre Rube Goldberg contraption, and some kind and dedicated doctors and nurses.

In the hours after that trip to the shore, he noticed bleeding – a lot.  Mom took him, just in the nick of time, to the emergency room at CJW Johnston Willis, just off of Midlothian Turnpike in Richmond. He had lost about two pints of blood. After a couple of days of diagnosing, and about six units of blood, the cause was determined: a perforation of his bowel, likely caused by the combination of surgery to remove a tumor about a year ago, and the caustic side-effects of his chemotherapy drug, Torisel. Surgery would be performed to remove the leaky section.

The operation appeared to be a success.

Completed in around two hours, they removed the perforated section and re-connected everything.  The surgeon also removed “some of” a tumor that was known to be there in the bed from his previous surgery. He was in a lot of pain, and getting him the right kind and amount of pain medication proved to be tricky.  Too much, and he was “climbing the walls”: agitated and antsy. Too little, or the wrong kind, and he was in noticible pain. After a couple of days, he was complaining about “feeling like he needed to throw up”, and dreading that because of his centerline incision.  Finally, on Monday, Mom noticed that he was having some difficulty breathing, and sounded like he was “gurgling”. His stomach was becoming distended, and felt hard to the touch. She alerted the doctors to this condition.  Suddenly, things were going downhill.

His stomach had not been properly processing any of the bile, and it had backed up to the point where he was aspirating it into his lungs. Something had gone amiss with the surgery, and he had an infection, as evidenced by the very high fever.  He was going into respiratory distress, and failure.  They had to drain a bunch of bile from his stomach, and intubate him so he could breath in spite of the fluid that had collected in his lungs.   They moved him to the ICU, and worked very hard to stabilize his vitals so he didn’t go any further down.

Mom called to tell me this was all happening at about 11:00 PM on Monday (6/21), a week after he first arrived in the emergency room.  By the time I got over there, the staff was working very hard to get his vital signs to a place where he could effectively be treated.  His blood pressure, at one point, was 73/41 – much too low for them to be able to sedate him.  So, he was aware of, and will probably recount, once he’s recovered, what went on as they worked hard to help him.

After almost three days, the balancing act continues

They want to keep him sedated, so he’ll be comfortable, but the vasopressors they’re giving him to keep his blood pressure up interfere with other processes in his body. The nurses in the ICU are some amazing folks – they work as though it’s their own family member lying there, and we appreciate it.  This tricky balancing act has to be mastered so they can solve some of the larger issues.

I got a call from my daughter Lindsey a little while ago – she had gone to RIC to pick up my sister Kim, who flew in from Tulsa to help my Mom maintain vigil there in the little ICU waiting room on the fourth floor.   After dropping Kim at the hospital, Lindsey heard the report from the nurses that Dad’s vital signs are the best they’ve been since he arrived in the ICU. He also heard, and responded to my Mom’s voice and touch.

This is good news, but there are other problems to solve: pneumonia has set in, and that’s not good.  His remaining kidney is not producing the expected amount of fluid, and they’re not sure why, even though he’s been on dialysis for almost 24 hours.  Yet to be discovered is the reason all of this started: the source of infection. Blood cultures are in the process of being analyzed, and those results will yield a more precise prescription for antibiotics.

I think we’re just getting started here

It will be a while before Dad is back to where he was before this significant detour.  He had completed 10 of 12 scheduled treatments of Torisel, and our whole family (all 22 of us) were going to go to the Outer Banks in July for a vacation before he got a CT scan to figure out just what the chemotherapy has accomplished. These plans will almost certainly be modified. He’s going to need some time to recover from all this, so he can get back to whippin’ cancer.

Our family is thankful to friends and family members who have stopped by the hospital or inquired by phone, email, text message or social media about Dad’s condition.  We are especially thankful for the prayers that are being, and will be offered by many on his behalf. We look forward to the day when we can say he has successfully hurdled this obstacle, and is back on the path to recovery.

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Another great post by John Hayward.

In David Frum’s June 20 article in the Telegraph, he opines that “Tea Party radicalism” is turning off moderate voters, and will cost the Republicans in the November elections. In his response, Doctor Zero spells it out for Frum: the Tea Party isn’t looking to capture the hearts and minds of moderates.  We’ve had too much moderation, and the current social/political/economic malaise is the result of it.  If we continue to maintain the “vacuum” of political moderation -into which void the corrupt federal government unceasingly and unfailingly mines for money and power- we are headed for Roman-empire style collapse.

Here’s a small excerpt:

Vexilloid of the Roman Empire.

Image via Wikipedia

Obama is hopelessly corrupt and incompetent.  He’s totally useless in the face of foreign aggression, or a domestic crisis like the Gulf oil spill.  His behavior has led state governors to the same conclusion as the passengers on the Underwear Bomber flight: if you want to survive, forget he exists and fend for yourself.  His incompetence is partially a result of his single-minded focus on what he views as his true mission: increasing the power of the State, without reason or purpose, discussion or accountability.  It will take a spectacular President, following a disciplined Republican Congress, to undo the damage Obama has done… and we need them to do more than that.  We need them to address the systemic flaws that would have detonated our unsustainable entitlement state only a few years later, if Obama had never come along…

The Tea Party is composed of people who have no desire to reach a reasonable accommodation with comprehensive ruin. (my emphasis) They have accepted the difficult responsibility of showing their fellow citizens that the Big Government narrative of the past four generations is a fraud heading into a devastating collapse.  They understand that justice and prosperity require the elevation of reason over emotion, which will require an electorate composed of adults.  They believe the American people deserve to be addressed as adults.  Only the people David Frum keeps sneering at can give such an address.

Read the whole post at Doctor Zero.

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John Hayward -Doctor Zero- is an excellent writer.  His June 18 post describes in vivid, but painful terms the utter incompetence of the insatiable money-eating leviathan that is our federal government. As Obama and his cronies deflect blame and extract slush funding from BP, action in the Gulf meanders along with something short of a sense of real urgency.

The whole piece is good stuff, but I loved this paragraph – particularly his description of Bart Stupak (of HCR cave-in fame):

No Presidential speech could obscure the fact that incalculable, perhaps irreversible damage has already been done,

Bart Stupak

The Reptilian Bart Stupak via Wikipedia

while union politics prompted the President to ignore valuable offers of assistance from foreign ships.  Innovative strategies for dealing with the oil gather cobwebs while the Administration focuses on the really important task of securing a $20 billion down payment on a massive new slush fund.  Of course Obama and the Democrats will steal

much of this money, the same way they robbed the taxpayers for political cash and called it a “stimulus.”  The reptilian Bart Stupak has already floated the idea of raiding the BP fund for health care money.  I wonder if some of it would end up paying for abortions.

Read the entire post over at Doctor Zero: The Helpless Titan.

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This is a pretty good way to get some publicity.  I know Rod and Logan in the band, and I like their music.  They seem on

J Roddy Walston and The Business

the verge of hitting the big time.  I hope they make it.

You can hear some of their music here.

Read the article about their Manhattan public-piano blitz in the New York Daily News: J. Roddy Walston and band The Business want to play all 29 pianos in Manhattan parks.

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1880-2009 global mean surface temperature diff...

Image via Wikipedia

Only eight minutes long – worth the time. He presents some interesting data on warming and cooling periods on Earth long before we discovered and started using fossil fuels.  In the short run (if someone had been around to observe and report on it), those changes would have seemed pretty dramatic, too.

Especially interesting to me is the last section of the presentation, where he  compares the global temperature predictions of IPCC scientists to actual observations from 1990 to 2008.  It doesn’t seem to square with graphs like this, that you’ll find when you look most places on the internet (or, maybe it does – perhaps it depends on the context in which you view it):

At any rate, it’s an interesting presentation from someone who’s studied the weather for a long time.

http://www.kusi.com/v/?i=78477082

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