Monday, December 31, 2007

My Uncle's Situation

Many readers and listeners have inquired about how my uncle, Richard Goldman, is after my lengthy vigil with him and my aunt, Susan, at the hospital in New York earlier this month. Richard has struggled with pancreatic cancer since summer of 2006, a rather long survival period. Anyhow, I figured I'd post this email from my Aunt Robin, Susan's sister and Richard's sister-in-law, informing the family of the situation. My parents are Neil and Joan, my uncle's brother and nephew are Larry and Morgan, my uncle's daughter (my cousin) is Heather.

It was sent today and starts from the beginning:

On Dec. 6, Richard was rushed to New York Presbyterian Hospital because the biliary stents were not working and his body was purging bile. Over the previous few days, he had been experiencing increasingly tremendous pain that wasn't really being addressed adequately at home. He was also having difficulty tolerating the hyperalimentation. When admitted, it was found that Richard had an infection, probably related to the hyperalimentation and, initially, his vitals were all over the chart. We did not anticipate that he would last more than a few hours, perhaps days.

I had been in Albany but came down and met them at the Emergency Room (with a short stop for a speeding ticket...) Since it was the weekend that Susan and Richard traditionally host a Hanukkah party, Neil and Joan were in New York and Steven decided to surprise everyone with a wonderful Hanukkah gift of being with us for the party; what was anticipated as being an overnight day visit, resulted quite a bit longer visit. Richard's brother, Larry, flew back from Costa Rica on Friday evening, and both he and Morgan camped out with us at the hospital. As seems to be the Friess family way, we all gathered to support Susan and Richard during those very difficult first days.

The room was large enough to accommodate a cot so Susan was able to stay over at night, and we made sure that she had someone with her from morning to bedtime. Neil and Joan extended their visit for a few days but, with a new business to run, had to return to Florida. Richard's condition deteriorated day by day, with his morphine level being adjusted higher and higher to combat the excruciating pain. Both Shoshana, Susan and Richard's rabbi, and Rabbi Shem-Tov, Heather's rabbi, visited and provided him and Susan with much needed succor. When articulate, Richard very clearly declared his wish that there not be any extraordinary care, no tests, no machines, no nutrition. He was very calm and determined, and wanted everyone around him to understand that he was at peace.

After 10 days of decline, suddenly, late on Monday, December 17, Richard became very much awake and aware. He asked for some apple pie. Over the next week, his condition seemed improved. His blood pressure, pulse and oxygen level was strong and his pain was being contained. He developed a great appreciation for the smell and taste of Pepsi, enjoying mouthfuls of it as if it were the finest wine. He would have a teaspoon of Jell-O occasionally. He was very conversational and very upbeat. However, he did not change his wish regarding extending his life. Susan engaged the services of a night nurse and was able to go home to sleep. This phase lasted for about a week.

Over the past week, he has become weaker. An MRI on Thursday showed lesions on Richard's liver. The oncologist, Dr. Sherman, suggested that Susan and Richard speak with a surgeon about the possibility of having a feeding tube inserted directly into his intestines (since his stomach was not processing food) and even hinted that if that were possible, Richard might be able to go home. Initially, Richard seemed interested in hearing more about this but unfortunately, the surgeon did not feel that inserting the tube would be a good idea. He said that given Richard's condition an hour long procedure would be very trying to his system, that this method of providing nutrition has a very high incidence for infection and that given the liver lesions, it was not advised.

He reiterated what the palliative nurse had said a week earlier that when 'shutting down,' the human body naturally compensates by producing endorphins so that people in Richard's condition do not feel hungry. We were assured that by not providing nutrition, we were not causing any suffering. In fact, he said, if the tube was inserted, it would be more for those around Richard than for Richard's sake. It would not improve his comfort level.

On the same day, Susan was notified that a bed had become available at a hospice that is just a few blocks from their home in Riverdale and we are hopeful that Richard will be moving there later today. Richard remains emphatic about his wishes for his care and the hospice would seem to be the best way to respect those wishes.


doc said...

PEG tube placement for feeding has been increasing over years but the beneficial effects of this procedure in many patients esp dementia or terminal situations is controversial and impacted by complex considerations.