Tuesday, January 24, 2017

Beyond Difficult {Part 1 - To Intervene or Not To Intervene}

"Not compatible with life"
"A drain on our society"

These are the phrases she hears over and over in her mind whenever caring for her medically complex son becomes beyond difficult. However, looking back, although legal, she still could not have killed him before he was born, but maybe she shouldn't have forced him to live after he was born either.

She had her chance to avoid life getting beyond difficult. The doctors had said, "His diagnosis is not compatible with life" and "He'll be a drain on society." "Take him home and give him comfort care," which basically meant take him home and let him die with the aid of hospice and morphine.

Die?! She couldn't take him home and let him die! How dare they suggest she take him home and let nature take its course just because his body is not compatible with life.

But guess what? They were right. His body is NOT compatible with life. He has an overriding brain malformation which at any moment could just tell his body to shut down, but in the mean time, it causes a condition called dysphasia which means he cannot swallow without aspirating food into his lungs. When she tried to feed him by mouth it created enough pain so that he refused to swallow and probably would have ended up with chronic pneumonia if he continued to try. He was destined to die from either starvation or some kind of lung disease.

Therefore, he would not be alive today without the medical technology and intervention of a g-tube. She forced him to eat when his body could not naturally perform that function. And once she made that choice, she could not change her mind later when things got beyond difficult. It was a one time decision that she can never go back on lest she be accused of negligence at minimum or murderer at maximum.

So now that he had officially become a drain on society with all the expenses of medical technology that entails, she has to play the game of picking and choosing which medical interventions will give him the best quality of life on top of the general maintenance and costs of keeping a medically complex child healthy which includes an abundance of healthcare and mobility supplies and medications as well as hospital stays for common illnesses because they turn into life and death situations so quickly.

She had to choose to get a shunt, a high tech valve implanted in his skull with a drain tube snaked into his abdomen, when his head kept increasing exponentially in size because the fluid around his brain didn't drain on its own from his skull. At the time of his surgery, it was not yet considered a life or death situation. There are cases of children living years with enormous heads from hydrocephalus. But they can't lift their head, and the pressure inside the skull can be painful, and caregivers have difficulty moving and caring for a person with an immensely large head so they elect to have brain surgery where a shunt is implanted to drain away this excess fluid before the head size gets out of control.

She had to request a suction machine to remove excess mucous from his mouth because although he was not eating by mouth, his body still generates its own secretions along with the occasional reflux of stomach contents which he tries to swallow. Because he aspirates when he tries to swallow the secretions and refluxed food, he was still experiences pain along with dropping oxygen levels with the chance of pneumonia. By jamming a small plastic vacuum tube into the back of his throat and along the sides of his mouth while he fusses and squirms, she can help his airway stay clear,  prevent his O2's from dropping for too long, and stave off respiratory illness.

She's had to choose to do another brain surgery called a fenestration where they go into the brain and poke holes in all the non-communicating fluid filled cysts to force them to communicate. Basically the shunt was not able to drain the fluid from these cysts because they were closed off from the other fluid filled areas. They were continuing to grow and put pressure on what brain exists, continuing to cause pressure, head growth, and additional seizures.

When X-rays showed signs of developmental dysplasia of the hips, again not a life or death situation, she chose to get a relatively non-invasive surgery called SPML along with a hip orthotic/brace in hopes of preventing complete dislocation of the hips along with the anticipated accompanying pain.

When that didn't fix the joint migration, she chose the next level of hip surgery with the unfortunate acronym SLOB with the hopes that it would prevent the hip joint from dislocating so she wouldn't have to resort to the very invasive bone-cutting procedure called a VRO. The surgery typically has a four day inpatient stay, followed by a 3 month recovery using a movable brace instead of a cast to prevent loss of range of motion and to promote healing. It was going to be simple, and just another one of those medical interventions that she has had to choose from that would increase his quality of life while draining society.

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