Well. As choices go, that sucks.

[wordinista]

Okay, so.  After this post, I'm going to start f-locking things talking about Gramps because I realize that not EVERYONE is going to want to read about it. 

Just got back from Mom's, and we had an... interesting talk.  She's good friends with a nurse who has worked extensively with dementia patients.  From what she says, when the body is under general anesthetic, that can cause a spike in the dementia's progression.  This was why Grampa's behavior was so completely weird after his surgery in July -- he was exhibiting that spike.  And the bitch of it is, he'll come back a little bit (he's just starting to really be himself again -- since July), but the damage done while he was under the anesthesia is done.  There's no undoing the damage.  So he can come back a little bit, but he'll never reach pre-surgery mental levels.

Now, Grampa's urologist (who, let me say, is a complete dipwad for a NUMBER OF REASONS starting with performing the surgery in an outpatient clinic that he co-owns, all the way to not arranging for an in-home nurse to help with Grampa's after-care [translation: My mother had to be the one who kept the incision point clean and who changed his urine bag. THIS IS NOT ON.] HE DIDN'T EVEN SEND HOME AN INSTRUCTION SHEET REGARDING AFTER-CARE) -- the urologist wants to do another cystoscopy (note: dipwad either did not use enough local anesthetic or did not wait long enough for it to take effect, because my grandfather was in enormous pain during the procedure -- so much so that my mother could hear him yelling in pain from the other room -- and he remained in pain for three weeks afterward).  Now, if he does another cystoscopy and finds that the cancer has come back to his bladder, the doc is likely going to want to do perform another surgery.

Hopefully y'all see the problem here.  If he does go in for the cytoscopy (by the way, good luck getting Gramps to agree to undergo another one) and more growths are found, and another surgery is performed, we're looking at another spike in the dementia's progression.  And?  AND.  That part of the brain, as I understand it, also governs breathing.  So another spike in his dementia's progression could put him somewhere he can't come back from.

Given this, Mom's wondering if he should undergo the cytoscopy at all.  (Assuming he doesn't say "fuck that" and digs his heels in, refusing to go in or the cytoscopy, 'cause dementia or no, he damn well remembers THAT. And my grampa? Is TOTALLY the type to say "fuck that" and a host of other colorful things.)  I mean, do you save the body (for a little while, maybe -- this last surgery bought him three months) at the expense of the mind?  I can't condone that.  We're working so hard to keep the dementia at bay, it seems crazy to entertain the thought of a procedure that could very well push him past some point of no return.

I don't even know.  I'm not even sure there's any sort of right answer here.

Under my covers is looking really appealing right now.

Comments

[darkfrog24.livejournal.com]

I have an uncle who's been in care for many years now. Dilemmas of this kind are starting to come up for him. They're not easy.

What would be best for your grandfather's quality of life? Is the bladder cancer such that it would make his remaining time miserable or could he deal with it? If you ask me, brain trumps bladder.

[cyperian.livejournal.com]

That is *such* a tought choice. I would hope that if my mind started to go that my body would naturally be there as well.

Assuming that they do a cystoscopy and there is something to remove/fix, I wonder if there's a way to avoid using general anesthesia (I assume that's being completely out is what progesses the dementia). If they can do a local the way they sometimes do for C-sections and such, maybe it wouldn't cause so many problems? Speaking as someone who just had surgery while awake, it's just an option that springs to mind - and I wonder why it didn't occur to the doctor who is supposed to know the way anesthesia can affect dementia...

[emrlddragon.livejournal.com]

There is sadly, no right answer. And no one can tell you what to do. I think it comes down to quality of life. Even if this surgery extends his life, would it be a life worth living?

And, remember, that it isn't just about him, but you and your mother as well. Can you handle taking care of him in the condition he's likely to be in after the surgery?

I don't know if it will help, but Newsweek did a great article on this topic.

http://www.newsweek.com/id/215291

I hope everything works out for the best.

[vespurtine.livejournal.com]

I'm sorry to hear this. Decisions like this are never easy (in fact, a decision like this actually divided my family and they've never patched it up again) but I think the only thing you can do is try to consider what your grandfather wants, right?

In any case, good luck with it :(