There are moments when it is difficult to know when one day ends and another begins. That is how it feels regarding this last week.
Last Thursday, we were in the ENT Specialist office. He took CT Scans of my husband’s head and sinuses. He examined the mouth and he concluded that the origin of this massive infection was in the teeth rather than in the sinus. That is not to imply that the sinuses are not troublesome, they are. It appears that the teeth may have been the original problem….or conversely, the sinus, may have caused the dental decay.
It is the old question, “Which came first, the chicken or the egg?”. Things are so murky that we don’t know which came first, the infection of the teeth or the sinus infection that has infected and affected the teeth. The debate could be the basis for MRI’s, CT scans, ultrasound, on and on it goes….Regardless, he has a massive infection that has overpowered his immune system.To completely irradiate the infection, the teeth must be extracted and that is not a simple procedure.
Because of my husband’s history with pulmonary embolisms (blood clots in the lungs), he is on a blood thinner as a precautionary measure. Surgery on someone who has treatment to thin the blood makes any kind of surgery “tricky”. So, our family doctor must coordinate and manage the dosage until the PT/INR is at a “safe” level for surgery. At the same time, things must be managed to continue to prevent his body forming any clots…. This is a difficult situation. Bleeding or blood clots can present a life threatening scenario.
After seeing the oral surgeon, I withheld his Coumadin and a blood test was taken on Friday afternoon with a repeat blood drawal on Monday. Friday’s results showed that my husband above therapeutic level (exactly where he needs to be to prevent clots), but too high for surgery…
Today, as my husband got ready to go into the doctor’s office for the re check, he had a terrible incident of pain. In the past few days, the tumors seem to go into a massive spasm which causes him to double over with pain. He is horrific abdominal pain for a few minute. These minutes seem like eternity.
I immediately go into “nurse” mode and start pulling all the pain medication that I have for his pain and I potentate it as best I can. The bowel seems to “cramp” and the next few minutes do little to relieve the pain or the cramp. It takes 15 minutes at a minimum for him to begin to feel some sort of relief.
As he holds his stomach and cries out for Jesus to help him, my mind is working double time to make sure that I haven’t overlooked anything that may help him get through this situation. It is in these moments that I sense his fear. I know he fears that this can develop from an infrequent situation to a continuous.
My fear is that I cannot get the pain reduced and I will have to “fuss” with him to get him into the car and on into the hospital. He is so adamant that he does not want to go into the hospital, now. It seems that I have to wait until the pain gets severe enough to overcome his resistance. Those few minutes seem to stretch on forever and I am without recourse until the pain wins.
It was clear that he wasn’t going to be able to go into the doctor’s office to get his blood draw, so I called the family doctor and explained what was happening and that we would be in there for the blood draw. It is very important to get a PT/INR because my husband is tenatively scheduled for extraction of all of his upper teeth.
Before you think that it is too many teeth to take out at one time, I should explain that my husband only has 8 teeth on the top and 14 teeth on the bottom. He has inhereted his mother’s propensity toward lousy teeth. His mother lost all of her teeth in her twenties. My husband lost the majority of his teeth in his early 30’s. I suspose he is fortunate to have this many teeth left.
Now, the next question will be how to pay for an upper plate. Teeth and dentures are not covered under Medicare. The majority of this episode is directly out of pocket. The problem is that there is a hole the size of the Grand Canyon in both pockets…we have no money for this expense.
This situation reminds me of my mother and her final days of cancer. My mother had multiple melonma. (I doubt that I spelled this correctly). Her kind of cancer was of the platlet cell and she was in the terminal stage when she was diagnosed. A month before she passed away, her forearm broke and the doctors and my father were debating as to whether her arm should be set and placed in a cast. At that time, the major consenses was to do nothing because she was failing fast and it was doubtful that it would “knit” back to gether.
Needless to say, I wasn’t happy with my dad for allowing the doctors to talk him into not setting this broken arm. I explained to my father that ends of broken bones will touch each other which set up terrible bone pain. I was very upset that the attitude was to leave her in pain because it would be a waste of time and material because of the cancer.
This attitude was prevelant at the time with cancer patients. If they were not going to live past a few months, save the money and let things ride. I told my dad to put himself in Mom’s shoes and see how he would like this kind of neglect and state of pain. I asked him how he would like being discriminated and treatment withheld because he was a cancer patient….My mother’s arm was set with in the next 24 hours.
In my husband’s case, no one said anything about not working on his teeth and not buying dentures because he has terminal cancer, but I know that it crossed their minds because it crossed my mind. I was prepared to fight all of them if anyone hinted that this was a lost cause and he didn’t need dental care…
Besides, this situation maybe indirectly tied to the cancer metastaticly. It doesn’t matter to me if he has a week to live or a month or another year. No one needs to suffer with infected and abcessed teeth that causes pain.
On Friday, the oral surgeon called to find out the results of the PT/INR. I suggested that we tentatively set the oral surgery for Tuesday. That way, we will not have to do and “on call” situation where the surgeon’s office calls and we have a few hours to get up there. That is just too hard on anyone, not to mention someone who never knows what the morning or evening will bring…
So, he is set for oral surgery tomorrow afternoon. He was unable to go in for the PT/INR today because of the pain situation, however, we have over 8 hours before surgery that can accomidate obtaining this blood work….then we had another complication today (Monday afternoon).
As I was hanging up the phone from leaving the message that we would be in Tuesday morning for the PT/INR, my husband was holding his chest. He looked pale and his respirations were not right. He told me that he was experiencing all of the symptoms of having a blood clot in his chest. He had pain, breathing changes, he was eating “Tums” like they were candy.
Of course, I said that we had to go to the hospital now if he believed that he was having a PE (pulmonary embolis). Much to my frustration, he refused to go. He said that he only told me because he knew that I would be upset if he didn’t tell me about it.
Absolutely, I would be upset, but how much more frustration can I endure if he refuses to go to the hospital…..He told me that he needed something to calm him down and he wanted his anti-anxiety medication.
At this time, I thought that I was the one who needed that medication more than he did, but I did as he asked. He is so determind to not go to the hospital. I had visions of him standing in the doorway one minute and the next minute, he is hitting the floor with a sickening thud. He can be such a mule.
Then, I rethought this situation. Would I rather die quickly from a pulmonary embolisim or from the cancer that is causing me this kind of pain in the “gut”. What would I want?
I made an “executive decision”. (That is a left over term from when I was president of the family’s small company). I gave him his anti anxiety medication and double the dosage of the blood thinner. If he can’t get his teeth pulled because of this PT/INR, we just wait a few more days while he is on his high powered antibiotic, regroup our thinking about this turn of events and procede as the doctor’s advises.
That is a “rouge” decision, but it is the only option that I could think of should he be throwing a clot.There is little that I can do if he is refusing to go to the doctor’s office or the hospital. I also gave him pain medication for his “break through” pain. I knew that he was heading to sleep from all of the medication that I administered. I would re evaluate the situation when he woke up….
I asked him if he was alright with me going out to mow the grass. It was clear that he didn’t want me to hover over him like a hawk. I knew that I would come in and check on him frequently and I would take this situation from that point, but I was not about to argue with him and cause a high blood pressure situation that could aggrevate the possible blood clot in the lung.
So, that is what I did. I mowed grass with a push mower. I reasoned that physical activity would work off my anxiety and I would not have to sit on pins and needles as I watched his breathing or waiting for him to get over his stuborn spell.
I trimmed around all of the obsticles that the yard offers and then some. I needed to work to get my mind off of his potential death from his refusal of medical care. An hour later, he had no further complaint about chest pain or abdominal pain. He was sleepy.
After pushing that mower, I cam in the house. I noticed that I could hear my heart beat in my ears and I decided that my blood pressure, in all probability, was elevated. I remembered my B/P medication so I took my meds and I laid down on the couch in hopes that my B/P would decline. In the next few minutes, he was asleep and before I knew it, so was I.
We slept from 3 PM to around 7 PM. When I got up, I noticed that my husband was making coffee. I didn’t think that it was unusual. I thought that I could use some coffee. There are times where I make coffee in the late afternoon or early evening. I didn’t think anything was wrong until my husband asked me about the time we would need to leave to get to the family doctor’s office for the PT/INR. I answered that we would need to leave about 8 AM tomorrow morning.
My husband got a paniced look on his face and he said that we were already late and I needed to call the oral surgeon that we would not be able to get to his office on time. After a few seconds, I realized that he was confused.
He thought that it was 8 AM, day of surgery. He believed that we had slept all night and it was the morning of the surgery…I looked at him to try an evaluate as to whether he had a slight stroke. I didn’t see any drawing of his mouth. His speech was slow, but I attributed that just waking up after taking the pain medication. I asked him to squeeze my hands so as to evaluate any neurological weaknesses. I began asking him things that required short term and long term memory…
Everything was alright except for the loss of time and his believing that we were late for the oral surgeons.Then he spoke out what I was thinking…”it is the medicine, isn’t it? It is the pain medication. It does this…doesn’t it?
I suspect that it is, but I also know that he has done this long before he had cancer. I reassured him that he was resting very deeply and things like this can happen outside of medication. That is a true statement, but I also know that, in his situation, it is more likely to be the medication.
He finally settled down. I asked about the pain in his abdomin and in his chest. He stated that both pain areas were below a 5 on a pain scale. I couldn’t help but think, “Mission accomplished. Out of pain and no trouble in the respitory department. Color is better, skin is not as cold and clammy. He is appearing improved. I was both relieved and frustrated. Now, he will never consent to go into the hospital tonight or any night when he is able to “beat” this kind of situation….
We were lucky, this time. But, for now, and for the expanse of time that he is on this powerful pain medication, days will run into night and night into day…he will continue to have to be oriented to day and time and possibly place.
I don’t mind orienting him to place and time when I know that he can grasp the correction. I am not looking forward to the day when I tell him the time and place and he argues with me…I suppose, I need to begin taking the local newspaper. That is the only thing that will give the correct date…
He will have to figure out that the night ran into day or the day ran into night. Either way, we didn’t oversleep and miss our appointments…it is at the oddest times that scripture comes to me. “As long as it is called ‘Today’….” it is the day of salvation…
As long as it is called today, the pain medication failed to steal a day from him or from me. We are greatful for the small things. We are greatful for even the smallest things, like knowing the actual date and time. As long as it is called “Today”. We will not worry that we missed anything important.