Test results

Mom called me this afternoon. She said that she had visited Dr. Kubac yesterday and (the exact way she put it was) "It's not good news." Yesterday's blood test showed that her potassium level is going up. Her last blood test was six weeks ago, and back then her potassium level was 1.6. Yesterday it was up to 1.9. This indicates that her kidneys are not functioning well. This is the delicate tight wire that she has been walking for quite a while: reduce the fluid in her body to assist with the congestive heart failure, but reduce the fluid level too far and it causes her kidneys to fail.

Dr. Kubach has always told her the straight truth, and this visit was no different. He is increasing her dosage of two drugs (metolazone and something else) and wants her to come back next Friday for a follow-up blood test. If her potassium level is still up, then he wants to put her in the hospital for three days of some intravenous drug. If that intravenous regimen doesn't succeed in bringing the potassium level back down, then basically there is nothing more that can be done.

Mom reported this to me very matter-of-factly. She considers the 3-day hospital visit to be an experiment, and if it doesn't work, then she wants to come back home to Rocky Point to spend whatever time she has left at home. She made it very clear to Dr. Kubac that this is what she wants and she will not allow any more than the 3 days in the hospital.

Bill had come down to Rocky Point yesterday to spend the weekend with her, and he called me this afternoon out of earshot of mom. He had asked her if her fatigue was worse than it was two weeks ago when he was there. She said that it definitely is worse and that she knows she is declining.

Bill is going to go back down to Rocky Point next Thursday afternoon so he can take her into town for her follow-up blood test next Friday. The result of that test will determine whether she goes immediately into the hospital for the 3-day "experiment."

Meanwhile, I have been investigating hospice care. Apparently if her primary care physician certifies that she has a terminal condition that cannot be "cured" (i.e., the congestive heart failure and associated kidney failure) AND that her prognosis is 6 months or less, then she is eligible. The goal of hospice is NOT to cure the condition, but to manage it for her comfort. They would provide an RN to come out to Rocky Point once a week, plus home health aides who would come up to 3 times a week to assist with daily care. They also provide any necessary medical equipment, such as bath chair, hospital bed, walker, etc. If she outlives the 6-month prognosis, they extend it for another 6 months and so on indefinitely. I discussed this with mom in our phone call this afternoon and she likes the idea, but she wants to wait till next Friday to see how the blood test goes. However, I said that regardless of what the blood test shows, hospice care would be a good option because they will assist her no matter what. So the plan is that I will wait till next Friday and then contact her primary care doc (Dr. Kim) to discuss this.

Mom, Jack, Bill, and I are all in agreement that the end of this life is not "The End," and that it is just a transition, a shedding of an old worn-out shell so the spirit can go on to the other side. All of us consider this to be a good and natural thing, and mom is definitely approaching her transition with equanimity. She has made it very clear that she does not want any extraordinary measures to delay her transition, and she does not want to spend her last days in the hospital. Many of mom's dear friends feel that she should be in a safer environment with more medical care, but mom has told us very emphatically that this is NOT want she wants, and we will honor her wishes if we are able to.