I can't breathe, but I'll be fine

[I wrote this on July 13, 2015, but never posted it then. I was waiting for the other shoe to drop. But instead, Dad miraculously left death’s embrace. For two and a half more years. The last paragraph still applies.]

My father is almost 88 years old, he's had Alzheimer's disease for several years, and now he has pneumonia, the old man's friend.

He had barely moved into the memory care unit, where he would have a closer knit community to watch over him. When I came to find him on Sunday to take him out to lunch, he was sunk deeply into a low-slung soft couch in a very deep sleep. Not unexpectedly, he was hard to arouse, and even harder to bring to his feet. He seemed barely able to command his body to walk. He even seemed short of breath walking his tiny little steps. After some investigation, it became apparent that he has pneumonia and his oxygen level drops low when he walks.

His facial expression was saying "I can't breathe" but his meager complaint was "oh", [step], "oh", [step], "oh", [step] with each breath, with each step. He just wanted to pause a moment, as if to say, "if you let me rest a moment, I'll be fine".

Our life together the past four years has been going out to lunch, having a ride in my car, and going to the park to see little children to smile and chat with. We both got a lot of pleasure out of those weekend visits.

Yesterday though, I spent a lot more time witnessing his daily activity of walking and eating and finding the chair and finding the bed. All of those are pretty difficult now. Despite the difficulty, it was pretty easy to admire him. His complaints of discomfort were almost imperceptible. If we managed to get him to look up at us, a smile always came to his face.

His suffering is plain to see though, in this final illness. We always knew a day like this would come. We didn't know it would be now. My brother and sister, my wife, and other close relatives are rallying to support dad. In a few days I'm sure my work community will pick up the slack when I'm gone for a few days. Our neighbors will offer to help. People will offer their condolences. People will smile and recollect their stories of my father, appreciating who he was and what he did for them. We will all come together to smile softly and whisper one last goodbye.

I'll scratch your back. Period.

That's the kind of man my father was. I remember him frequently scratching my back when I was a young boy and even later in life. What a pleasure for me! He was not expecting anything in return. None of this "if you scratch my back, I'll scratch yours".

He was always willing to serve others. When he was living at The Bluffs, our community nursing home, he was usually cooperative. On the rare occasions he tried to do something inadvisable (like elope, or intrude unwelcome into someone else's room), the staff knew how to redirect him. 

"Bill, would you help me out?" And he would follow. Service to others.

---

Somehow, he did it again.

My mother-in-law died February 5. We're planning her memorial service for March 10. Our son, Stuart, will be flying in from Hong Kong and another son, Mark, from New York to attend. 

Dad displayed perfect timing. With the scattered tribe gathering, this gentle warrior left to join the ancestors. 

Sitting at his bedside after he died, I placed my hand on his chest to feel him once again. To remember him. Moving my hand, I remembered all the times he had scratched my back, and later in life how I had scratched his. A pleasure for both of us. One way I could express love after language had failed, or when language was never really needed. Nothing expected in return. 

Dad, I'll scratch your back, one more time. Period.

The culture of "yeah yeah yeah"

As my father continues his slow descent into Alzheimer's dementia, some features of the disease strike me as blessings. We go out for lunch and a drive most weekends. He's gradually less able to express himself. However he commonly repeats this soft mantra: "yeah, … yeah, … yeah".

I recognize that repetition as a symptom of the dementia, and it's called "perseveration". I used to make rounds at the nursing homes myself in my younger days. I would often hear patients down the hallway crying out "Help! Help! Help!" Or "No, no, no!" My dad is saying just the opposite. 
 
He is exhibiting the "culture of YES" (a "culture-change" effort at my organization). He always had a positive attitude toward life, and this is his way of expressing it despite the limits of language.

I'm retiring from patient care Sep 1, 2016

I'm retiring from patient care Sep 1, 2016

It's no secret. 
I'm turning 65 on September 2, and plan to retire from patient care then. I'll work 75% time in my geek role at the University of Missouri, improving the usability of the software physicians use so they can spend more time with you and less time with the computer in the room. 

It’s been a true pleasure and a great honor serving so many of you over the past 34 years here in Columbia. I’ll miss the relationships, but I’ll savor the memories. I’m confident we’re training the next generation of healers well here at the University of Missouri.

What should you do if you are a patient of mine?

Since last September, I've been helping each patient I see pick their next primary care physician (PCP), finding a good match for their particular needs. 

What if you have not seen me in the past year?

We’ll send you a letter identifying your new family physician. You’ll have the freedom to make an alternative choice if you prefer. The letters go out in August. The computer listing the identity of your new PCP gets changed September 1.

What should you do if you can’t get an appointment before I retire?

That could happen as September gets closer and the openings get fewer. If you have a need and can’t get an appointment, you can call and leave a message at 573-884-7733, or send a secure message in the online portal, MU Healthe. We’ll find a way to meet your needs, whether it’s simple advice or recommending a visit with a trusted colleague of mine.

What if you want to change your PCP listing now (rather than waiting)?


You really don’t need to do that. I'm still your doctor until I'm gone (that sounds so final – almost fatal). Your new physician at University Physicians Family Medicine has immediate access to your medical records. All my notes about you since I started working there in 2007 are readily available. 

Do you need to contact your health insurance to let them know of your new PCP?

Mostly no. 
Only if you are leaving our Family Medicine University Physicians group of practices do you need to do that. For instance, if you decide to see one of the doctors who admit to Boone Hospital Center, then you should contact your health insurance company to make that primary care physician change as of September 1, 2016. 

Should you request a medical records be sent to your new physician?

No. I suggest you simply see your new physician first. 
Then together you’ll discover what information, if any, is needed from your medical record. In many cases, only immunization dates and medication lists are needed. In complex situations, your physician will help select the specific details that they need. My most recent note is likely to have 90% or more of the necessary information your new physician will need. 

Please DO NOT request “Send all records”. That's information overload for your new doctor. The needle gets lost in the haystack. 

Best wishes with your new physician. I am looking forward to taking Friday's off.