The Devil in the Detail

In preparation for Neil’s return home from the hospital, we had rented a hospital bed and positioned it to face a freshly-cut Christmas tree. We had to establish new home routines, since Neil was now bedridden. We had converted the rest of the dining room into a private hospital ward. We stocked the dining room shelves with towels and hospital supplies and stowed bulkier items under the bed – a carton of feeding formula, disposable bed pads, a package of Depends and a giant bag of mouth swabs.

Dr. B. had given us a plan for gradually resuming Neil’s therapy infusions, and there was a tangle of tubes and bags to organize and manage. Dean set up a pole behind the bed for hanging ANP bags and the Liquid Hope feeding formula bag, along with their associated tubing and pumps. Liquid Hope is not a product provided by hospitals. It is a special formula made with real whole food ingredients. Unlike standard hospital formula, it is a plant-based organic product, that is corn-free, soy-free and GMO-free. Before ordering it from the manufacturer ourselves, we had to demonstrate to the hospital nutritionist that it was nutritionally complete and met their dietary guidelines.

Syringes, spring water, a suction pump and hand sanitizer sat on the table next to Neil’s bed. In between ANP cycles and Liquid Hope meals, we used a syringe to provide Neil with water through the percutaneous endoscopic gastrostomy (PEG), a flexible feeding tube that had been surgically placed into Neil’s stomach before we left the hospital. We ground up his pills and dissolved them in small amounts of water, which we pulled into the syringe, measuring and delivering the fluids through the PEG. We used the suction device, with its tube and attachments, to keep Neil’s throat clear of phlegm. It was a noisy machine, yet it worked as needed. Dean handled suctioning during the day. Evie and I took turns during the night, while sleeping vigil on a living room couch.

Maintaining the proper amount of water was a challenging trial and error process. Since Neil was no longer able to self-regulate his water intake, we had to try our best to regulate it for him. In mid-December Neil was again at Death’s doorstep, because his potassium had dipped dangerously low and his sodium had risen alarmingly high. As we were updosing the ANPs, the blood test results that informed us of this were delayed, delivered over three days after the blood had been drawn. We relied on a phlebotomist to perform daily home draws and next day results to properly monitor Neil’s blood levels.

Dr. Burzynski provided us with a prescription for a liquid potassium supplement. The only liquid potassium supplements available at the pharmacy were formulated with added sweeteners and colored orange with chemical dyes, ingredients known to promote cancer. This product was the only option available.

We kept detailed records of all the fluid going in – ANP infusions, Liquid Hope, potassium and water – and all the fluid going out. An indwelling Foley catheter steadily filled the urine bag hanging off the end of the bed frame and every time we emptied the bag we recorded the amount. We also tracked vital information with a pulse oximeter, a device that clips onto the finger and monitors blood oxygen saturation and pulse.

The visiting nurse in charge of Neil’s case, Gail from South County Hospital Health, was a dear friend dedicated to his care. Neil had grown up playing soccer with Gail’s son, Trey. Gail coordinated a wonderful team of home care specialists for Neil. Erin, the physical therapist had been helping Neil with balance and strength since September. Now she focused on maintaining the range of motion and circulation in his legs, and she showed me how to massage his feet and legs and manually rotate the joints of his ankles, knees and hips. Donna, Neil’s occupational therapist, had been helping with hand and arm coordination. Julia, a speech therapist, helped troubleshoot swallowing issues. Pam, the home health aide, came three days a week to spend an hour assisting Gail or us with Neil’s personal hygiene and bed sheet changes. And Jaymi, the alternate nurse filled in when Gail was unavailable.

Transporting Neil to MGH for neurological assessments was far too complicated, so we recruited a close friend, Dr. Achina Stein, DO, DFAPA, ABIHM, IFMCP, and her associate Sally Davidson, RN, MS, ANP-BC, IFMCP onto the team, as alternate sub-investigators. They graciously agreed to doing house calls and neurological assessments. Urologist Drew Tompkins was another valuable member of home care our team. We were truly blessed with the best home care support one could expect given the circumstances. This compassionate team of nurses, practitioners, aides and doctors took us under their wings and taught us an unbelievable amount in a relatively short span of time.

When not coordinating practitioner visits, I was moving constantly back and forth between the kitchen and the dining room – checking on Neil, monitoring apparatus and managing water, food, supplements and medicine. Moving in a clumsy hurry one day, I managed to pinch my left thumb as the door swung shut. The bruise that grew from the base of the thumbnail took the shape of a tiny wrench squeezing a tiny heart and producing a teeny drop of blood. My body seemed to be expressing outwardly the heart-wrenching feeling I was suppressing deep down within.

Neil could no longer walk nor dance nor sing nor talk. He could no longer eat nor drink nor grin nor laugh out loud. Yet, his heart was strong, his mind was sharp, and his eyes could speak. He was entirely present, he still had his sense of humor, and together we all called upon the Jester’s positive spirit to lift us up through the holiday season:

Whenever I feel like crying,

I smile hard instead!

I turn my smile upside down

and stand it on its head!

The rhyme is from The Jester Has Lost His Jingle, an uplifting children’s book by David Saltzman. Purchases support the Jester & Pharley Phund, which donates copies of the book and jester dolls to hospitalized children. The imaginary jester was Neil’s constant companion.

This post is an excerpt from Neil’s DIPG story, a work-in-progress. To put this chapter into context, this all happened in December 2016. Indomitable in spirit, Neil had survived six months beyond his three-month prognosis. I write this to raise awareness about the realities of pediatric brain cancer and to share what went on behind our family’s doors. While these words describe our experience at this stage in the progression of this disease, another family’s telling will differ greatly. I am interested in those stories, because they may hold valuable gems of information. The telling is always hard, and the memories difficult to revisit. For me, the writing process is strangely therapeutic, bringing with it a release of emotions.

I welcome editorial comments and reader reactions to this draft.

Evie hanging out with Neil

5 thoughts on “The Devil in the Detail

  1. Wow. I am sitting here with tears streaming down my face as I smile with my own memories. I am a nurse’s aide and for 7 out of the 15 years I’ve been in this job, I did home health and 2 years where I was one of 3 specially trained Palliative Care Community aides in my area. We traveled extensively and we saw only at-home patients who were on the Palliative program. Your description of your daily life at home (including the dining room set up!) brings it all back to me as it’s identical in so many ways; unique in that your family’s journey has it’s own silver linings and pain, the “before” memories of your beloved Neil, and your own ways of living and learning and loving as you go. My heart aches because I know all too well the heart-wrenching measures you and your family take to keep Neil as comfortable as possible. What a blessing it is to know you had such an amazing team!
    My thoughts and love are with you all. Thank you for sharing. xo

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      1. I think it’s much easier for us because the pain and empathy we feel for our clients is real, but it’s not the same as being family. Being a parent or sibling or child caring for their loved one who is terminal (although I did go through my mom’s ordeal with cancer and her own palliative care chapter in her short but storied life). God bless you and your family and your son. His short life was not in vain. And thank you for your kind words.

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  2. My initial, actual reaction was to peruse and then look away, peruse and then look away. The devil is in the details, demonstrated. Sometimes to look back is too painful but then life gets too painful without first looking back to remember. This is a much needed “walk through” that is not without pain but it is ultimately positive. I think this could be very helpful to people.

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    1. Jack’s #1 Angel, thank you for reading what may have been difficult to read. I tend to keep all my writing upbeat and positive, so I can send positive energy out to the world. This entry is a departure for me. I’m coming to realize that it’s okay to share the tough stuff, because it is about shedding light into the darkest corners. How can people develop solutions, if they are unable to see the problems clearly?

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