As of last night, Dad is a patient at the GPU (Geropsychiatric Unit), at the same hospital he left only 10 days ago. The chain of events that led to this admission would take too long to explain, so to summarize: Dad has become increasingly aggressive, hitting and kicking the staff at R Center. At the same time there has been concern over possible blood in his catheter bag. Yesterday things came to a head when he hit the OT in the arm and kicked an aide in the chest and stomach. At the same time he was complaining of pain in his rear. The nurse called Dad's doc at Generations to explain the situation. Basically it is no longer safe for him to be cared for at R Center, at least not in his current state. However, they were quite concerned about his pain as well as the blood and clots in his catheter bag that were really obvious. With our permission he was sent back to the ED for tests, while his neurology doc arranged for him to be admitted to the GPU, where he is the attending MD. As luck would have it, there was a discharge yesterday so a bed was available, and Dad's transition from the ED to the unit was pretty seamless. Tests showed that he does indeed have an infection, but it will be a few days before the bacteria is identified.
All patients admitted to the GPU generally stay for a baseline of two weeks. It takes about that long to observe their condition and behavior. In Dad's case it will probably also take that long to make sure the infection is well and truly gone. We have no idea at this point whether the infection was the original one that never got cured, or a new one caused by contamination of the catheter. However, Mom can attest that he was in a lot of pain when they replaced the catheter. By the time I was able to go and see him, he was resting quite comfortably, probably due to the new antibiotics and pain meds he was given.
The nurse told us that during the next two weeks they are hoping to determine whether Dad's aggressive/violent behavior was due to the infection, or also from his progressing Alzheimer's. If the infection disappears but his behavior continues, we will have to discuss a new category of meds, anti-psychotic. Then he will have to stay for at least another two weeks, because that is generally how long it takes to know whether the meds are doing their job.
On the way home Mom talked about the catheter, and how much it must have hurt if all the bacteria were growing inside. Then she suddenly said, "Wait, this must mean he has the wear the catheter forever right??" and I said, "Yup." Which implies that an infection might recur, which means another sharp decline in behavior, another progression in dementia.
Anyone who has experience with infection and Dementia probably knows where this is headed. Have we now gotten on the merry-go-round of infection, aggression, treatment,decline, rinse and repeat? As I was thinking about Dad lying in his GPU bed, I suddenly asked myself, who wants to live like this? Who would want to live like this? Mom and Dad never talked about end of life issues like this, so we are merely guessing at what Dad would want us to do. But in the midst of this merry-g-round, I know that Dad is suffering pain whenever an infection comes on. And one thing we wanted to spare him was suffering of pain. If he were completely lucid, what would we want us to do?
This is where I really need to have an in depth conversation with Dad's neurology doc. He must have some idea of where the majority of cases like this end up going. And somehow Mom and our family has to get into the head space to act in Dad's best interests.
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