Family news

Joy couldn't get my visa papers because she needed to bring a "power of attorney" paper. So we will get that tomorrow.

I probably could just go, since I have a permanent residency here, but that would mean airport hassles, to check my status.
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Joy's cousin's son is still in ICU after cardiac arrest from an arrhythmia. I thought it was sudden cardiac death from ventricular fibrillation syndrome, but apparently his heart is large, so maybe he had a viral diluted cardiomyopathy. His heart is now stable, but the brain damage is still there... and now he has been placed back on the respirator, running a fever (Sepsis? or maybe atelectasis). Not a good sign.

Sigh.

One of the reasons why docs shrug at that UK case about the baby on the ventilator that is making all the pro lifers hyperventilate: we see prolonged expensive care, and the result is a dead person anyway, or a person bedridden and with little cognitive function.

of course, the problem? in the young, the brain could recover a bit with time, so you hate to stop fighting.

and one does get the feeling that "cost" might be influencing the doctor's decision in the UK: Remember that terrorist dying of cancer who was denied treatment, and Ghadaffy got him home and the guy lived two years? Tony Blair was criticized for letting him go when he didn't die right away, but the reason was that the NIH had refused to treat his cancer. Dirty little secret about the British health system: QALY.

Catholic ethics don't allow euthanasia, but also don't insist on "extraordinary" treatment to keep someone alive.

So what is "extraordinary"? Depends on the time, place, age, and health of the person.

For example, amputating a limb was once considered "extraordinary" treatment, so refusing amputation, which would have left you unable to work, was ethical in the past.

Dialysis is still "extraordinary" here in the Philippines, as it was in the US until Medicare started to pay for it.

Ventilators are "extraordinary treatment". Period.

Feeding tubes were also "optional" until recently: John Paul II noted that there was a euthanasia scam to kill patients, where the tube removed deliberately to kill them when often they were not "comatose", just brain damaged... I say scam because the staff were forbidden to feed them when the tube was removed, even when the patient asked for water, so often the patients were given sedation to keep them quiet.

usually the pro euthanasia press calls these people "vegetables", but if they were actually in PVS, a tube would only keep them alive for 6 months according to studies: but the dirty little secret is that "PVS" is misdiagnosed in 30 percent of cases.

(When I worked with the mentally retarded, we had several of our patients diagnosed as PVS after a short visit with the consulting neurologist, when we knew that they could recognize and interact with staff. )

And some neurologists recommend "stopping treatment" (aka starving the person) even when they didn't come near the "PVS" diagnosis: We had an Ojibwa lady with frontal lobe syndrome, where the consultant didn't examine her but spent the hour trying to talk the family into stopping the feeding tube. When they left, the niece told him off: That's the difference between you white folks and we Indians: We care for our elders.

which explains why Lolo wanted to retire to the Philippines: They respect and care for elders here, (although the danger of overtreatment if you do go to the hospital is a lot less than in the lawsuit happy US).

On the other hand, too often the feeding tube is put in for "convenience" of the staff, so they don't have to bother to take time to feed an often uncooperative patient.

Bad or good? in many cases, the feeding tube might not prolong the life much, but at least you die fat and happy, without bedsores and other complications from malnutrition.

Some men just don't want the tube and say so. The original "Brophy" case was this: Everyone in town knew he said he never would want to be kept alive with a tube, so even the church backed his wife's court case to have it removed.

In contrast, the Schiavo case was pushed because the husband wanted to remarry so suddenly "remembered" she didn't want a tube to keep her alive: and what made it a euthanasia case was because the family were willing to nurse her in their home...

And of course, for terminal patients, IV's and feeding tubes are extraordinary treatment: Lolo didn't eat the last week of his life, but would take small amounts of fluids and medicine. He didn't want the hospital, so died in his bed, a choice that Barbara Bush just made.

Here in the Philippines, a lot of the poor can't even afford their high blood pressure or diabetes medicines, so it is quite common to see men limping with a foot drop from a stroke. Or they die of complications. Our new mayor has started a program to supply these to the poor, and also to pay for rabies shots and basic antibiotics for kids, but alas the program often runs out of medicine, so they come to our door for help to pay for this. (we are down the street from the clinic).

Back to Joy's cousin: the reason he didn't die was because his sister in law who was a nurse was there and started CPR, and the ambulance came quickly, and the hospital was a class A hospital in a large city. If it had happened here, he would have been DOA.

so if you believe in God, and that "everything" that happens has a reason, then you have to blame God not only for his cardiomyopathy but for the fact his sister in law was there to give CPR.

Sigh. The family has had several other health problems in the last year, and when I heard this, all I could think of was "Job".