This week at the hospital…

I had a young patient (in his early 60s), that was admitted for dehydration but was struggling with advanced Parkinson’s disease.  He didn’t fit the typical mold of late stage Parkinson’s; he seemed too young for this level of disease, yet here he was.  He also had dementia, an unfortunate complication of Parkinson’s.  His wife was so lovely, so let’s call her Lovely Wife. Lovely wife was a goddamn warrior; advocating for her husband, asking questions, ensuring that his wishes were followed, being present.  It was obvious that these two had had many difficult conversations (when he was still cognitively intact) to get to this place, where she felt completely comfortable executing his wishes.  The recommendation from the medical and physical therapy teams was for transfer to a rehab facility to get him stronger, decreasing his risk for falling at home.  Lovely wife felt pressured to send him to rehab, after all, that’s what the professionals were recommending…His Parkinson’s was so advanced, that he was barely able to walk without making everyone (except his wife) panic that he would fall.  Once we fixed the presenting problem (the dehydration), we had to make a choice about discharge.  Lovely Wife chose home.  Some might think this is a reckless decision (on the part of Lovely Wife), but I found it beautiful.  She knew her husband, she knew his wishes, and when he couldn’t voice them himself, she did. While the discharge coordinators encouraged a rehab transfer, she stayed strong, she could not be persuaded. She asked the team: transfer him for what? To sustain an invisible quality of life? For him to go there and be more confused and stressed?  She firmly responded: no, I don’t think so, no thank you. You see, these types of decisions are not black and white.  You can make a different choice; you can choose quality over quantity.  She chose to take him home, fall risk and all, to spend time with him on his own turf.  Sure, he may end up back in the hospital at some point, but for now the idea of transferring him to another facility where he would be further disoriented, felt cruel.  Just because it was recommended as the “safest” option for him, it didn’t mean that it was the best option for either of them. When I agreed with Lovely Wife that sending him home would actually be the best thing for him, she beamed.