A few weeks ago my dad landed in the hospital.
Mom drove him to the emergency room because his blood pressure was fluctuating wildly. To be accurate, this blood pressure condition has been going on for some time now. A year ago it was this same condition that took my father from hospital to rehab to in-home medical care.
All that care, but no cure. My father’s blood pressure fluctuations will not change; they’re a side effect of his worsening Parkinson’s.
This time, after three nights in the hospital, the discharge planner came to talk to my mom and dad. Her “plan” was to place my dad in rehab, so that the medical staff there could monitor his blood pressure.
When we asked how long, she replied, “A week to 10 days.”
My mom, dad, sisters and I wondered what monitoring would do if there was no treatment or cure.
On the last go-round my dad hated rehab. To be fair, it was a good place with a caring staff, but it wasn’t home. It didn’t include my mother’s cooking or her gentle touch in bathing or her speed in rushing my father to the bathroom, preventing an accident.
Previously, after a few days of rehab, we begged the staff to let us take my father home. We were all certain it was the best solution. With some reluctance, they agreed.
Eventually, my father’s strength and abilities got better, and soon in-home care was discontinued.
This time, in the midst of his hospital stay, my father’s discharge planner was adamant in her recommendation for rehab in spite of agreeing that my dad’s condition would not improve.
This time I called my friend Viki Kind, a clinical bioethicist. She provided me with a lightbulb moment. Viki said, “It’s important to realize that everyone in the hospital has a role, and the discharge planner’s role is to ensure you dad is safe upon discharge.”
I got it; the discharge planner felt sending my dad to rehab would be a safer option than sending him home with my mother. But if that was the case, my dad would never be discharged from rehab because his condition is not going to change, and he would always be “safer” in rehab.
As part of my role on the Ventura County Coalition for Compassionate Care, I’ve been working with Laura Zempel, the palliative care nurse at Los Robles Hospital, a remarkable woman who advocates for enhancing the quality of life for patients with a serious illness.
It dawned on me that there had to be a palliative care specialist at the hospital where my father was a patient. So we asked if we could have a palliative-care consult.
The consult was a turning point for all of us. After asking a series of questions and assessing my father’ s condition, the palliative care doctor asked why we called for a consult.
We explained that while we understand the discharge planner is doing her job, my father does not want to go to rehab since it would not help his condition, and he would prefer to be at home.
“Is that a crazy thing to want to do?” we asked.
The doctor told us our wishes were perfectly reasonable and in my father’s particular case made the most sense. We were overjoyed.
The next day my father was discharged with orders for inhome medical and palliative care.
What is amazing to me is that during the progression of my father’s disease no one had ever mentioned palliative care— ever. No one in the hospital and neither my father’s general physician nor his neurologist, all of whom know that my dad is nearing the end of his journey with Parkinson’s.
As my father was waking up from a nap the day he came home, my mother asked him if he knew where he was. My dad kissed my mother’s hand, flashed a smile that lit up the room and said, “Home.”