kitchen table math, the sequel: "The Joy of X"

Wednesday, March 3, 2010

"The Joy of X"


Speaking of joy, I finally got back to my ALEKS geometry course,* which I abandoned last August after my mother fell.

My mother is continuing to improve, by the way. Which means the four death talks -- four -- that various doctors initiated with me and my siblings were premature.

Actually, the four death talks appear to have been not only premature but wrong in every respect. Take, for instance, the observation, made by my mom's intensivist in ICU, that: "Your mother has tiny little lungs and an enormously enlarged heart. Her only hope of survival would be a heart-lung transplant."

That appears to be codswallop, according to my mom's new cardiologist. "Heart function is good." "Heart muscle is strong." "Ejection fraction is normal." "Pulmonary hypertension has resolved." And so on.

Also, the diagnosis of congestive heart failure: wrong, it seems. My mom tells me she was given a brochure on congestive heart failure sometime after her heart attack 5 years ago, which informed her that a person in her situation had 5 years to live, max. Also wrong. Unless, of course, she doesn't have congestive heart failure (confusion reigns amongst us family members), in which case the brochure is possibly right but irrelevant.

Meanwhile, the physicians associated with the nursing home where my mom is recuperating have been operating under the assumption that my mother's diagnosis is congestive heart failure so they are now trying to nail that down. Congestive heart failure: yes or no? That is the question. The nephrologist (my mother does have kidney failure; of that we are sure) says she is going to read the entire history.

oh, man

My life goal: vegan my way to a healthy old age and die in my sleep. By then I will have spent a good 30 years dealing with the public schools; I don't want to spend the last 20 wrangling with hospital intensivists and hospice-touting PCPs. Noooooooooo.

That said, I will also point out that modern medicine is a miracle. Wow. My mom is alive and recovering because emergency rooms do what they do and dialysis machines & nephrologists do what they do and a good nursing home does what it does - because they all do what they do. Modern medicine keeps desperately sick and dying people alive and then some.

true story: in February I flew back to Chicago and went with my mom to an appointment with her new cardiologist. We're sitting together in his tiny office, my mother is back from the grave and getting around by wheelchair and medi-van...... and the doctor tells her to "lose weight and exercise." In 6 months we have gone from "tiny little lungs and an enormously enlarged heart" to "lose weight and exercise."

Alright, then!

Seriously, though, I don't know what to make of our experience thus far, and I have made a conscious decision not to delve into the literature on US medicine. (Also banned: the literature on US food industry.) I've read just enough to see that some of the institutional problems besetting health care are similar to institutional problems besetting public education, and that is helpful and intellectually stimulating to know. But that's enough. If I start finding out what goes on in your basic American hospital, my head will explode. Ditto for factory farming and the USDA.

The one tentative conclusion I hold at the moment: doctors aren't particularly expert at making predictions about an individual patient's immediate future. That's fine with me. I want doctors to save my mother's life, not ship her off to hospice because things look bad. And save her life is what they did.

My advice, which I realize is not original but bears repeating: when you're dealing with major medical, keep your wits about you and take things with a grain of salt.

And: if different doctors are telling you different things, pay attention to that fact. In our case, we were getting so much bad news about our mother, doctors were so insistent the jig was up, that we discounted the observations of doctors who weren't telling us that death was imminent. Not long after the intensivist told us my mom's only hope was a heart-lung transplant, another doctor told us, "She's doing well. This is what we do in ICU. We support a patient's organs and bodily systems while the patient recovers to the point that they can function on their own."

Hearing this, my sister and I thought, in so many words: this guy is nuts.

Then, during my mom's third hospitalization, when I received two hospice-promoting telephone calls from two of her PCPs, the hospital cardiologist told my sister that my mom's heart was strong and we weren't anywhere near hospice decisions. The nurse said the same thing. Another glaring contradiction.

That go-round we reached the reductio ad absurdum of having the hospital social worker apparently develop a suspicion that we children were trying to usher our mother out the door, seeing as how we kept bringing up hospice. The social worker actually interviewed my mother on the subject. What is your relationship with your children, she asked.


Next time, Ms. Hospital Social Worker, try asking: What is your relationship with your PCP and why does he keep calling your kids up long-distance to bend their ear about how their mother can have a "peaceful, quiet death" if they talk her into going to hospice sooner rather than later?

My other provisional conclusion: more specialists. Fewer PCPs. (Just kidding.)

In any event, my siblings and I needed to attend to the fact that we were getting wildly different opinions from different physicians, and we needed to find out why that was happening and insist that everyone get on the same page if possible. Instead, we assumed the worst and we grieved. Grieving before the fact clouds your reasoning. I don't think there's any way not to grieve before the fact, but from now on I am going to know that's what I'm doing and try to reason my way around it.

But back to ALEKS. I've got 3 more topics to master, then I return to Algebra 1, which I was working on before I decided to sign up for geometry last June because I was forcing C. to sign up for geometry. During the 9 months I've been away, ALEKS Algebra 1 seems to have grown from 288 topics to 333. Oy. When I switched to Geometry last June, ALEKS erased my Algebra 1 records, but my screen grab says I had mastered 270 topics.

Will I ever get to calculus?

* Now I just have to get back to Fluenz Spanish and life will be good.


Anonymous said...

"My life goal: vegan my way to a healthy old age and die in my sleep."

There is an old joke about this. It goes something like, "When I die, I want to die like Grandpa -- peacefully in my sleep. Not screaming in terror like the other people in the car."

-Mark Roulo

Anonymous said...

I did ALEKS Algebra I and Geometry. For some reason, the geometry took half the time of the Algebra I. It didn't seem to test as often.

Catherine Johnson said...

Mark - I LOVE IT!!!!!!!

Love it, love it, love it.

Anonymous said...

Catherine, your experience with your Mom and her (disagreeing) physicians is not unusual. And you can easily find cases that turned out the other way (i.e. the family tended to believe the optimists among the specialists, then the patient died anyway). If we want high tech medicine, it's going to work out that way a fair amount of the time.

Catherine Johnson said...

Is it common for physicians not to know they are disagreeing? That's what happened here.

I've never heard of a situation in which PCPs are actively lobbying family members to **persuade** a fully conscious, with-it sick person to refuse rescue care (ER care) and die on purpose - while a hospital cardiologist is saying things like, "Her heart function is good."

That seems awfully extreme to me.

(By the time we got to the point where a hospital cardiologist was saying 'heart function is strong' we were backing away - far away - from all the hospice lobbying. But by then the damage had been done....we were operating under the assumption that our mother was supposed to die ANY DAY. That affects decision making.)

Catherine Johnson said...

Evanston Hospital has what seems to me a terrific 'team approach' to taking care of ER patients (maybe all patients).

Now that was great. The team would debate back and forth about what to do and what the most critical problem was: was it her pelvis? was it her heart? was it her kidney? etc. She was absolutely on the brink of death for weeks, and they were constantly trying to figure out what to do NOW - and how to keep what they were doing NOW from killing her off via the side effects of what they were doing NOW.

Treating any one of my mom's gazillion critical issues tended to get in the way of treating the others & nobody could **really** figure out what the number one priority was. was a case of doctors not exactly disagreeing but simply not knowing & hashing it out.

With all the hospice and tiny-lung talk, it was a case of individual doctors actively pushing us to persuade my mom to die. I'm not kidding about that. At one point I finally said to one of the PCPs, "but my mother doesn't want to go to hospice." Which was true. I assume that's why he was talking to me instead of to her. (I don't have durable power of attorney, either, fyi. My brother does.)

The hospice talk, by the way, did not come from cardiologists and nephrologists.

Another interesting aspect of the whole thing: the specialists didn't believe my mom had a broken pelvis. We went back and forth and back and forth on that. One day: broken pelvis. The next day: she doesn't have a broken pelvis. Next day: broken pelvis. It got to be a running gag. (Seriously.)

Finally my mom's PCP ordered a horrible test that, in retrospect, I wouldn't have allowed anyone to do; it was grueling. But it DID establish the fact that her primary care physician was right: she had a broken pelvis.

Afterwards, he said, "Sometimes the PCP is right."

Anonymous said...

I've found a kind of contempt for the elderly in hospitals--let 'em die 'cuz they're going to anyway. Well, so is everyone else! They haven't had their life because the doctors think they're plenty old and should shuffle off to make room for someone else or whatever.

I'm never going to let my parents sign a DNR. NEVER. It's like signing a "yeah, he's life's over, we don't really care" certificate. I've seen it in person. Blech.

I hope my parents die in their wing of my house, in their sleep, at a ripe old age!

Anonymous said...


I know that Fluenz was designed with adults in mind, but I'm wondering how well you think it would work with a 10-12 year old?

We may not be able to start my child in Spanish in the 7th grade due to "Resource" eating one of the two electives and a strong desire on the part of this child to participate in band as the other elective.

This means that Spanish I would be delayed until 9th grade. Meanwhile, I'm thinking we could use a self-study Spanish course afterschool. I've only begun to research this and I'm not sure whether Fluenz, Rosetta Stone or MangoLanguages (available through the public library) or some other program would be best.

It needs to be something the kid can do alone, because neither parent speaks Spanish.

We may opt for a private Spanish tutor eventually, but I'd like to see how the kid can manage with software or an online learning system first.

Catherine Johnson said...

My mom has a DNR & it has worried all 4 of us, mainly because the reason she has it seems to be 'legal' instead of medical or emotional. (My mom says we four would have to go to court to take her of a respirator & she wants to spare us that.)

However, after one of the terrific intensivists at Evanston walked us through the whole thing, we felt better. He explained that, basically, patients in ICU don't just suddenly "crash," out of the blue.

Instead, it happens in slow motion. Things start to go wrong --- and the nurses & docs can ***see*** that things are going wrong. That triggers a 'rapid response' situation where they're drawing blood like crazy, getting 15-minute turnaround (or less?) from the lab, throwing everything they've got at the patient (pressor drugs, etc.)

By the time you get to the point where resuscitation would be done, the team has been trying to save the patient's life for perhaps 24 hours and nothing has worked. With an 80-year old (maybe with a patient of any age), it's unlikely the crash cart is going to do what all the other interventions did not.

Apparently DNRs were invented for young or young-ish people whose hearts have stopped due to shock - drowning, car crash - that kind of thing.

We saw what he was talking about in the hospital. My mom had a couple of days where she was clearly heading towards a crisis, or was in fact in a crisis (I didn't necessarily know this, btw.)

Of course, that doesn't change your point about whether the DNR order in and of itself makes people think they **also** don't need to come in with the fast testing & the pressor drugs, etc.

Where we were, in Evanston Hospital, there was **no** assumption that there should be slacking off 'cause of my mom's age. (She turned 80 in the hospital!)

Same thing at Highland Hospital. (The two calls I got in that case were from PCPs who hadn't even seen my mom --- it was so strange.)

Overall, it was a reassuring experience in terms of how old people are treated by doctors & hospitals, etc. Very reassuring: basically, a case of, "We're doctors & nurses. We save lives. End of story."

BUT it's not something I want to put my own kids through.

Catherine Johnson said...

Boy, I wouldn't go with Rosetta -- it's pure immersion & the one friend I have who tried it with her kids sent it back.

I don't know what to say about Fluenz. I like it myself, but I did take Spanish for years.

I tend to **think** a 7th grader could use it....but I don't have a lot to base that on.

It **is** direct instruction (small letters). So that's a big help.