He Ain't Done with You Yet

Rabbit to Bear: I will always be by your side.

And the Principal Care Provider looked up at my husband from her computer and the mess of sheets from Gundersen Lutheran Hospital in front of her. She sighed and then asked how are you feeling?

"Like shit," he answered simply. Dr. Sauvery knows Rich well enough to know that means 'overall crappy in health and mood'.
"Depressed over this?" she asked.
"Well, of course."

She nodded. "That was a significant PE that you went through. Frankly I am surprised you are alive. Very few people survive what you went through so I guess you should feel lucky?" Dr. S is straightforward and she knows Rich wants to hear it that way.

"Lucky?" he asks with a glance at her and then the floor, "Lucky? Well I don't know about that. I may feel better if I was dead." His hand comes up shaking a bit from his enormous fatigue.
"To live like this? This is not being alive."

She nods, "Yep, your are right, but you survived and you need rest and you WILL feel better."
She does and exam as she talks. "You are amazing, all of these things you've been through would have,"...she shrugs, "you must have amazing genetics and you must be here for a very good reason."

Rich looks tired and worn out. So Dr. S sits next to him and puts her hand gently on his arm.

"You go home and rest, follow your meds. YOU let Christmas come to you and New Years also. You set in that easy chair and tell the kids that Grandpa is tired and needs his rest. You enjoy those kids. You enjoy them seeing you. Have family make visits but be short. This is winter and the weather is yucky, you don't have to go out and do stuff outside..."

This was the longest 'speech' Dr. S has ever made. Then when we stood to leave, she hugged Rich and then me. Her parting words were said quietly, and I don't believe they were meant for Rich to hear...or???

"Watch over him as you do. You are an Angel at his side."

We check out at the desk. Rich has known the receptionist there for many years. She asks, "Dang Rich you were in the hospital again! What happened?"
He responds, "Well I guess I am lucky to be here, most don't make it through the really bad blood clot thing I had I guess." He shrugs.
The place is quiet and the other receptionist steps over.
She has a very southern drawl.
"Sir, I think God put you on this Earth for a reason and ain't done with whatever He has intended for you."

We set up the follow up appointment, Rich comments quietly, "If I make it to spring."


I helped my exhausted sweet heart get into the Subaru and get settled. The sun was getting ready to set in a blaze of colorful glory. Rays of light blasted through holes in the clouds and went up into the sky while another set lit up the countryside.

Rich reclined in the seat and was silent for our drive home.

Rest.
See your family.
See your Grand children.

My mind went places it perhaps shouldn't have.
He had cheated death again. The Grim Reaper had knocked on the door a week ago on that frosty foggy morning.
Exactly how much more pain and discomfort could a person live with.

"Sir, God put you on this Earth for a reason and he ain't done with you yet."

I wonder. And I drive home in the quiet car and fight back all sorts of thoughts and emotions.
I reach over and lightly hold his hand while I can on the nice straight parts of the road.

We've had quite the journey together, I think.

The letter & Appointment

The letter regarding Rich's test results with Neuro-Psychological testing came today.
The letter diagnoses Rich with a major neurocognitive disorder called 'dementia'. The severity is considered mild at this time.

The letter goes on to list the main causes of his diagnosis. In some ways I am glad the list is there and in some ways I find it offensive. In one hand I knew that his health issues are all contributors to his 'Vascular Dementia' however having it printed out in black and white seem to be a shock.

Depression and PTSD are major contributing factors but cerebrovascular disease are the main causes. Yes, I knew that.
The facts are there.

I asked Rich if he wanted to read the letter. He waved a hand at me. "You read it, you can understand it."
So I read it.
The recommendations are fairly straight forward. Exercise, quit chewing tobacco [he is trying when he remembers], eating healthy [we mostly do], speech therapy, language therapy to help practice communication skills, and thinking skills.

Exercise. He preaches it to his mom. And when I ask him to do something physical -- he can't or is it he won't? I think it is *he cannot*. He says that he feels exhausted at all times. He says he can't, he can't do it. Over and over. If I push for him to do something physical he gets angry and goes to bed.
I get tired of pushing and asking him to help.


During the afternoons now, he watches Netflix and sits on the edge of the couch with the volume turned up nearly as high as it can get.
I can't go back and change his lifestyle that lead to this place we are at now. I can only try to deal with it one day at a time.

Yesterday we had an appointment with Neurosurgery. We were nearly late when we arrived at the VA so I hustled us to the floor where we'd seen Neurology last year only to find out we were in the wrong place. Again, we rushed down to clinic B.

After the vitals were taken [his blood pressure was high] we were ushered into an exam room.
The doctor sat down and I innocently asked why we saw him in this clinic rather than the clinic upstairs.
He very pointedly told me that HE was Neurosurgery [emphasis on surgery]. Upstairs was Neurology, they were vastly different.

I explained that we thought we were there because he was supposed to see Neurology for a follow up in one years time. [Emphasis on Neurology]

He batted an eye and then asked Rich if he knew what he was here for. Rich glanced at me and then the doctor. He shrugged. "Because of my brain?"

The doctor launched into his spiel. "The CT scan you had done a few weeks ago show a change in your brain aneurysm. We are here to discuss ways of dealing with that. Did you know you had an aneurysm?"

Rich glanced at me. I answered, "Yes Dr. Kabbani who did the surgery to clear the clots in his brain told us that last year in May of 2017. The neurologist that we saw last year at the VA also reviewed it at the time. The aneurysm is in the Circle of Willis and it is a fusiform aneurysm. We were to follow up with Neurology one year later."

Rich added in his halting aphasia way that he knew the Doctor had to go in more than once to get stuff out and that his thoughts and words were scrambled.

The NeuroSurgeon turned and began typing rapidly. He started to read Rich's history. I pursed my lips. This doctor hadn't done his backround on his patient. My confidence level in him changed. What happened to cause this appointment? Did he note that Rich had a rare aneurysm? One that would be an interesting case to 'fix' surgically? The doctor was a UW Madison doctor, the UW is excellent and is also a teaching hospital.

Finally he turned back to us and said, "I see, last year you saw Dr. ---- in Neurology and he consulted with Neurosurgeon ... Dr. ---- and that doctor said nothing needed to be done at that time."
He frowned and then continued, "I'll put a call into Dr.----- and see what he recommends for this change in your aneurysm."

Rich stared at him and then the doctor pulled out a sheet of paper and explained to Rich what his odd and rare aneurysm looked like and how difficult it could be to 'fix' because it was between two major arteries that fed the brain.

"We may need to do an angiogram or another CT...," he went on, "..and then make some decisions..."

He made a quick exam of Rich and his reflexes then asked a few questions. He then reiterated that he'd let us know what was going on.

I stood and looked the doctor in the eye. "You do understand that my husband has been recently diagnosed with Vascular...." I let my words fall off.
He nodded. "I read that."

"You have read his history and health then right?"

The doctor nodded.

I don't think he really had. I think he saw an opportunity to see and possibly do surgery on a rare case. I think Rich's brain was of interest to him. His demeanor was not compassion for the whole person.
I decided that I didn't like him at all.

We left with no plan of action and we felt as if we'd been broadsided.

On our way home Rich said, "My life stinks. I have no life. I don't think I want that guy inside my head."
Me: Then he won't be.
Him: I mean what if the thing blows up? I mean what if he fixes it and I keep on living like this?
Me: Well he didn't really end up talking surgery, but I wonder what the risks are.
Him: Me too. What if he scrambles me more.
Me: Won't happen. I won't let him in there if those are your wishes.
Him: I'm dying a little at a time anyway. I'm so depressed.
Me: Silence.

Him: Do you suppose I can go to the doctor just ONCE and get some good news?
Me: Silence again.
Him: What next?

Rich reclined the seat and went to sleep while I drove.
I thought about the letter and how we were supposed to push and pull, exercise, OT/PT, mental exercises, ....push push push.

Indeed.
What next?

I am Nowhere.

So on the last check up with ENT a week ago there is still no re occurrence of cancer. Everything looks 'good'. 

We both sighed at that thinking soon the endless appointments and follow ups regarding the dreaded 'C' word would slow down to a six month break.

However Neuro-Surgery called and scheduled a CT scan to check out Rich's brain and to see if there were any changes to his brain aneurysm. After we got home a Neurosurgeon called to let us know that no significant changes had occurred but we were still scheduled to see them for his one year follow up.

The results from the tests with Neuro-psychology were in. Cognitive Disorder...Vascular Dementia. The full results will be mailed to us in two copies. One for Rich and one for me.

I think they will write up and include their recommendations. There was almost too much information given at our meeting of nearly 90 minutes.
My take away was the following.
Are POA's in order? Yes.
Driving? That will be addressed with OT/PT.
Could I now prepare his meds? Yes.
They are ready to invoke POA for Medical as they don't feel Rich can make decisions for himself.

I did explain that all of our decisions were made together and had been since he'd had cancer. 
The best thing I liked about these doctors is that they looked Rich right in the eye and explained things to him. They also confirmed that I understood what was going on.
I'd already had an inkling of the possibilities before the appointment.

The signs were all there. The confusion, the far away looks, the getting lost in 'No Where Land' as Rich had told me over and over again. The lack of ability to make an easy decision like to call to have his truck fixed, or to arrange to have some cattle shipped is now beyond his reach and thought process.

As I explained to our Farmer Friend, I wanted to let Rich feel like he was making the call, that he was still in charge. But I realize now that he may not be capable any longer. He has become mostly apathetic to what is going on around him.

It seems that decision making is too difficult for him. I've resisted that thought, I've resisted that conclusion and I had even decided that Rich was just too lazy or unconcerned to make these important decisions. I'd leave a phone number in front of him to call for his truck. He'd push it away and not look at it. I nagged, cajoled, and begged for him to call.
I got an irritated look in return and then nothing.

The shock for me is that it was there in front of me and I didn't want to believe it. 

Yesterday morning I felt lost. I felt panicked with the sudden realization that indeed my world had flipped again and so had Rich's. He was slowly drifting away into a place where I couldn't find him.
He can sit and have coffee with me in the morning. But I look at his face and find him not there.
His eyes are blank.

I ask him what is on his mind. And he blinks, then looks at me with a question on his lips and says, "I am nowhere."


My husband is leaving me. No dramas, no slammed doors - well, OK, a few slammed doors - and no suitcase in the hall, but there is another woman involved. Her name is Dementia. ~~ Laurie Graham.