Towards the end

Leaves from my diary

" Today my doctors gave up. It seemed they had tried everything, sometimes against all odds. But now they did not know what else to do. Dr R, my cardiologist, who had been a perennial optimist, now seemed crestfallen. He wanted to see me after three months- almost as if he did not expect to see me again. Dr S, my internist for almost two decades, called me at home early in the morning- something that was so rare that it took me aback. He did not even suggest the next meeting date.

It was a strange feeling - to be completely alone in the fight that lay ahead. And it would be a fight. My condition had rapidly deteriorated. My caregiver had described it in a short, but brutally honest,  memo:

"He has simultaneously:

1.   Chronic Heart Failure:  With an ejection Fraction of between 15 and 20, there are severe limitations on his physical movement.
2.   Diabetes 2
3.   Chronic Kidney Disease for which he needs to undergo dialysis sessions three times a week.  

He can only walk, with effort, for about half a block before needing to stop and sit. He has the use of a wheelchair, but which needs to be pushed by a caregiver, because his upper arms do not have sufficient strength to push big wheels for any length of time. He just cannot ascend or descend stairs (more than 7 or 8) without becoming breathless.

He sleeps on a hospital bed, which allows him to rest his head at a raised angle, and also enables him to raise his feet which prevents, or eases, edema. He needs a "dedicated" bathroom.  He has a commode with hand rails over the regular toilet; a seat in the shower stall, grab bars,  and because he has external access for dialysis, can only use a hand shower.

His meals have to be specially prepared since his diet entails the use of minimum salt, no sugar, and vegetables and fruits with minimum potassium and phosphorus content.  Dialysis means that certain fruits and vegetables have to be soaked in water for a minimum of two hours before eating raw or cooking them so that phosphorus can be leached out.

His condition needs constant medical monitoring.  Apart from the 3 weekly sessions of dialysis, he has an office appointment with his nephrologist each week, and a monthly appointment with his cardiologist and another with his primary physician.  So in effect he has 18 medical appointments during the month which are essential for his maintenance.”  

Last week we decided to experiment with dialysis. Or really the lack of it. The results were disappointing since the toxic levels leapt back to abnormal levels. So the experiment was abandoned and we are back to dialyis as before.

Yes, it had been a strange year. 2013 had been a tumultuous period in my life. What began as a normal year had turned by mid august into one fraught with danger and filled with pain. I spent almost six months in the grip of medical professionals and in hospitals and nursing homes.
And it had all started with a swelling of my feet-an indicator of edema increase. Mine had, it seems, gone beyond limits. So I was rushed to the hospital and then followed some of the most painful days of my life.

It had been seven years since I underwent quadruple bypass surgery at the best heart center in the US. Unfortunately that experience had left me with an ejection fraction of 15% barely adequate to pump the heart. During the past few years, three doctors had managed to skillfully redesign my life to a relative health. But now I was back again having fallen off the strict regime, which had upset the chemical balance of my body.

 I had entered the hospital in early October and soon enough found myself engulfed with various experts. During my first seven days scores of specialists visited my bedside but three standout, because each of them predicted my demise with different degrees of subtlety. One prognosed that the only solution to my condition was a heart transplant. But a few years earlier, John Hopkins, after a detailed assesment had declined to place me on the list because of old age of 70. Another suggested an LVD but in the present condition it was not possible. A third assesed that dialysis was only a temporary fix --in short, I should get my affairs in order. Another suggested I focus on Gita . In short all of them saw but a limited lifespan left for me. Fortunately my old cardiologist was there to provide a common sense path forward. And that had led to the new dialysis regime in the hope that it would rid the body of the toxins that had built up.

But now even that slim hope was rapidly fading. And I was left alone to face the uncertain future. Not completely alone for I still receive messages and calls from friends and family that are reminders that you are still loved and missed and that you may have a life, a trifle altered, still awaiting you ahead.

Their words always provide "comfort on difficult days, smiles when sadness intrudes, rainbows to follow the clouds, laughter to kiss your lips, sunsets to warm your heart, hugs when spirits sag, beauty for your eyes to see, friendships to brighten your being, faith so that you can believe, confidence for when you doubt, courage to know yourself, patience to accept the truth,  and love to complete your life".