It won't kill you...

First of all, I want to thank all my readers for their patience while I have been away from the blog. I appreciate the many letters I have received expressing concern for my lack of posting. I want to assure you that I’m OK. It’s just been a little more difficult lately and my usual time for writing has been overtaken by other responsibilities.

After Riley returned home from the hospital, he never quite returned to where he was before he went in for stabilizing. He is weaker now than ever. He has absolutely no bowel or bladder control and cannot walk without assistance. On Thursday he fell eleven times. One of those falls was only about an inch from the fireplace.

I met with Gill and we talked about having Riley committed to the state mental hospital. My fear was that he would detox and come home so we could start up this routine all over again. It pains me to say that I really don’t want to go through all this insanity ever again. I’ve done it so many times and each time my physical health deteriorates and he just goes on. If the hospital would keep him, I’d be all ready to have him committed.

The reality is detox is dangerous. I know that and I know that Riley may not survive detox this time. But, too many times I’ve been told he that he would not survive and then he becomes immortal. When Riley is alcohol-free after detox, he actually presents himself as a sane and rational individual. I don’t believe it’s sane for anyone to return to drinking after detox, but my opinion means nothing.

Because I thought it might be possible that they would keep him, I did some checking to lay the ground work for Riley’s being committed. I spoke to the Magistrate. I learned that going before the Magistrate only initiates an order to have a Sherriff’s squad car to come to my home, handcuff Riley, put him in the back of the car and transports him the almost 3 hour drive to the hospital. Well -- that doesn't sound like something I would want to have happen to him. It just seemed like overkill to me.

Once there, he would be evaluated by a hospital doctor. That doctor would make a recommendation as to treatment. It may be that he will simply be detoxed and let go. If he presents himself after detox to be a danger to himself and others, then and only then, they would admit him in a residential program. Well – for me – that sounds like a crap shoot! I’m not much of a gambler and I think maybe I should just pick up my cards and go home.

I took my information and met with Gill once again. We agreed that for Riley to state he intended to drink again was an act of insanity. He is a danger to others by virtue of admitting he would drive drunk. He is a danger to me because of his inability to clean up his biological waste from the floor and walls. He is a danger to himself because he knows the drinking will kill him. But, generally speaking, they don’t commit people for that – or at least – I don’t think they do.

When Riley was discharged from the ICU, I was told to take him back to the doctor’s office on Monday to get his lab work re-done. There is no way that can happen because I can’t get him into the van and once in, I don’t know if I could get him out. I called the doctor’s office to let them know that I wouldn’t be bring him in. I was told not to worry about it, that the doctor would be calling me.

I rarely have much sympathy for the medical community. I find their lack of knowledge and understanding to be a constant irritation. When the doctor called me back I knew I would get the lecture about getting him detoxed and into rehab. I was surprised when the doc simply said that there was really nothing more he could do for Riley. He understood that Riley was not going to stop drinking even if they got him to agree to rehab. There was nothing medically that could be done for him. He couldn’t even give him anything for the pain from his arm or any past or future injury because there was just too much alcohol in his system. When I told him that I didn’t know how much longer I could take care of him, he said he would be ordering hospice. I told him I was reading between the lines. He acknowledged that I understood what that meant since he knew of all the work I have done in writing this blog. Because he knew that I was informed, he didn’t try to give me anything but the facts. I was so appreciative of that.

The events over the past week had made me a bit unsure of a few things and I asked him some questions.

Q:        Riley’s ammonia level is increasing at the rate of about 250-300 micrograms per month. What can I expect as the ammonia level increases?

A:        There will be increased confusion and agitation. He will lose all control of his bodily functions. He will be falling more because he’ll become unable to balance himself. He will sleep almost continuously and will fall asleep any place and at any time. Eventually, he will most likely fall into a coma from which he will not recover. However, it will NOT kill him.

Q:        If the ammonia (hepatic encephalopathy) doesn’t kill him, what will?

A:        The elevated ammonia level is caused by his liver failing to function properly and that WILL kill him. But, that is if nothing else is going wrong inside his body, which clearly there are lots of things going wrong.

He has a history of esophageal bleeding, so he may have esophageal varices which are almost instant death.

His potassium level is extremely low makes him susceptible for a heart attack and since his system is so weak, he would most likely not survive.

He has a lesion in his brain which was the cause of his last stroke. His blood is thinner from the alcohol and any bump to his head could cause that lesion to bleed. That can either cause another stroke or kill him. Because of Riley’s history of falling, he believes this is the most likely thing to happen.

I found it refreshing to get straight forward answers from a medical pro. I know I knew all of this, but to have validation that I am correct is great to hear. But it wasn’t really great because, until now, my knowledge was all about my research and experience. Now I have to look at reality and make some decisions or changes. I’m just not sure how to do it or what changes to make.

Today the hospice worker will come out and evaluate Riley’s condition and what they can do to help me take care of him. I’m also having the POA’s updated, so a Notary Public will be here. It’s Friday, so the housekeeper will be also here. It’s going to be a busy day – again.

At the moment, Riley is asleep sitting up on the love seat in the den. It has been peaceful in my office and I’m grateful for having the quiet so that I could write this post.