Live cells v. dead cells...

Last week Riley had an appointment with a Veterans Administration doctor in order to set up a primary care relationship with the local VA clinic. I had originally thought it was an evaluation for his disability compensation claim, but I was wrong. This appointment was only to do with his request for VA medical services.

I’ve heard a lot of horror stories about these clinics and the medical staff. If this clinic is representative of other centers, those horror stories are without merit. I found the clinic to be very clean and well equipped. The staff was friendly and cooperative. Things felt as though they had all been trained in the art of efficiency and customer service. I was impressed.

I was also impressed with the demeanor of the doctor that had been assigned to us. He was knowledgeable and spoke to me as one human being to another. He didn’t use medical-eze which would leave me running to Wiki to find out what he had said. He was a real person who used his own personal experiences to show that he understood what we had been going through. He explained and when I left I felt we had a plan of action and I knew the consequences of all the possibilities.

While we were all talking and relating, he was examining Riley. It wasn’t a huge exam. There was no disrobing or standing and touching his toes, but rather simple things.  To a lay person it might seem that he did next to nothing of a real exam. That assumption would have been wrong.

This is what I learned –

The liver can, in fact, regenerate new cells and continue to function. However, there must be a sufficient amount of LIVE cells for regeneration. DEAD cells are just dead. They cannot regenerate. The just remain as scar tissue impeding proper function. If the liver has been constantly asked to recreate itself over and over again, it will get to a place where the regeneration cannot replace all the cells that have been killed by the intruding factor. New cells WILL regenerate, but the question is will it happen fast enough?

The only way to really determine how much of the liver is functioning is to do a biopsy. It’s a simple procedure of inserting a needle into the liver and withdrawing a sampling of the cells. Without the biopsy there is no way of telling the percentage of dead cells versus the live ones. However, the procedure generally causes heavy amounts of bleeding. Alcoholics are susceptible to having bleeding issues and are not good candidates for the biopsy. In Riley’s case the risk of him bleeding out is not worth taking the chance that a biopsy would present. So for Riley -- we don’t know and we won’t know how much of his liver has the capacity to regenerate.

The same theory works for LIVE cells and DEAD cells in the brain. However, the brain is not as forgiving as the liver. Alcohol anesthetizes many of the cells so that they do not function properly. Other brain cells are simply killed off. As the alcohol stops entering the brain, these anesthetized cells seem to wake up and start functioning again. But the dead ones are just gone forever.

It is obvious from observing Riley that he has made a remarkable improvement. However, he is now about a month from the heart attack and the condition he is in currently is about as good as he is going to get.  He will have very good days and very bad ones. But this is what it is and this is what it will be.

I’ve been trying to visit Riley at least every two days. Sometimes it’s longer. Visiting him less often allows me to see his progress more clearly. If I see him every day the subtle changes may not be as noticeable to me.  And I DO see changes. His eyes are much clearer and skin is not as yellow. He doesn’t mumble so much when he talks. He is able to follow a conversation – to a certain degree. He is also developing a desire to maintain his personal cleanliness and keep track of the schedule. He knows that does NOT want to be there. He wants to come home so that he can drink.

 S..i..g..h..

This puts me in a Catch-22 position. If he stays in the facility, he will not drink and live longer and healthier. If he comes home and can get alcohol, he will most likely die within a year but be happier about where he lives. I would like to say that this is about the “quality” of his life. But that is subjective. What would be a quality life for me would probably make him miserable.

There is the issue of having him come home endangering my health. Caretaking him has had a huge negative effect on me personally and medically. I have no desire to die. I asked Riley how he would feel if he came home and then woke up one day to find me dead on the kitchen floor. His response was that he would be worried about who would be taking care of him now. WOW!! There was no expression of regret or even that he would miss my company. His only concern was how my death would possibly upset his living arrangements.

The doctor at the clinic has noted in Riley’s file that he should be institutionalized because he is a danger to himself and others due to the fact that he will not stop drinking. Even if Riley is not displaying any outward signs of needing hospice, he is still terminally ill which will only be intensified by his return to drinking.

On my plate for today, I must request a comprehensive neurological psychiatric evaluation to determine if he is competent to make his own decisions. If he is deemed incompetent, he will not be able to make the choice of staying in a facility or coming home. If he is, in fact, competent he will be allowed to make his own bad choices. But… really… isn’t that what he’s been doing all along??