Limbo redux

The Medicare mambo is the sort most people don't want to think about until just before getting out onto that dance floor. Various family members with inside knowledge had warned that the hospice number could get a little bumpy; they were right. After a hip fracture, our father was put on hospice within the context of his ongoing nursing home care. Doctors also ordered post-surgical physical therapy.

A few weeks post-op, with strong therapists on either side of him, he managed to take a few shuffling forward movements on-command. Voila! He self perambulates, ergo he is alive, ergo, he is not going to expire any time soon from congestive heart failure/kidney failure/alzheimer's/mesothelioma/asthma/asbestosis disease and lesser ailments. Hospice was deemed no longer medically necessary.

Never mind that he has been taken off all medications for said ailments, other than to make him comfortable. Never mind that he cannot remember from one moment to the next why he is where he is and why everyone else around him is so old or unfamiliar, why his sons have not yet arrived to go hunting, why his hip and leg hurt all the time, who the old woman claiming to be his wife truly is, and why he can't find his tools, yet again. Disregard that more and more often he must be fed, he cannot get out of bed any longer without a lift, and he is now catheterized because his muscles and nerves no longer coordinate his bodily functions.

Meanwhile, the family plans another Last Thanksgiving While Dad is Around (but really isn't), making plans to have Thanksgiving nearby to support our mother, close enough to make individual pilgrimages to see our father, too. Because one never really knows. Except that we have been doing this same ritual for more years than I would care to count: holiday plans and family rites of passage, all revolving around the same theme. Where will Mom and Dad be? It may be his/her last, so we should be together.

One year ago, the day before Thanksgiving, our father's heartbeats slowed to 12 per minute while he was at his nursing home. Our mother made the decision to have a pacemaker put in the day after Thanksgiving. She imagined the holiday being ruined for the family, forever, had she chosen to let nature take its course.

It's not that we - I - resent either her decision or that medicine has given us a few extra years with him. It's just that no one can ever truly anticipate the day-to-day outcomes of a medical decision, made with the best of intentions. Plus, our culture lacks the accompanying layer of social niceties and customs to smooth the process.

Awkward moment around the office: Where did you spend your Thanksgiving? Oh, as close as possible to my father's Alzheimer's unit. His nursing home is in a small town in the country. So we all stayed nearby. Our mother doesn't want to be too far away, and we want to be there to support her. Plus, if we choose to go somewhere else and leave him there by himself, we will feel guilty. And it could be his last. Oh, I said that last year? And the year before?

Welcome to limbo.