In the spring of 2022, eighteen months after the hospital care team had inserted an indwelling catheter, a nurse at The Meadows noticed tissue erosion.  I drove David to the urology clinic, and the physician’s assistant recommended taping the tube to avoid enlarging the pressure sore or surgically placing a suprapubic catheter.  Under general anesthesia? I asked.  Yes.  Sitting in the same exam room, I recited the same caution: “People with LBD often respond to certain anesthetics and surgery with acute states of confusion or delirium and may have a sudden significant drop in functional abilities, which may or may not be permanent.”  We agreed to start with the taping strategy and consider the surgical procedure.

The staff at The Meadows took the matter seriously, carefully taping the catheter tube and measuring the tissue erosion. Their careful attention prevented further erosion.  Still, all of the healthcare providers – including the person I trusted most, the palliative care doctor – recommended placement of the suprapubic catheter.  I scheduled the surgery for May, after classes ended. 

The second care conference of 2022 landed between two of my last classes that semester.  As it often did, the report started with dietetics.  The dietician reported that David continued to eat 76 – 100% of his food.  His current weight – his current weight was 143.  Both of us were silent; both of us started to speak.  His previous weight was 161, she said.  This may be a documentation error, she added.  I thought so, too; I’d seen him twice that week, and Fiona and I had seen him every day during her recent visit.  Neither of us had noticed a sharp drop in weight.  We agreed that the nursing staff would weigh David again later in the day, and they would report back either in the afternoon or the next morning.  The care conference went on. 

The next day, the care manager called me.  They had weighed David twice, on two different scales, and the weight of 143 was accurate.  He reviewed the weights recorded in David’s chart for the past six weeks; David had lost 17 pounds in two and a half weeks.  Did I want to consider applying for admission to hospice?