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Morphing: What I Call It and Why It's Hard to Detect - But It is There
I have watched two people with sepsis try to return to their previous condition.
Both of them did something I call morphing. Why can't I remember? is the common complaint. The complaint is that they find out that they have lost days and they don't remember anything about the experience.
It's disturbing to the patient and so, as people tell them what they have observed in the patient, these stories become the patients new reality. It's a pretend situation. The mind is so intent on replacing what was missed, that it will grab onto any new data and try to file it in the missing area.
The first time I was aware of morphing, was when my father was taken to the emergency room because of a few factors. He had a urinary tract infection that was so bad that he was peeing blood.
He had complained that he was wetting the bed, something that he had outgrown some 80 years previous, but now it was back, in full force and it was really getting him down. Not to mention, when he'd sit in his chair watching television and he'd need to go to the bathroom, that pesky bathroom door would change walls. One minute he'd see it on the west wall and head toward it, only to find that there was no door there when he walked over to it. Just a wall.
And, there was this woman that kept visiting him, watching him as he watched television. He lived alone.
My sister took him for a drive to go to a clinic, since my father had not seen a doctor for the past thirty years and really needed to go with this craziness that he was experiencing. They told them that they didn't treat urinary tract infections, that they'd have to consult a urologist.
I don't understand why, but my father was apparently angry about some issue and demanded to go home. My sister took him to her house, where he was visiting for the weekend, and he went to his room and apparently laid down.
She peeked in on him after a bit, and was shocked to see him kneeling next to the bed, clutching his chest and grimacing. His tooth was on the floor Apparently, he had ground his teeth so hard, that his tooth had broken off.
She and her husband called the ambulance and the ambulance drivers came and evaluated his condition and decided that he needed to go to the hospital some 10 blocks away. Can you take him to the VA Hospital, since he's a veteran? No. He's not going to make it that much longer.
So, they took him to the hospital.
At the Emergency Room
nWhen I arrived at the emergency room, after I received the call, the stench of urine coming from my father's room was almost unbearable. The catheter of urine coming from his body, was flowing bright red.
His urinary tract infection had turned to a bleeding mess.
How was one to know that this was happening? A person doesn't usually discuss urine habits with their father, nor are you in the bathroom when they are peeing. I wasn't around to see his used adult diapers, but had I seen one, I would have known. He was bleeding internally.
When I saw him, he was glad to see me. He was jabbering about a few issues, none of them made any sense whatsoever. He kept talking and talking and talking. He noticed some people outside his room and asked me if they were my brothers.
No. They aren't. Are they coming? I don't know.
He was attached to an IV that was dripping antibiotics into his body. The doctor informed us that he was in Sepsis and that if he had not reached the hospital at this time, in less than 12 hours, he would have been dead.
He would have died in his sleep.
Sepsis is bad stuff. Sepsis is an infection of some sort that is in your blood. It's bad blood and your blood circulates through your entire body at all times, and when your organs use this blood, it poisons them, also.
He was kept in the hospital for a few weeks, then moved to a transitional unit. He was at the transitional unit for a few weeks, then he was granted admission to an Assisted Living environment.
He was at the assisted living arrangement for a while, and then his urinary tract infections attacked again. He ended up in the emergency room.. He was given antibiotics. Then, he was having some sort of delusional behavior, so he was removed from assisted living and moved, down the hall to the nursing home.
The problem: the antibiotics were not allowed to come with him. So, his prescription was left behind. My sister and I had to have him moved to a Memory Care unit. Problem again. They wouldn't accept any outside prescriptions. You had to use their own pharmacy.
This affected his urinary tract infections, since he was not getting treated while we waited for the prescriptions to arrive. I took him to the VA and got him looked at. We tried to arrange for his prescriptions to go to the Memory Care. Same problem. They wouldn't accept prescriptions from an outside source.
My brother had me check into the Memory Care located near where I work. They accepted prescriptions from external sources. My father started to have regular episodes with urinary tract infections.
You could tell when he was getting them, because his speech would be affected. He was an intellectual man who apparently spent many hours a day, reading books such as dictionaries. He had a large vocabulary of large words. He'd use the larger words, and one hospital person was so intimidated that he told him, you don't have to talk to me with such big words, Just use regular words with me.
Well. I'm sorry, sir, but that's how he talks. We cannot do anything about his vocabulary right now.
About the Morphing
My father had no recollection of the events that happened previous to getting to the current Memory Care and would spend moments with me, discussing what he was thinking about. Much of it, flipped between talking about his parents, his home life, his naval career and things that apparently weren't lost by the bad blood.
He'd say Why am I here. Well, it's because of the urinary tract infections. You are in a safe environment..
There was a lot of things that we'd talk about one day, suppositions, that would morph into being his new reality. He'd listen to his visitors and the next day, he'd be questioning things about what they said. It wouldn't matter what was said, he'd add it to his current mass of data collecting in his brain.
It was becoming his new reality. Morphing. It was like his brain was trying to make sense of what was happening and was like a new sponge slurping up a bunch of facts and opinions and making them his new standard.
If you did not know him, it was normal. For someone like me or my sister, we knew that he was changing himself to suit the circumstances.
That seems to be what morphing is.
I spent every day with my father for a while, stopping there after work each day and taking him places. I took him to his appointments at the clinics and the VA hospitals. In all, there were over 30 trips that we took together. Visits to the ER. Visits to the urologist. Visits to the regular doctor. Surgery on his cataracts. Several trips to get his urinary tract infections under control.
He finally had his last urinary tract infection in September and told me that he didn't want to do this any more. He wanted to just get in the car and drive and drive and drive. He managed to get the VA to complete a form of DNR so that if he didn't want to be treated, he could just be left alone.
So, as the last urinary tract infection started, he was informed that if it wasn't treated that it would indeed end his life, since it would turn to Sepsis. He was okay with that, relieved almost and was very complacent at that point, waiting for his death.
He was in the care of hospice in his final hours. As I sat by his side, holding his hand, he'd have moments where he was joking around. One moment, he grabbed the rail of the bed by his head and looked at me and said, Is this it? Meaning, am I going to slide out of here into death right now. We shared a common brain link and would share humor in very dry ways.
Intellectual humor, humor that is based on experiences, but not necessarily based on facts, just intellect. Almost sarcasm, but not hostile like sarcasm.
So, I noticed his morphing quite a bit closer than most. This dry humor did not exactly go away, but, it was added to his morphing. The Memory Care staff found him to be quite amazing and really liked his personality. That was a good thing for him.
While in hospice care, as I sat and held his hand, I watched his breathing. It was an odd thing. His mouth was open in an O shape and his breathing was the same as his heart beat. He wasn't speaking to me at all, except the moment when the fire alarm started to blare.
He opened his eyes, and with a lot of effort and a gravelly voice, looked at me and asked me if I was going to answer my phone. My phone. He thought the noise was my cellphone. It was not.
As I sat with my father, waiting for his heart to slow down and shut off, I decided that this was the moment to tell him that I was glad that he and I had had the opportunity to spend so much time together. That I would miss him and that he'd be okay where he was going and not to worry about me, that I loved him and I'd miss him.
I didn't think that he'd respond, but, he did. Two large tears rolled out of his eye on my side of the bed and splashed into his ear.
He did hear me. Moments later, his stomach seemed to bang into his chest and moments later his heart beat just slowed down to nothing. His body just seemed to deflate, like a tire that the air went out of.
Then, he passed away. I took note of the time and went to find an aid.
That was the end of my father. It was an experience that I will never forget.
My friend went in for double knee replacement surgery.
It was supposed to be a simple surgery. In, have the surgery, be out, do some physical therapy and go home and back to her regular life.
She had the surgery done and because of her phone and social media, I was aware of the fact that she was in a lot of pain. I was up at 2 a.m. and was reading her posts. I offered support in the way of social media.
Then, I went to visit. Brought her an orchid and some floppies. A bluebird and a butterfly on wires. I was there for a period of about 10 minutes before she told me that she was really tired and was falling asleep in her chair trying to talk to me. Lots of pain. The surgery was unsuccessful and she had bleeding on one knee.
I left her to sleep.
Later that weekend, her sister reported that they had moved her to the hospital and that she had a bad infection. Then, she posted that her sister had sepsis and was being given antibiotics.
I visited again, this time just bringing her some flowers I cut from the plants in my yard. I visited for a while and listened to her talking.
She didn't remember two days worth of her time in the hospital, which we agreed was probably a blessing in disguise, since she was in so much pain the previous week, perhaps she didn't need to remember it.
As I was there, she was with her physical therapist and her daughter and grandson came to visit. I soon left.
Hopefully, she will be okay.