I am his medical and durable POA. He is retaining 1500cc of urine in his bladder after voiding, and it will soon cause kidney damage. He is "with it" enough to understand this but he finds the indweling catheter intolerable and threatened to pull it out when he had one placed, and stated "it is better just to die than wear this".
So I went back to the hospital and had the nurse deflate the balloon and remove it properly, and she told me to get medical POA (which I already have). I am wondering about this nurse's comment: even though I can legally enforce that he wear a catheter, he may do some serious physical damage pulling it back out again if he doesn't want to wear it. And guardianship is obviously not an option because he is competent although moderately demented. He is living in a locked memory care unit with a 24/7 charge nurse so catheter maintenance is not at issue here.
More details: This catheter is meant to be worn only one month while the urologist assesses if he is a candidate for surgery (cystometrogram, cystoscopy, kidney imaging) and to prevent kidney damage.
This blockage is caused by prostate enlargement (BPH) which has been medically treated with 5mg finasteride and 2 flomax for 3 months to no avail. He was diagnosed with BPH years ago and was taking 1 flomax daily the whole time. This is probably more detail than anyone wants to read but just in case anyone is thinking there it can be medically treated.
So the family doctor was following the BPH for years. My Dad finally complained of bedwetting (really out of character for him because he is embarrassed by it) so I immediately took him in for a workup and he got referred out to a urologist.
Nobody wants to wear a catheter all the time, but would he be willing to have one inserted and removed every 6 hours? Could he do this himself with a reminder from the nurse? For example: 6am, noon, 6pm and midnight?
Reminders are not an issue as he is in a locked memory care facility with 24/7 nursing staff; the issue is that he absolutely refuses the catheter.
Basically, I am worried because apparently without it the surgeon will not be able to even assess his bladder function and his candidacy for TURP. The surgeon is not going to perform a TURP if his bladder is not functioning well enough on its own. So I am thinking, the surgeon is not going to perform a TURP if my Dad absolutely refuses any catheterization with retention this pronounced.
Clearly, any procedure is risky in a 84-yr old even with local anesthesia, so add to that noncompliance and no assessment of bladder function. I don't think TURP is going to happen.
he definitely would be able to pull out a foley if he puts his mind to it. It might hurt but it still can be done with a good tug. he may even figure out that if he cuts the end off the little side tube he can drain the water out of the balloon then it's easy to get out. Would Dad accept a supra pubic catheter.. A small incision is made just above the pubic bone and a catheter inserted into the bladder where it remains permanently. A supra pubic catheter could be put in without anything else being done. I would not try to enforce any treatment against Dad's will. it really isn't worth it. hope all this works out for you and Dad. Let us know what happens.
My Dad like I said does have memory problems BUT he is extremely intelligent. He knows more than average. He will remove the bag, cut the catheter, yank on the thing, and complain loudly to the point that he will get transferred to a SFN, even if he can't pull it out.
Just out of curiosity I read up on Guardianship in California and even for a temporary emergency order you have to file a full petition for "Conservatorship of the Person" (aka guardianship in other states) and the conservatee has to attend the court proceedings. Only lasts 30 days with no extension. Yeah, probably not going to be the most expeditious way to get things done.
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