When I arrived at the ICU on Friday morning, I found Dr. Milton Koch already there to address the nutritional issue. He inquired as to the history of the Zenkers. I told him it was at least 25 years old and my father wasn’t having trouble with it. Some swallowing difficulty that he started complaining about 2 years ago disappeared when he was put on prevacid. I asked him if he would try to insert the NG tube that the nurses were unable to. He refused, saying that there was nothing about his expertise that would allow him to be more successful. “The only way to insert the tube would be under X-ray guidance,” he told me, “requiring a lot of expensive labor. It would take perhaps 6 people to vent him and get him down the elevator to radiology.” He asked us (Ruthie & Nomeda were with me) to wait with my father while he goes to the nurse’s station to write his orders. He would order a form of light nutrients through the regular IV line for now. No questions for him other than nutrition.

I walked over to Dr. Koch and related how some 8 years ago after doing an endoscopy to check for ulcers (dx helicobacter) Dr. Barry Rubin told me what a difficult time he had getting the scope down until he remembered about the Zenkers. Then he just guided the scope visually until he found the esophagus again. I asked him if perhaps he might use an endoscope to get the NG tube down. Dr. Koch replied, “May I be frank with you? I want to do as little as possible for your father because I don’t want to hurt him.” His hostility was palpable. I felt a sudden chill as I looked at my father through the glass window with my friends near him. I was scared. What am I going to do now?

Friday afternoon I see Dr. Weiner in the waiting area where I am sitting with Nomeda and Katrine. I ask him how soon he would contemplate removing the tube. “Some time next week,” he replied. “He’s not ready yet. I know it when I see it and he’s not there.”

Right before Sabbath I return to the hospital to find my friend Hakki waiting for me, giving me encouragement. Later that evening my father is switched from propofol to atavan / morphine as needed. He begins to get restless and shift in the bed. Resident says they may extubate on Saturday then comes back and says “don’t quote me on that. All decisions are made in conjunction with teaching staff.” No food today, only sodium chloride drip. Nobody can answer me as to the plan for nutrition or why no nutrition has come today.