Feeding Tube Drama Continues Via Another Form

[Guest guest]

This is not a commentary on religious faiths or anything. It's just

remarkable to me that that there's another feeding tube in the news

now, so I've posted this since we covered that topic last week.

 

Pope Receiving Food Through Nasal Tube

 

International Herald Tribune

 

ROME, March 30 - Pope John Paul II is receiving liquid feedings

through a tube that has been inserted through his nose and winds

down into his stomach, Vatican officials announced today, raising

new alarms about the pope's deteriorating health and his ability to

lead the Roman Catholic Church.

 

"To improve his calorific intake and promote an efficient recovery

of his strength, nutrition via the positioning of a nasal gastric

tube has begun," said the Vatican spokesman, Joaquín Navarro-Valls.

 

The announcement did not say exactly when the feedings had started.

But the ailing pope appeared silently at the window of his chambers

at 11 a.m. local time, without a feeding tube in place.

 

"Public audiences are still suspended," the announcement added.

 

For the first time, the Vatican seemed to damp down a bit its

normally upbeat assessment of the pope's medical condition, now

characterizing his convalescence as "slow." For the time being, it

seemed unlikely that the pope would continue the silent, symbolic

appearances at his apartment windows, that have become his only

contact with the outside world since the surgery to create a

breathing hole in his throat two weeks ago.

 

In these highly choreographed moments, the Vatican has been careful

not to show signs of medical paraphernalia. To remain safely in

place, nasal feeding tubes must be taped heavily to the nose.

 

It was also unclear if the Vatican had plans to replace the nasal

feeding tube, normally a temporary device, with a more comfortable,

efficient and permanent type of artificial feeding conduit that is

placed directly through the abdominal wall.

 

This device, called a PEG, is the type that has kept Terri Schiavo

alive for the past 12 years. Although it is put in under local

anesthesia, the procedure would presumably require a brief return to

the hospital. Also, it represents a more permanent commitment to

aggressive end-of-life care, and it is not clear if the pope would

chose that route.

 

"When you start adding things up, you have to think he's having very

serious problems with his airway and his ability to swallow and that

can happen in Parkinson's disease," said Michael Kaplitt, a

Parkinson's expert at the Weill-Cornell medical Center in New

York. "After the tracheotomy, they issued a press release saying he

was eating dinner. Now he needs a feeding tube." Dr. Navarro-Valls

said the pope required the feeding tube to improve his intake of

calories. Elderly, debilitated patients like the pope sometimes

cannot eat enough on their own to sustain an effective recovery from

a major illness.

 

But tube feedings would serve other important protective functions

for John Paul's failing body: Because of poorly coordinated muscle

activity in the throat, people with advanced Parkinson's tend to

accidentally inhale food into their air passages when they eat,

producing choking and seeding hard-to-treat pneumonias. It is highly

likely that some of the pope's recurrent respiratory problems stem

from such a deficiency, Parkinson's experts said.

 

A feeding tube averts this risk by delivering food directly into the

stomach, separating the paths for breathing and eating entirely.

 

Also, medicines crucial for the treatment of Parkinson's can only be

taken by mouth and so can be delivered by feeding tube if a patient

is having trouble swallowing, doctors said.

 

"I frequently use nasogastric feeding tubes for a month or so to

tide over elderly patients who have a transient illness and can't or

don't want to eat," said Dr. Myles Sheehan, a Catholic medical

ethicist and physician at Loyola University Medical Center in

Chicago.

 

Since he came to power 26 years ago, John Paul II made appearing in

public and close to the people one of the signatures of his reign.

He has done so even in illness, and in these recent weeks of serious

debilitation, he has struggled to show himself, in order to reassure

the world that he remains, at least in a basic way, engaged and at

the head of the Roman Catholic Church.