Yesterday was taxing. Physically, emotionally and intellectually.

I had long conversations with Drs. Tambe, Stewart, Moreno-John, Patel, Tay and Van Loon, as well as Case Coordinator Rohan, and Nurses Renee, Roan and Alex. And a dietician and an X-Ray tech.

And it was all about understanding the implications of every choice related to Jacqueline's care as we tried to transition to hospice. I had to absorb a lot of highly technical information about TPN (Total parenteral nutrition) lines and why doctors don't like to use, them and the NG (Nasogastric) Tube down Jacqueline's nose which I promised her we would remove at night so she could sleep and what a G-Tube (Gastrostomy) procedure involved, and whether Jacqueline could be fed through it. All from different doctors and nurses who had slightly different takes and agendas and also manners of presentation.

At the end of it I understood everything I needed to know to make a decision with Jacqueline, but I had a brief thought that my entire process that day would have been impossible for somebody on the spectrum. Because all of the doctors are being circumspect, and don't want to push you in one direction or another, but they have more information/experience/knowledge than you.

So I had to read each doctor very carefully, to ascertain why they had a particular qualm or hesitation, or why I was framing a question incorrectly etc.

There's some combination of letting the patient and family decide, with a little dusting of liability, and also a desire to be gentle with how they unfold the bad news to you.

Then I would check in with my nurses to get their perspective and experience, and then go over it with Jacqueline but she's really exhausted and has a tube down her nose and throat so hard for her to process all the details. But I know what she wants, and I'm advocating for her with the doctors to get to agreement on the plan.

Hec, it’s all so much for you to deal with. My thoughts are with you.

I want to say that she's lucky to have you, but I know she'd do the same for you. I guess I'm glad you have each other.

NG (Nasogastric) Tube down Jacqueline's nose which I promised her we would remove at night so she could sleep

In 2003, when my grandmother was in ICU with (among other things) a bleed in her stomach, she had an NG tube for 24 hours to help clear the blood out. She had to be restrained to keep her from pulling the NG tube out. Every time she woke up, I had to help her re-orient, and then she would beg me to "let her loose" until she exhausted herself and fell asleep for another half-hour. I think that was the longest night of my life.

...everything I needed to know...I know what she wants....

Sounds like you are doing better than most would in this situation. I am impressed.

I want to say that she's lucky to have you, but I know she'd do the same for you. I guess I'm glad you have each other.

Exactly this. When I have taken care of ill loved ones I knew they would do the same for me, and often reminded them of that fact.

Yes. During my Dad's final hospitalization he apologized for being a burden, and I told him he definitely wasn't that. When someone you love is in dire straits, you want to do everything you can for them.

You are both lucky to have each other. I hope you have someone to lean on during this and where you can take some time for yourself to regroup.

Talking to that many doctors and specialists is so draining. I hate that they can't just be more direct about options and recommendations.

Man, that is a lot of work on top of the emotional toll. And physical toll. It's just a lot all around.

I hope you don’t have to advocate too hard, David, to attain what should 100% be Jacqueline’s right to determine. A decision should bring peace and acceptance, not be an invitation for strangers, even if they’re medical professionals, to insert themselves.

Navigating all that you are is so hard, and I’m sorry you and JZ are having to.

She had to be restrained to keep her from pulling the NG tube out. Every time she woke up, I had to help her re-orient, and then she would beg me to "let her loose" until she exhausted herself and fell asleep for another half-hour. I think that was the longest night of my life.

Time for another chapter in the story or Nurse Renee, the Fucking Champ of All Nurses.

As you recall, starting the NG tube on Jacqueline was a torturous nightmare. Three failed attempts by two other nurses was like watching Jacqueline get waterboarded while somebody jabbed a sharp implement up her nose.

Nurse Renee stepped up with her 35 years of experience, pulling the "million dollar tube" out of the back closet, looked Jacqueline in the eye and saying, "I'm very confident that I can place this tube and it won't hurt." And then she did.

So the NG tube is pumping away, sucking greenish brownish gunkish out of Jacqueline's body and off to a discrete canister and Jacqueline falls asleep. (This was on Sunday - the same day we'd shown up at the ER). So I thought that was a good time for me to make a run home and get her phone charger and pajamas and grab some food for myself then return.

I came back and Jacqueline was sitting up and no tube, and looked much better with her belly somewhat deflated. And I thought, "Okay, I guess they got it all out."

Then her nurse came in and said, "Oh. Who took your tube out?"

And Jacqueline said, "I did. When I woke up I panicked and pulled out my tube."

Me: "What? Are you fucking kidding me? After all that work to get it in, after watching you suffer through all that and all you had to do was let it finish!"

Jacqueline: "I'm sorry. You know I spent years typing up doctor notes and every time I typed up 'patient self-extubated' I'd think, 'That's stupid! Why would they do that'."

Now let's do a quick quiz and see how well you all know me.

Did I at this point take a deep breath, regroup and calmly assure my wife that it was a perfectly understandable instinctive response and we'll figure out what to do next... Or ...Did I start to berate my terminally ill wife on her hospital bed with my very sharp tongue despite my assurances that I would stop doing that.

If you chose sharp tongued beration you will know that I am not a fully actualized human being quite as yet.

Here Dear Reader, I will share Jacqueline's gentlest riposte ever. Delivered with absolutely no snark or anger, and perhaps even a touch of kindness.

JZ: "Oh, look it's 8 o'clock. Visiting hours are over."

...to be continued...