End of Life Decisions - No Good Choices

[LoneAspen]

So sorry to hear that @TCABM!

My Mom lived to 86, and was in palliative care for her last few days. Similar to hospice care, those people are amazing, and I can't imagine how stressful their jobs are. We ended up thanking them in Mom's obituary, along with some neighbors and other folks who cared for her in various ways in her last couple weeks.

Best advice I can give is just to be there with her. If she's awake and lucid, talk to her, laugh with her, listen to her stories, and make sure as many family members as possible can visit her, too. And even if she slips into a coma or deep sleep (as my own Mom did once she was on a morphine drip for pain management), I believe they can still feel you all there and maybe even hear you, so we'd all hold her hand and talk to her still.

You and your Mom will be in my prayers!

 

[Ted]

Well, made the decision last week to transition our mother to hospice. In her case, the cure is going to kill the patient. Since we’ve stopped all medication and nutrition, she took a day essentially in coma, and has been on a 3-day rally. She’s gone from unresponsive and agonizing pain to somewhat lucid and pain free. Her birthday is Thursday and we hope to celebrate it with her.

The reality is she’s outlived her 5-day prognosis. But, her condition is complicated. The medication necessary to treat the basic illness causes a sepsis. Alternative treatments are too invasive with no guarantees of success.

I can’t say enough about the hospice staff. The have cared for us just as much as they’ve cared for her. It’s been a blessing and a curse all at once.

Sorry to hear. I hope you will be able to celebrate her birthday and that she will be able to have a peaceful end of life.

I like your style.

You know of a Duke that’ll make it halfway?!

(Well, maybe we can at least make someone smile during these tough times...)

The nice part about my plan is that it doesn't really matter if the Duke actually makes it halfway.

 

[X3 Skier]

These times are tough but sometimes inevitable, TCABM. I had made arrangements for my wife to enter a hospice but she passed away before she could move. As you noted, the staff at a hospice are some of the finest people a person can ever meet.

Condolences to you and yours.

 

[Half Fast]

My greatest fear is that I might have to face this with my wife someday, and then I won’t have her to face it with me when my time comes.

Why do husbands usually die before their wives? Because they want to.

 

[benyflyguy]

My mother... She's 86 years old. She had a stroke three years ago, but had recovered somewhat, had to walk with a cane, her mind was unaffected. Over the last few years her strength has declined and she has switched to a walker. Up until this January she'd been living by herself, with a helper coming in once a week. She'd moved to an assisted living facility the first of February.

I think what prompted the move is that she was diagnosed with severe aortic stenosis, and the weakness that comes with it. At the time she moved, she was still using the walker, but becomes fatigued quickly. It's a struggle for her to get down to the dining room at her ALF, which is maybe 100 feet total from her apartment. Shortly after she moved, she also developed severe reflux, and has difficulty eating and particularly drinking.

So, Tuesday I get a text from my sister, telling me that Mom has fallen in her apartment, and that she's going to the hospital. A couple of hours later, the diagnosis comes back, broken femur, or as we lay people call it, a broken hip, surgery scheduled for Wednesday. Wednesday comes along and her platelet count is low, and there are detectable cardiac troponin levels in her blood, so no surgery, she gets sent back to her room to see if she improves. Thursday comes along, when the nurse comes in to check on her, her breathing is noisy, so they suction her, move her to a different unit, and cancel surgery. As of now she's on a lot oxygen, on an IV drip, not allowed to eat or drink, and on pain meds.

There's no good end to this. The best possible result, at least medically, would be for her to get strong enough to have surgery, and then send her to rehab for a few weeks, then somewhere less intrusive. Reality is she was barely ambulatory when she came in, and even if they get her patched together she's not likely to be ambulatory when she gets out. She has limited heart functionality, hardly any metabolism, and can't process very much food. The bone broke because it is weak, I wonder if the surgery to put it back together will even work. If she survives this, most likely she'll be bedridden, and a prime candidate for bed sores and pneumonia.

I've suggested that we try to talk to an end of life counselor, but I'm not sure she's medically eligible for that since none of her conditions are considered terminal. There are just no good choices.

Not true. She has severe/critical AS and the probable CHF accompanied with that. With those dx to be a hospice candidate all a practitioner has to agree is that she may have less then 6 months to live. I’m a PA who works in geriatric care and unfortunately we see this cycle all the time. It’s a tough boat to row for families. These falls are the ultimate game changer.

 

[FormerHangie]

Not true. She has severe/critical AS and the probable CHF accompanied with that. With those dx to be a hospice candidate all a practitioner has to agree is that she may have less then 6 months to live. I’m a PA who works in geriatric care and unfortunately we see this cycle all the time. It’s a tough boat to row for families. These falls are the ultimate game changer.

She was ultimately admitted to hospice care when she was discharged from rehabilitation. She only lived six days after that. I do believe once she was in a place where she felt comfortable, she just stopped fighting her condition, and that's all it took.

 

[bflynn]

Well, made the decision last week to transition our mother to hospice. In her case, the cure is going to kill the patient. Since we’ve stopped all medication and nutrition, she took a day essentially in coma, and has been on a 3-day rally. She’s gone from unresponsive and agonizing pain to somewhat lucid and pain free. Her birthday is Thursday and we hope to celebrate it with her.

The reality is she’s outlived her 5-day prognosis. But, her condition is complicated. The medication necessary to treat the basic illness causes a sepsis. Alternative treatments are too invasive with no guarantees of success.

I can’t say enough about the hospice staff. The have cared for us just as much as they’ve cared for her. It’s been a blessing and a curse all at once.

I am sorry that you have to go through this and I feel your pain. We are in a similar boat with my mother.

Our decision to go to hospice will happen next week although from a practical standpoint, it already has been made since she cannot do PT. Since Feb, she has been in and out of medical facilities, er, hospital room, rehab, assisted living, er, hospital room, surgery (for a broken femur bone), icu, a different hospital room and back to assisted living.

At this point she has more wrong than right - heart, diabetes, severe osteoporosis and testing in the hospital says she probably has lung cancer. There is not much more to do than try to make her happy and comfortable. Maybe she will hang on for a while longer, but she is miserable and in pain. I try to visit as much as I can but it hurts when I remember her from before.

In the end, none of us make it out of this alive. The outcome is a certainty, only the timing and conditions are the question.

 

[benyflyguy]

She was ultimately admitted to hospice care when she was discharged from rehabilitation. She only lived six days after that. I do believe once she was in a place where she felt comfortable, she just stopped fighting her condition, and that's all it took.

God Bless.

 

[TCABM]

@bflynn, thank you for your thoughts and we will add y’all to our prayer list.

Today, we celebrated her 84th birthday; it’s the 8th day since the decision was made. Since then, we’ve seen her condition swing wildly, processed it all, grieved, laughed, and spent time as a family. All four of us kids have spent more time together with our mother than we have in the last 30 years.

The last two days have been a marked decline in her condition. She was able to spend about ten minutes in a somewhat awake and coherent state today to see her kids and half the grandkids sing her Happy Birthday. She managed a taste of her favorite icing on her favorite cake.

We are grateful that her pain can be controlled without narcotics. We are grateful to have this time with her. We are grateful to have employers that give us the time to be with her. We are grateful for the staff at the hospice facility and their philosophy to let us care for her the way she wants to be cared for.

None of us believe she will be move to another facility. I’ll be surprised if she makes through the night. But, then again, Sunday is Mother’s Day.