Dear Barbara, My mother-in-law is 93 years old and was recently admitted to the hospital. Her blood pressure is extremely high, and the doctor is keeping her in the hospital to treat the blood pressure. Her other symptoms are paranoia and agitation. She refuses to eat, and spits out her food, liquids, and medication. She has refused anymore blood work and tests. Every time they try to draw blood, she cries or screams that the technicians are hurting her (even if they haven't even touched her). I wonder if she is beginning the dying process. I have encouraged my husband to speak to her doctor about the possibility that this might be the case, and if so, is she eligible for hospice care. The doctors have done multiple tests with no abnormal findings, with the exception of the high blood pressure.
How can I convince my husband to ask his mother's doctor the question that he dreads asking? It kills me to hear about the army of doctors coming through to try and diagnose a 93 year old woman, who clearly does not want to be treated.
The very fact that your mother-in-law is 93 says she is dying gradually. How long it will take is another question. Obviously if she continues to not eat or take the medications the process will move more quickly. She is not in labor (weeks with different signs) but if she continues to not eat she probably won't be here next year at this time.
How to get your husband to see this? I'm not sure. Research has shown that Americans spend the most in medical care during the last year of life. That statement tells me we treat from emotions not reality. "I don't want mom to die no matter how old she is" vs. "Everyone dies and it is now her time". You might talk with your husband about how distressing it is for mom to be in the hospital with strangers and being forced to have procedures instead of being in an environment with those she knows and a routine she is familiar with.
A hospice referral is a win win. If she out lives the hospice certification requirements she and your family have had 6 months of guidance and support AND she has been treated with gentleness and respect for her wishes. If she indeed dies while on hospice she and your family have had support and guidance during that time as well. There is nothing to lose by being on hospice at this time.
Why make your mother’s remaining time be unhappy and with more discontent than is already there due to age and illness? Being old is hard work. Our thinking processes aren't as sharp, our memory is diminishing, our personality changing, our independence curtailed and then our children can't come to terms with the fact that death comes to all.
My blessings are with you, your husband and your mother-in-law during this challenging time. My hope is that your husband can put aside his own feelings of loss and uncertainty and give his mother the gift she so clearly wants--to be left alone medically and to let life take its natural course.
Something more about... Refusing Treatment at Age 93
There are times when people who need education on the signs of approaching death just can't read, GONE FROM MY SIGHT. Anxiety or depression about their loved one keeps them from being able to concentrate and sit quietly to read. That is when the dvd NEW RULES for End of Life Care comes into play. It's short, gentle, clear and easy for families to absorb. Often, the family member who couldn't read the booklet wants to watch the dvd again and again.
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I concur with the comment about the benefits of hospice also – when my dad, 95 years old with congestive heart failure, came out of the hospital for the second time in six months, he was finally willing to accept help. When he stated clearly that, no matter what, he did not want to go back to the hospital, we signed him up. The social worker gave me a copy of Gone From My Sight and I ordered the rest of the set of books. Each time the nurse comes, they revisit the question and he still remains adamant that he will die at home, when his time comes.
Again, you have explained the ‘impossible’ with clarity and grace–approaching it with body-mind-spirit resourcing. Unfortunately, where denial & avoidance become innocent, well-intentioned cruelty, there are no easy answers in this oh-so-human EOL chaos. As a hospice chaplain, I ask the (usually but not always) breakthrough question, “What would she (or he) want?” I don’t ask them to answer it for me but to consider it and we can talk again…
This is the tenderest of processes that is best be addressed in sweet, small steps over time. Hospice gives us time.
Thank you for all you do, Barbara. It matters.
Thank you once again Barbara for your experienced words. I have given your web sight to many professionals/families,/ young/old, etc. too many times to count. Everyone by 18 or 21 needs to have an Advanced Directive in place. No one knows their expiration date.
My mom outlived the 6 mos. of hospice care for another year because she challenged each day with ‘how shall I conquer today’?
I am also an advocate for deleting the word ‘medical’ in many instances with the word ‘health’ as in health care, health/patient record, health care home, health care provider…..which promotes a
place for nursing. We will never be an autonomous profession until we see ourselves as one of the spokes in the umbrella of health care.
There are more professionals in the umbrella than just medicine.
Barbara, I love how you explained the win/win. As a retired hospice RN, I often explained this to families. It was the rare patient or family that did not feel they had made a good decision to elect the hospice benefit. Patients usually just loved the way they were loved, supported, made comfortable, and pampered. I recently knew of an elderly woman who responded so positively that she made a complete turnaround and soon took herself off of hospice. She loved the attention and pampering that she got from hospice professionals and, or course, from her family.
I have worked as Vol Coor in hospice for the past 17 years and have learned so much about the elderly and dying. I use your videos, books and booklets for all of the volunteer training because it is ‘right on’ about death and dying.
I found this article most validating. My mother will be 94 years old this month and is starting to withdraw. She has always been the life of the party and never missed a family or social function. But she is tired and wanting to stay home more. It is secure and safe for her. She gets anxious around lots of people and the noise and commotion of too many people talking at the same time is too stimulating for her. She sleeps a lot more during the day and does everything in slow motion. She still has a hearty appetite though.!
Although she is rather healthy, nothing but hypertension and arthritis, she has a DNR. My sister and I discussed it with her a couple years ago, and she is very certain that she does not want life saving measures taken if she stops breathing or her heart stops. She says she is ready to die. She has lived a long life. She does not want to be a burden to anyone. As sad as it makes us think of her dying because she is healthy for her age, she has the right to make her own decision. We will honor her wishes.
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