A mental level of finality

There is a mental level of finality involved in filling out the
papers at at nursing home to eliminate medical intervention in the
care of a patient. To realize in your head that no medical
intervention is useful is not to realize it in your heart. Making the
correct choices for another person is not easy but participating in
extending suffering is far worse. Living an honorable life while
watching another's life ebb away is distressing. Being prepared for
something you have never experienced is impossible. If death is a
sleep with no pain, why do we try to avoid it, even at the end?

Ah the power of modern medicine

And then it was Friday.

Mother has responded, finally, to the medical support in the hospital
and after four days of "non-responsive state" she is back to
"baseline" state, or, no worse off then she was about 10 days ago,
which was not very good state to begin with.

Three IV solutions have been used. Potassium, Sodium and an antibiotic.

She is now responding to speech, seems to recognize some voices and
her eyes are open some of the time.

She is asking for her father, asking for Jesus and moderately aware
between times of sleep or non-responsiveness.

The hospital doctor again repeated his professional opinion that the
"aspiration pneumonia" was ultimately untreatable since any ingestion
of food or liquid will restart the infection and he can not recommend
repeated hospital admission cycles. Dad and I agreed with his opinion.

Mom has been discharged back to the nursing home and her care plan
has been adjusted to prevent this cycle from repeating in the future.

And then it was Thursday

Today the updates on Mom are not encouraging.

She is not responding to the antibiotic IV in the hospital. She is on
a IV drip of fluid and (I presume) nutrition also.

The hospital doctor spoke with Dad and they discussed options
including ending the IV system and antibiotic intervention.

Mom is "non responsive" and unable to sit up and drink or take
nourishment by mouth.

Dad and I and doctor are meeting at bedside tomorrow around 11 AM to
discuss ending of all intervention and starting hospice.

Hospice means, among other things, palliative care only, comfort
care, no intervention, ending in death.

Mom has aspiration pneumonia

It has been a tough couple of days.

Mom was admitted to hospital yesterday and the hospital doctor, not
her regular physician, discussed the reality of aspiration pneumonia
with Dad today. I went up and visited with Dad yesterday and did not
go in and see Mom at the hospital. Dad and I shared a meal and
discussed Mom's situation with "possible pneumonia". I have learned
much in 24 hours.

Dad called me mid-day today and updated me. The doctor apparently had
a rather frank discussion with Dad about the reality of what is
happening with Mom and the Alzheimer's. There is no way I can type
all the material I have read today on this topic and I will post some
links here on what I have found. I have known of aspiration for
years, you choke and get a little water in your windpipe. Well, with
the advanced deterioration of the brain in Alzheimer's the lower
level brain controls begin to break down and the semi-autonoumous
action of breathing or swollowing gets confused and happens at the
same time. Fluid gets into the lungs, infection sets in, aspiration
pneumonia has arrived. And medically it is discussed at length, how
much treatment is appropriate, the infection will continue reaccuring
and the cause can not, ultimately, be removed.

http://www.caregiver.org/caregiver/jsp/content_node.jsp?

nodeid=399&expandnodeid=387

http://pages.prodigy.net/bjbservices/eol.htm

http://www.cnn.com/HEALTH/library/HQ/00618.html

Tough decisions. What to do, what not to do?