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Old 04-26-2011, 09:44 PM   #41
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Well, the point was that undergoing additional medical procedures may sometimes give you many more years, even if you're already old. Do you think that you will be the best judge of that likelihood? Are the folks that love you going to be good judges? I'm skeptical. What do you know, and what do they know that qualifies them to make the best decision?
I have long maintained that if I knew that I was going to die after a long and painful illness, I would willingly sacrifice 5 healthy years to avoid that. I have spent too much time in hospitals and in pain already in my life.
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Old 04-26-2011, 10:16 PM   #42
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Well, the point was that undergoing additional medical procedures may sometimes give you many more years, even if you're already old. Do you think that you will be the best judge of that likelihood? Are the folks that love you going to be good judges? I'm skeptical. What do you know, and what do they know that qualifies them to make the best decision?
I'd like to hear your alternative. Who would be best qualified to make the decision?
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Old 04-26-2011, 10:24 PM   #43
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When my father was in ICU (due to a hospital-acquired infection) for two days before he died, I saw several patients who had been there for many days (weeks?) with little or no family visiting, no observable consciousness of their surroundings, and some seeming to be in distress at times. My father passed quickly, before he could be moved to the hospice. But I shudder to think of the potential suffering those other patients endured, not to mention the cost, of them being sustained for days, weeks, longer, because of a lack of advance planning and thoughtfulness on the part of the patient and/or their family.
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Old 04-26-2011, 11:07 PM   #44
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I'd like to hear your alternative. Who would be best qualified to make the decision?
I don't have an alternative to suggest. I suppose the doctors would be best qualified to estimate the likelihood of treatment leading to an appreciably longer and healthier life.
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Old 04-27-2011, 12:22 AM   #45
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When my father was in ICU (due to a hospital-acquired infection) for two days before he died, I saw several patients who had been there for many days (weeks?) with little or no family visiting, no observable consciousness of their surroundings, and some seeming to be in distress at times.
... But I shudder to think of the potential suffering those other patients endured, not to mention the cost, of them being sustained for days, weeks, longer, because of a lack of advance planning and thoughtfulness on the part of the patient and/or their family.
I've noticed that when patients don't get visitors, at least half the time it's due to the way they've treated their family over the years. Karmic payback.
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Old 04-27-2011, 12:46 AM   #46
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I like morphine, it relieves pain and suppresses breathing so can cause death.

My dad was about 80 and a smoker, he had some heart attacks and a stroke and lung problems. The doctor came to the house and said he had kidney failure and was having total system shutdown. He didn't have a DNR but when they took him to the hospital I told the driver to drive slowly that dad wasn't coming home again. He spent two days on morphine in the hospital before moving to a nursing home. He died a few hours later but the morphine let him not hurt. The morphine might have made him die quicker since it supresses breathing, but that would be a good thing, he was done living and ready to pass on.
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Old 04-27-2011, 05:24 AM   #47
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I've noticed that when patients don't get visitors, at least half the time it's due to the way they've treated their family over the years.
++++1
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Old 04-27-2011, 08:04 AM   #48
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I think it's easier to talk about end of life options and choices while we are younger and healthier. When the time comes, however, we may not be mentally alert or physically capable. We may also have a different view on the trade-off and cost of staying alive. This is a rational discussion and I suspect at that moment of truth, reasoning will have little to do with the choices most people make.
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Old 04-27-2011, 02:47 PM   #49
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Several years ago my Mom found out her swelling midsection was cancer amongst her lady parts. She also had paid reservations for another Central American trip.. We talked and I urged her to go on the trip, as regardless of the treatment it might be her last chance. She made it about a week or so in and we had to retrieve her from Mexico as she was in way too much pain. She got surgery which also involved removal of a section of her bowel and resection. Cancer was causing obstruction and was invading that area as well. The surgery was not a success - the resection of the bowel didn't hold and contents of the bowel developed a path to the surface of her abdomen. Lots of pain, expensive nutrients via IV, other food ending up between her skin and a big plastic bandage over her stomach.

After some weeks in hospital she went to a nursing facility. After a month or so there she threw enough food in the trash to claim to the doctors that she was eating enough nutrients by mouth to be released home. She went to a little house we fixed up with the contents of her mobile home (my gal - took lots of pictures of the interior of Mom's mobile, we moved everything, and she arranged everything in the same relationship it was in down south). Mom was there for a week, we had Christmas, and the power went out so we carried her to our house to stay. We were trying to get hospice care set up and realizing just how unprepared we were for someone that needed some serious care. She had asked me what was going to happen - things couldn't go on the way they were! Told her that if she didn't eat she wouldn't make it.

On NewYear's Eve predawn she fell partially from her bed, her vitals were not good. Sat with her till others woke and showed up, was convinced she should go to the emergency room, though it was obvious to me she was dying. At the ER I told the head doc I felt she was dying and wanted nothing done to prolong her life, indeed, if she could get a hot shot to do that. Was told that's not what they did, however, morphine (I think) was given to reduce breathing distress and I encouraged it's repeated use as time went on in an attempt to hasten her easy parting.

She lasted about four more hours with two of her kids and our partners by her side. She was out of it on drugs. Think her demise was hastened by well meaning staff trying to suction her airway - "stuff" was backing up from her stomach. I have regrets, some things could have been handled better, but given her condition and future I wish I'd argued to keep her at home or at least refused the suctioning and asked for morphine even more frequently. I was pretty numb though. Nobody gets out alive, but the manner of one's passing might be changed.
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Old 04-27-2011, 03:20 PM   #50
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A friend's father did that and apparently that is not a physically traumatic way to die (and that is the peaceful, died-in-their-sleep death that nature initiates for the lucky ones). I know God will get me for this, but when I think of assisted suicide I have to say I wonder why people don't just decide to follow Nords's mother's path rather than involve anyone else when they feel it is their time to go. A horrific accident or debilitating illness of course might put the power and responsibility to feed/hydrate yourself in others' hands, so along with the question of assisted suicide, there's that consideration, too--how much emergency treatment would an otherwise healthy person want?
Feever, this is where I pitch one of my and T-Al's favorite happy reads, Loving and Leaving the Good Life, by Helen Nearing. It details the chosen end for her husband, famed back-to-nature guru Scott Nearing. Feeling his mental acuity declining, he simply stopped eating and then drinking. From her depiction of his life and end, it was quite peaceful. That's my plan.

Plan B is for my younger cousin to take me out in the woods one morning and if I find my way back, great, if not, die of exposure. Cheery thought!
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Old 04-27-2011, 06:03 PM   #51
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My FIL was in ICU for six weeks after surgery unresponsive and being kept alive by machines. His wife refused to make a decision even though there was no hope and made my sons make the final decision. It was a very difficult ending for all of us.
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Old 04-27-2011, 06:48 PM   #52
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Several years ago my Mom found out her swelling midsection was cancer amongst her lady parts. She also had paid reservations for another Central American trip.. We talked and I urged her to go on the trip, as regardless of the treatment it might be her last chance. She made it about a week or so in and we had to retrieve her from Mexico as she was in way too much pain. She got surgery which also involved removal of a section of her bowel and resection. Cancer was causing obstruction and was invading that area as well. The surgery was not a success - the resection of the bowel didn't hold and contents of the bowel developed a path to the surface of her abdomen. Lots of pain, expensive nutrients via IV, other food ending up between her skin and a big plastic bandage over her stomach.

After some weeks in hospital she went to a nursing facility. After a month or so there she threw enough food in the trash to claim to the doctors that she was eating enough nutrients by mouth to be released home. She went to a little house we fixed up with the contents of her mobile home (my gal - took lots of pictures of the interior of Mom's mobile, we moved everything, and she arranged everything in the same relationship it was in down south). Mom was there for a week, we had Christmas, and the power went out so we carried her to our house to stay. We were trying to get hospice care set up and realizing just how unprepared we were for someone that needed some serious care. She had asked me what was going to happen - things couldn't go on the way they were! Told her that if she didn't eat she wouldn't make it.

On NewYear's Eve predawn she fell partially from her bed, her vitals were not good. Sat with her till others woke and showed up, was convinced she should go to the emergency room, though it was obvious to me she was dying. At the ER I told the head doc I felt she was dying and wanted nothing done to prolong her life, indeed, if she could get a hot shot to do that. Was told that's not what they did, however, morphine (I think) was given to reduce breathing distress and I encouraged it's repeated use as time went on in an attempt to hasten her easy parting.

She lasted about four more hours with two of her kids and our partners by her side. She was out of it on drugs. Think her demise was hastened by well meaning staff trying to suction her airway - "stuff" was backing up from her stomach. I have regrets, some things could have been handled better, but given her condition and future I wish I'd argued to keep her at home or at least refused the suctioning and asked for morphine even more frequently. I was pretty numb though. Nobody gets out alive, but the manner of one's passing might be changed.
Thank you for sharing your story. Your Mom was very fortunate to have you with her Calmloki. And we are fortunate to have a person like you on this forum.
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Old 04-27-2011, 07:41 PM   #53
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I agree, Calm, that was a heartrending story. You all did everything you could to make her comfortable and there's no second-guessing it now. Thank you for sharing your story. And your gal is amazing with the decorating to match Mom's old house!

I had the honor of sitting with my grandfather (along with my two most-treasured cousins) at hospice in the days preceding his death. He had a peaceful end, brought on by a brain injury from a fall that prevented him from eating or drinking, and as per his living will, no tube feeding.

Interestingly, his last words to us were quite astonishing: He opened his eyes after sleeping for several hours, looked deeply at each of us, then stated unequivocally "We're Jewish, you know." This from a lifelong and very staunch Methodist!
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Old 04-27-2011, 08:56 PM   #54
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I know that we in the Pacific NW can be a PITA when it comes to health care and end of life care management. It may be because we, as a culture, reflect the culture of many of our Scandinavian immigrants. Do take a look at this: POLST.ORG - Physicians Orders for Life-Sustaining Treatment Paradigm

The program was developed as a result of a community leader who had prepared all those end of live directives but, when that time came, the people who she had on the list were out of the country. Her heirs funded the development of this program.
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Old 04-28-2011, 02:48 PM   #55
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....
Interestingly, his last words to us were quite astonishing: He opened his eyes after sleeping for several hours, looked deeply at each of us, then stated unequivocally "We're Jewish, you know." This from a lifelong and very staunch Methodist!
The end time is very interesting. Yesterday would have been my hero gal's Mom's 96th birthday. She had wanted to make it to that date but was getting more and more out of this world. On March 22nd she woke and very brightly said "today is my birthday"! One of her daughters said "yes Mom". She had a good lunch, then another lucid spell and asked my gal "What if I die"? My gal said "it will be ok Mom". Within 15 minutes she died with my gal holding her hand.

In both Mother's cases there was a time before death when I think realization hit - both mothers had sudden distinct moments when their eyes showed, I think, surprise. That's the best way to describe what we agree we both saw - surprise that, "oh! the time is now?!".

In both cases it seemed in the weeks before death that they were spending more time "elsewhere" - whether that was a real visiting with spirits of those who had passed on or angels or just a revisiting of old synaptic pathways really doesn't matter to me - the important thing is that for the dying person there was real joy in the visiting. A comfort for the future for those who still have that time to face.
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Old 04-28-2011, 03:17 PM   #56
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Calm, how very comforting. And I'm with you, I think there was much intensity to the hard work of preparing internally for death that my grandfather did in the days preceding his death. It wasn't sad for him, but it was all internally focused.

On a related note, I was looking up something about James Herriott (real name Alfred Wight) yesterday (he wrote the charming vet stories from Yorkshire) and read that his longtime vet partner Donald Sinclair killed himself with barbiturates days after his wife died and within months of Herriott's own passing. They'd all remained close and I guess he didn't want to be the last one. Sad, somehow.
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Old 04-29-2011, 04:37 PM   #57
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Old 04-29-2011, 08:42 PM   #58
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beach boys

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Old 05-01-2011, 08:19 PM   #59
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Old 05-02-2011, 12:16 AM   #60
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Interestingly, his last words to us were quite astonishing: He opened his eyes after sleeping for several hours, looked deeply at each of us, then stated unequivocally "We're Jewish, you know." This from a lifelong and very staunch Methodist!
Geez, this would make me run to check the family genealogy tree.

George Carlin would speculate that he was dreaming about telling a joke and woke up to deliver the punch line...
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