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neetsiepie

MIL update

neetsiepie
10 years ago

Oh boy, this just keeps getting more and more absurd.

A little backround: She has Stage 4 uterine cancer, it's actually a type of sarcoma. It has spread to her liver and was inoperable. She went thru a series of approved chemo treatment, but it did not provide sufficient success, so there was nothing left to do. However, her oncologist told her she'd be a candidate for a clinical trial, so she agreed to do that.

MIL is not educated and is not of high intellect. She did not fully understand the magnitude of her diagnosis, and her medical team never really explained it to her in simplistic terms. If they'd said 'you have less than a year to live' she (and her children) would have been better off. Instead, she was offered the opportunity for the clinical trial and her words "well, any day above ground is better than being below' and she agreed to it. I'd learned that it was really for research purposes only, she'd basically be a guinea pig, but since there were few side effects, and she was willing, maybe it would be ok. At least it'd give her more hope. I read over the side effects and in the zero to Guess what category my MIL fell in to? She might as well have played the lottery.

We just learned today that this was the cause of her liver failure. Now the oncologist has requested that we hold off on pallative care and continue pushing fluids to help her liver enzymes to stabilize. I don't know the exact numbers, but a normal liver enzyme count is generally a single digit. Last night her count was over 15,000. With the push of fluids it has now 'improved' to 12,000. IMPROVED. This is the key word...IMPROVED. This is the word that her sons (and new DIL) are hanging their hats on. But the reality is that the oncologist/trial supervisor NEEDS the numbers to come down so as to not have a serious impact on the clinical trial numbers.

There is no way her liver is going to function normally. Her kidneys are in failure, her blood is essentially plateletless-and there is a very good chance she has brain damage. If by some grace of God her liver enzymes come to be normalized, she will never leave the hospital-at a minimum will require nursing care for the rest of her life.

So, the small group of us who are more pragmatic and fact driven know that the 'improvement' is just a clinical term. She is never coming back to us. However, it has been agreed to wait 24-48 hrs and if there is no recovery of consciousness and liver enzymes are still not within a normal range, she is to go on comfort care-essentially hospice related care.

She is no longer coded as an ICU patient, as she has essentially been written off as a coded patient by the hospital (this is good in an economic sense-no sense billing at in excess of $5k/day for the room alone).

So this is where we are at-those who feel what is going on is inhumane and know barring a miracle, she is dying, and those who believe that there is a good chance she's going to wake up and ask for a cheese burger.

Ok.now that is not all. I was late in getting to the hospital today-apparently the oncologist called and spoke to the family (her sons) and explained the situation. They heard 'improvement' and 'could wake up hungry' and they believe that she's going to rally. (note that she has not had any food or drink in 3 days, her veins are collapsed and she has no urine output.)

At one point new SIL (H) got in a p*ssing match with MIL's step-daughter (Sue) who is her father's (B) spokesperson. B is the only one with the legal authority to determine MIL's treatment. B, via Sue, has agreed to the 48 hour time frame.

So H started being really snippy and got into it with Sue, Sue came out of the room shaking, and I decided we needed to put an end to this. H has been dictating everything since she got here yesterday afternoon-Sue and I have remained quiet because we don't want to fight in front of mom. I went into the room and politely asked H if she would step outside with me for a moment so we could talk. She refused and got all up in my face-now, realize, that I am NOT the type to take that-and I used all my professional skills and remained polite and asked her again to please come outside with me to talk. Long story short-she started yelling and causing a scene and was removed from the room. She then called BIL and, of course, said I'd kicked her out. I finally had a few minutes with mom and next thing I know BIL and H come storming into the room and he's screaming curses at me and H is glaring at me and I just kept calm and quiet-asked to please, lets not fight in front of mom. Finally THEY were pulled from the room, and I walked out so we could all go to a private place to hash this out. Sue, my DH, BIL, H and I all went to talk and I was so upset, I was having daggers shot my way-naturally *I* was the bad guy. I let Sue do the talking as I was so upset and I didn't want to cause a bigger scene. We finally came to an uneasy truce but it got ugly there a few times. Sue and I were accused to trying to 'pull the plug' and going behind their backs to do so. H had screamed at me that since I hadn't spoken to the oncologist, I didn't know what was going on. Heavy sigh...I got all the facts before I even entered the room with mom, but that is beside the point.

So we finally all got on the same page that Sue and I and the others are not sitting outside the door with the hearse, that we will not discuss final arrangements with them (but we did give the hospital direction). We'll respect their wishes that we won't be 'morbid' and they'll respect our being pragmatic.

But H got a little lesson on her place within the family-she said she thought they ought to buy mom a dress for the funeral. BIL told her his mom had never worn a dress-and I mentioned she hadn't worn a dress in over 50 years-when she had married their dad was the only time she'd ever worn one. Pardon my humor, but mom would not be caught dead in a dress. And besides...she is to be cremated-no funeral, no casket. Other comments came up to remind H that I had been part of this family for 24 years and I have been thru their father's death, mom's original fight with cancer-I've been to all the oncologist meetings-I know her medical history intimately-she and I have a lot of history. Once BIL acknowledged that, he and I were a little better-but H had her nose out of joint.

Ahhh-the drama of families.

In any event, there is no hospice-she's not going to leave the hospital this week. If she does, we'll look into that, but she'll need full time nursing care. We're planning to have her DH move to his son's house, so their apartment is to be packed up soon. The boys will have opportunity to go get some of mom's personal things before then, and we made it clear that no one is trying to take over. LEgally her DH gets it all-it's even in her will-so that should stop some of the fighting. My DH is the executor (BIL was pretty shocked that we had a copy of her will-we've had it for 20 years!). So the drama will likely continue, and moms' suffering will continue a few more days. But honestly, I don't think she's going to make it that long. She is incredibly jaundiced, has no cognitive ability, even involuntary movements and sounds have diminished considerably. When her eyes open involuntarily, they're yellow and there is no recognition in them. I am mourning her now-the little pest who I had an incredible love/hate relationship with is gone-now there is just a poor, wretched body hooked up to an IV and a heart monitor. There is a DNR, and we agreed no central line (her body can't take it any way). So no food, nourishment other than glucose, and just some IV pain meds. I pray that she goes peacefully soon.

Comments (29)

  • Annie Deighnaugh
    10 years ago
    last modified: 9 years ago

    Wow! Families are never easy, are they.

    It sounds like her chemistries are so awry that most likely she is not aware enough to be suffering. Hopefully, they have her on whatever pain meds she needs.

    If the liver failure was due to the trial treatment and it helps speed her demise, it may actually be a good thing....with terminal cancer, you don't want anyone to suffer for any length of time.

    I'm so proud of you for keeping your temper in the face of someone going ballistic on you. Very hard to do, but so necessary in that situation.

    Hang tough, kiddo!

  • golddust
    10 years ago
    last modified: 9 years ago

    I'm sorry, Pesky. Sounds like a red hot mess. Still think Hospice would benefit te family. They can come to the hospital...

  • liriodendron
    10 years ago
    last modified: 9 years ago

    Oh, Pesky,

    I am so, so sorry for you and all your family, even your plague-ed SIL. I send you all the comforting energy I can summon to give you peace and calm.

    I am sure your MIL knows that you will do what's necessary and in her best interests, when all is said and done- and that you have the strength to handle it all, and take care of her son, your DH, as well.

    I will hold you in my thoughts over the next fe days..

    Liriodendron

  • DLM2000-GW
    10 years ago
    last modified: 9 years ago

    Reading all of this makes me so sad for you and your entire family. The passage from here to whatever it is that comes next for the elderly and very ill should not be fraught with such anguish and acrimony. You're showing a great deal of restraint and calm in the face of turmoil. I wish for your MIL's sake that things were different. I agree with golddust about hospice - they do come to the hospital. We had hospice come to my father's bedside and they were incredibly helpful. They broke down the medical jargon and helped everyone (including my father who was fully lucid) understand what was coming next. I'll be thinking of you and hoping for a peaceful end.

  • Bethpen
    10 years ago
    last modified: 9 years ago

    Pesky,
    My thoughts are with you during this difficult time. It sounds like a horrible time.

    Beth P.

  • User
    10 years ago
    last modified: 9 years ago

    Sending my comforting thoughts to you and your MIL and extended family. In my years of Home Health Nursing I saw families in this situation. The conflicting abilities to accept death as the natural outcome of life is common , unfortunately. Hospice is seen by far too many as a sign that you have given up . Far from it ...it shows that you are willing to accept help. I hope for your MIL's sake that her suffering ends soon. c

  • PRO
    Diane Smith at Walter E. Smithe Furniture
    10 years ago
    last modified: 9 years ago

    Thinking of you pesky. Your family is lucky to have you.

  • golddust
    10 years ago
    last modified: 9 years ago

    Thinking of you today. Hang in there. Maybe her Dr will refer her to Hospice without being asked. Sounds like your family would really benefit.

    Off to my local Hospice fundraiser at 'The Butterfly Garden of Rememberance'. I'll think of you.

  • hhireno
    10 years ago
    last modified: 9 years ago

    What a terrible situation but I'm so glad to read you still have a sense of humor (wake up and ask for a cheeseburger). That fact that you can still find some humor AND remain calm in this situation speaks volumes to your good character.

    Stay strong and rational. I wish you peace and calm during this difficult time.

  • hilltop_gw
    10 years ago
    last modified: 9 years ago

    Pesky, I've followed your situation on here for a long time. I'm so sorry you have to go through this. It's a tug of war on emotions and a power struggle with family ties. And then to have the slow lingering process. Sending warm thoughts and peace to you in this challenging time.

  • cyn427 (z. 7, N. VA)
    10 years ago
    last modified: 9 years ago

    Pesky, a little "refrigerator magnet wisdom" Peace. It does not mean to be in a place where there is no noise, trouble or hard work. It means to be in the midst of those things and still be calm in your heart.

    Don't let them get to you. I wish you peace during this time.

  • theroselvr
    10 years ago
    last modified: 9 years ago

    I pray she declines as quick as my dad did & goes as peacefully too.

  • neetsiepie
    Original Author
    10 years ago
    last modified: 9 years ago

    I spoke with my DH this morning-her kidneys are shot and there is no urine output-she's essentially drowning in fluids. But yet, she struggles.

    We discussed that it's probably best to tell her it's ok to let go-they will be fine-but she can let go now. He does not want to do that, and that's up to him. When my Dad was struggling to stay, I told him just that-that it was ok to go, I'd take care of mom and all would be fine. He relaxed and went peacefully shortly thereafter.

    But I fear she's going to fight it and it's going to be terrible and DH will witness that and that is not what he wants to do. He also doesn't want her to die alone (which I believe would be her preference). I just pray it's soon. But from what DH tells me, they're continuing to interact with her like she's about to get up and walk around. She's very agitated so she's on Ativan. But I apparently am Dr. Kevorkian so I won't say a word to them. I'm staying home today and I really hope it's today-and that it's soon.

  • mitchdesj
    10 years ago
    last modified: 9 years ago

    I agree with you Pesky, you are level headed even with your injuries and pills…

    Still, I wish you continued peace and calm in this trying time.

  • allison0704
    10 years ago
    last modified: 9 years ago

    When my grandfather started dying, it was very hard and sad to watch. Thankfully, he went quickly. I hate to see anyone suffer.

    Is her DH holding on to any hope, or just her sons? I also agree with you.

  • hhireno
    10 years ago
    last modified: 9 years ago

    A Hospice nurse told my friend's family, sometimes you should leave the patient alone because the patient wants to let go and die but they don't want to or can't do it in front of family.

    How many times have we heard "I just left the room for a minute and when I came back they were gone." Her advice was to give the patient that opportunity. They know they are loved and will be missed so giving them the space to finally go can be helpful.

    This won't help your MIL, because I think it's wise that you stay out of it, but it might help someone else here when they are faced with a similar situation.

  • theroselvr
    10 years ago
    last modified: 9 years ago

    You're a very wise woman. I hope at some point; they figure that out too. It's hard to let them go; especially since it sounds like she quickly declined.

    I wonder if you asked DH if they can handle her losing more of her dignity each day? How would she feel knowing that they are watching her lose her dignity?
    Has her body cleaned itself out yet?

    Hugs

  • judiegal6
    10 years ago
    last modified: 9 years ago

    I just lost my dad the day before mothers day. He had been in a nursing home or hospital for several months. Hospice was wonderful not only for him but for the family too. A hospice social worker spoke with us on Friday and suggested that I get in touch with everyone as he wasn't expected to make it through the weekend. My mom and all of my siblings spent the afternoon and evening with him. The SW let us know that we should talk to him and let him know it was okay to go. We all left that night and by morning he was gone. I'm so glad we all got to be with him, but I do believe he wanted to be alone at the end. He was 92 and the sweetest man you could ever know. I miss him.

  • allison0704
    10 years ago
    last modified: 9 years ago

    I'm sorry for your loss, judiegal. I second hospice. They were wonderful with my grandfather and more recently my MIL.

  • graywings123
    10 years ago
    last modified: 9 years ago

    Hhireno, the idea that people may want to be alone when they die is something I have never considered. Thanks for mentioning it.

  • OllieJane
    10 years ago
    last modified: 9 years ago

    Being alone may be for some people, but some may not want to die alone. Of course, they are so out of it, we really don't know. My dad, brother, sister and I were there until the very end with my Mom, who passed away this last October, and I know she would have wanted it that way-she wanted her loving family there. And, as sad as it was for us being there, I would not have changed it. We did, at one point tell her it was okay for her to leave us, and that we would be okay, and that we would all take care of Dad.

  • Oakley
    10 years ago
    last modified: 9 years ago

    Judie and Ollie, I'm so sorry.

    I'm not an expert by any means, but Pesky, since there's so much infighting within the family, is there one person in the whole world that your MIL is very close with and could be with her at the end?

    As much as I adore my DIL, I would only want my DH and DS's to be with me. I could never be comfortable with anyone else being there.

    Have the two brothers stayed with her by themselves? If not, it might be a good idea. No offense to you or your SIL, but there are times a mother just wants to be with her children, because this is the most personal situation she'll ever be in.

  • golddust
    10 years ago
    last modified: 9 years ago

    Oakley, I don't think we know what we are going to want or how we are going to feel until the time gets close.

    My MIL got nervous when I was away. Everyone told me she would ask for me repeatedly. "When is Golddust coming home?" As her needs became greater, she appreciated a female helping her with dressing, toileting and hygiene. Her sons were clueless. They were loving, willing and wonderful - but totally clueless and uncomfortable. I didn't leave her once in her last three weeks. Her sons would do anything at all, including taking the dogs to the vet, so they didn't have to stay with her alone toward the end.

    Better make good friends with your DIL. I think your DS will delegate your care to her more than you know. My MIL deeply loved me and appreciated me stepping in when she needed help. She didn't think anyone would be there for her.

    After caring for three elders until their death, I have no fantasies about old age or the rocky path toward death. It isn't usually pretty and I watched my MILs sons look to me for their Mother's care. They even looked to me for the way they should act around her. I told my MIL that her cancer had returned in front of them. (They thought she shouldn't know, rather than tell her themselves.) They supported me to take care of her and I have a lifetime of points in reserve because of the awesome care she got.

    If you alienate your DIL, you will also alienate your son. He will chose her over you, as it should be. Your best hope is to make your DIL love you. She will be wiping your butt, not your son. Trust me.

  • graywings123
    10 years ago
    last modified: 9 years ago

    I think Oak was talking about that very last moment of life, not the days and hours leading up to it.

    I know that I could likely end up as the butt-wiper for my MIL in hospice care, but at the end she would choose her good-for-nothing sister to be with her.

  • tinam61
    10 years ago
    last modified: 9 years ago

    I agree with Olliesmom. Everyone is different, but I cannot imagine leaving a loved one to die alone. I dont' know what I would do if someone made that request. I was present with my MIL, my husband and a very close family friend was with us when my FIL passed. My FIL knew we were there. When my own mother passed away, all of her children, our dad and a daughter-in-law were present, along with one of the caregivers who had helped us take care of mom during her illness. Mom loved those girls and it was comforting to us to have her there during the end. I remember she went outside afterwards and cried like a baby. We had wonderful help who truly came to love our mom. We were so blessed to have mom at home during her illness and to care for her and have family and friends able to visit and say their good byes. Hospice was a true blessing and I strongly encourage you to use them Pesky. They come to hospitals, etc. We have them for my grandmother at this time - they come to her assisted living facility.

    tina

  • golddust
    10 years ago
    last modified: 9 years ago

    Graywings,

    Sure she was but I can't imagine being asked to leave my MIL's bedside as she was dying. Not after all we went through together. Oakley said she would not want her DIL present.

  • Oakley
    10 years ago
    last modified: 9 years ago

    DIL and I are excellent friends. And Grays right, I'm talking about the last moments of my life. And of course I can't really say how I'd feel at that moment either. It just seems to be such a private and personal moment that I wouldn't want anyone else to see me that way except for DH and DS's. Now if DIL was there I wouldn't kick her out of the room. lol.

    I'm taking a wild guess here, but it seems there could be some embarrassment in dying from the patients POV. If there was a room full of people and I was being told to go ahead and pass on, (if its really that easy), I couldn't do it. I'd wait until everyone left except my family.

  • hhireno
    10 years ago
    last modified: 9 years ago

    I can't speak for the hospice nurse I mentioned but I don't think she meant abdandon them. I think she meant giving the person some quiet time, without the room filled with grieving people, without constant reassurances, without the restless energy of people waiting for the inevitable. I think it was also a reminder that the family needs rest, because after the death there are many more difficult days ahead.

  • User
    10 years ago
    last modified: 9 years ago

    Pesky, I am so sorry to read this, both of your MIL's decline but the family feud. Watching a loved one suffer is hard enough when the family is united. My prayers are with your family and that you can come together before you have to deal with her estate. You sound like you have a good head on your shoulders and know when to speak and when to back off. That's a rare gift.

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