I think my mother in law is getting ready to die
 

I think I have mentioned before that besides looking after various grandchildren I also help take care of my mother in law since my wife travels so much. Mom is close to 90 and up until now has been pretty much self sufficient. She lives in a senior living apartment facility, she cooks her own meals and other then using an electric wheelchair she is pretty independent. I take her to doctor's appointments since she forgets what to ask or remember what they tell her. I try to get her out once a week, her favorite lunch is the all beef hotdogs at Costco! She recenltly began having symptoms of Parkinson's although her tremors are mostly her right arm. We saw as Neurologist who said she is in the beginning stages.

Since early December we have noticed a real decline in her and her daily routine. She's gotten more forgetful, sometimes a bit confused and forgets to take her pills that we put out in daily doses. In January it became more obvious that she wasn't eating. I took her for a checkup with her family Dr. who we see about every 90 days so Medicare will approve her bath aide and a home health nurse and she had lost 14 lbs since August when he weighed her last.

But this week we think she is beginning the shut down process. She pretty much quit eating. She might take a bite and then say it just doesn't taste right. She also is drinking very little. She has developed a sort of tick where she licks her lips, it could be because she is getting dehydrated. She says she is not in any pain, not hungry or thirsty and is not sick in any way as her BP is great and no fever or anything. She has stopped watching TV which used to be her main companion other than her little lap dog. She just sits and pets the dog and looks out the window. She is very happy overall. We have asked her if she would like to see the Dr. or go to the hospital and she is very insistent not to do that. At the hospital they would probably give her IVs and get her back to normal but probably would not discharge her to go back home and insist she go to rehab or a nursing home. That would be very unpleasant for her.

My wife and I and her brother (only 2 children) have the belief that she is ready to die, perhaps voices from beyond are calling her to come and she is just tired of life. We feel like as long as she is comfortable and in no pain we will let her go. She has been widowed for about 12 years now, shes has no friends to speak of, only the family here.

Yesterday I went to a local funeral home to get prices. I had looked online a few months ago and saw the local place offered an online special for $1695, it was quite basic as that is what we want. They pick up the body, cremate on site and you pick up the container of ashes. We plan to scatter them at sea as we did with her husband's. So when the nice guy told me their basic package was $2400 but included things we didn't want I felt like when you go car shopping and try to get the price down. After a few minutes he agreed that they could do it for $1695!

Today I pulled all the legal paperwork together, powers of attorney, do not resuscitate, her will, etc. Just being proactive. She owns no property other than her personal belongings. The funeral home guy said if she dies in her apartment to call 911 and when the paramedics arrive show them the "do not resuscitate" and they will contact a Justice of the Peace Judge who will issue a death certificate and then the funeral home will be notified to come pick her up.

Anyway, that is what's up with us. I'm thinking Monday will be the day.

Chris, you've clearly got your shit together.

You've got what seems like all the "business" contingencies covered. The social ones are less well defined, at least as important, some more so.

I am hoping for the best for you and her and all your family.

Is there anyone else who might step in against her wishes and send her to the ER when you aren't around? A night shift nurse or somebody like that?

Make sure everyone around her knows what her wishes are and has a copy of her DNR and advance medical directive. That includes the night shift people.

When I went through this with my elderly cousin, they knew his wishes were to have no IVs to hydrate him, but they took a blood draw, found high white blood cells, and gave him IV antibiotics which happened to be in a saline solution delivery device. So they hydrated him under the guise that it was medically necessary to treat the suspected infection. And since the course of antibiotics was several days, they were prepared to have him hooked up to an IV that whole time. Medically necessary to treat an infection even though his paperwork said no IV hydration.

He died anyway, but the IV kept him alive a couple days longer.

Pisses me off to this day that they went against the legal documents. It was the night shift workers. He was in a rehab place that was trying to delay his move to hospice care so they could wring every last medicare payment out of him.

It sounds like she's seen the wolf. I hope her wishes are respected.

Thinking of you Chris

Chris, you are wonderful. Every family needs a Chris. tough days ahead

Im so sorry buddy..... I will say a prayer for your mom now http://i59.tinypic.com/72tuzr.gig

I was telling a friend about this tonight. She just paid $6000 a month ago for her mother's cremation, with no viewing, no ceremony, Just ashes back.

It is unfortunate to say but society will take care of that service if you do not buy it.

"Society hates a rotting corpse." - Jackie Kashian

I tell my loved ones now, if there are any left, my greatest wish is that you efficiently get rid of the biological waste that is my dead body, at as little cost as you can manage. Please do not spend anything on this.

Keeping you in my thoughts Chris.

We'll be praying.

My father's cremation frills free was $1900. He always wanted a service with a 100 cars behind the hearse. Alas he outlived all of his friends and decided on cremation.

tarheel

Thanks to all who replied. It was a busy week what with my mother in law, my wife and her pill-cam and me helping my 10 year old granddaughter get her science fair project done!

So today is Sunday and my mother in law has not eaten anything really since Wednesday which was a few bites of a hamburger, she probably has really only had 6 ounces of solid food in the past week. She only drinks a few sips of water and sometimes some lemon-lime soda. But she is happy and not complaining. She says food just doesn't taste right.

We took her blood pressure last night and it was 114/56 with a resting heart rate of 60. She has no fever and feels comfortable to the touch. Her color is good but if you pinch the skin on her arm it takes several seconds to retract which is usually a sign of dehydration.

This morning I told my wife we should try to get there a little earlier than her usual time for getting up around 10 so we got there at 9:30 and she was already up in her recliner with her little dog in her lap. She said she slept ok and had just got up. I worry she might fall from a bit of dizziness or weakness and then break a bone. Then she would have to go to hospital and might never come back.

I suggested to my wife that we get some adult diapers. Right now she uses Depends type ones but she might get to where she is bedridden and those will be harder to get on and off. That is what we had to do with my mom. And we got some baby wipes and latex gloves. I don't think she has much in her digestive track but better to be ready.

She is in a Senior Independent apartment complex so she lives on her own. We do have a bath aide who comes on Tuesday and Friday to bath her, we have alluded to what may be happening but so far mom is fine to sit in the shower stall with help and get bathed but I think that will stop next week. Also a home health nurse comes once a week who is also aware of some of what is going on. She says she would contact us first if she is worried about her. And I have the Do Not Resuscitate request there in case we need it. This is a different situation from what I dealt with on my parents who both had home hospice care. For that a hospital or Dr. had to order it. But mom hasn't seen a doctor or gone to a hospital. She has no symptoms that would suggest she do that like a fever or pain.

I've been doing some reading up on this stage of life as the body prepares for death. She could go 1-2 weeks without food and water especially if she is getting a bit of liquids to keep the mouth moist. She may have bursts of energy but will slowly get to where she will only lie in bed. She is sensitive to noise, this is common. I think that is why she either has the TV off or turned on with no sound. She mostly looks out the window, pets her dog who loves being in her lap or next to her. She dozes in and out. We go by at 7:30 or so and get her into bed, she sleeps the whole night getting up at 9:30-10. I think her soul knows it is time to go.

My wife is in town for the next 2 weeks. We are pretty sure something will happen before that time passes. Her brother decided not to fly in this week, he was here last month and visitors sometimes cause the person to rally and hold on. He doesn't want to be the cause of her prolonging what will happen and maybe suffering.


It's just a wait and see.

Yes, it's a drag when you know it's time, they know it's time, and you're both just waiting. It was that way with my grandparents and my mother. But you have no choice, try to think of things you may want to ask her before she's gone.

Ach damn, Chris - a sad time. But at least it doesn't sound like she is suffering.
Glad she has her little dog with her.

Hugs to all - am thinking of you

X Dani

It sounds like the absolute best possible way to go. I'm glad she's relaxed and in no pain.

Yesterday morning my wife and I discussed Hospice care. Having had home hospice for both of my parents and my wife dealt with it briefly with her dad we felt that if mom holds on but grows weaker it will take more than the 2 of us can handle. There is also the issue of when someone dies at home on their own. With hospice they handle the death certificate but if you don't have hospice you have to deal with the police and possibly the county morgue and sometimes a autopsy is required. So I found a local Hospice center that can does home centered care. Mom just doesn't want to leave her apartment and go somewhere unfamiliar.

A lady with the hospice came out yesterday and we signed everything, well I signed. I am the primary person for medical and legal power of attorney since my wife travels so much normally. The lady was so surprised how involved we are with mom and that we were so involved with other family members with hospice. She said most families don't want anything to do with it and prefer to not be too involved which I find sad. Today a nurse is supposed to contact me to come out and go over the medical history and medications. I called her GP Dr. this morning to tell them the hospice will be contacting them for records. Also the pain management Dr. since he prescribes her pain patch.

We stopped by to check on mom at 7:45am. today We were surprised to find her already up and sitting in her recliner with the dog in her lap. She was watching a cooking show, first time in a few days she has actually turned on the TV. It has now been a full week since she has eaten anything, just bite or 2 that day and her meals were very hit or miss the week before. She is typically only drinking a few ounces of liquid during the day. Hard to figure out how she has the energy to get up each morning or how much longer this can go on.

Neither my wife or I slept well last night. We both were thinking about what is going on with her mother. I'm trying to figure out what the heck we are going to do with all of mom's shit and she really has a lot of shit. She has a 2 bedroom apartment that is chock full of stuff. She was a crafts person as well as a doll maker so on one wall alone we have about 300 porcelain dolls that she made from scratch; pouring the slip into molds, firing them, painting details like freckles, eye lashes, lips, putting in eyes and hair and making the clothes. They are all different and unique. We put in her will that every granddaughter and great granddaughter should take whatever they want but that will still leave a great deal. She also has loads of little chathkis in curio cabinets and on shelves as well as hand painted plates and other things from her craft making days. And some butt ugly furniture. Plus 2 closets full of holiday decorations and I mean decorations for just about every holiday on the calendar. Maybe we can sell what the family doesn't want or need on Craig's list or eBay.

Sounds like you know what you are doing. Good luck, Chris.

There is always the Salvation Army or Goodwill for excess stuff, they'll take even butt ugly stuff.

Hello Chris,I wanna thank you for keeping us informed....... I think we all care very much!

Peace and love to you http://i59.tinypic.com/72tuzr.gif

This has been an interesting couple of days. My wife's oldest child came from Rochester. He is the son she had before she was married and put up for adoption. They reconnected about 12 years ago. He still lives in Webster, near Rochester and is only about 2 miles from where my wife lived and went to high school. The funny thing is that he looks a lot like my wife's late father, would be his grandfather. Anyway he wanted to come to see the only grandmother he still has before she goes. So he was here from Thursday until Saturday. He and my wife's other 2 sons spent most of the past 3 days here with their wives and some of the kids. The older teenager grand kids know that something is up with their great grandmother and seem to understand she is dying. The younger kids are less aware. So it was a bit lively here but my mother in law seemed to enjoy all the company. They ordered some pizzas Friday for lunch and my mother in law decided to have a slice. She ate about 2 bites of the topping and said that was enough. Other than that as of today it's been no food for 10 days.

We come over each morning to get her up at about 8am. We figure at that point she has been in bed about 12 hours and she really likes sitting in her recliner so we get her up. We switched to the small portable wheel chair for getting her to and from the bedroom to the bathroom or family room. I was getting worried about her ability to control her electric wheelchair with her being quite weak. She still passes a bit of urine, albeit the color is starting to get darker. My wife brushes her hair and gives her a warm wet washcloth to wipe her face. She rinses her mouth with some Listerine. Then she is led to her recliner, it's a motorized one so it raises up to help her stand or sit without a lot of effort. Today she seemed awfully weak, as I put my arms around her I could feel her weight and was careful that her legs did not buckle. Not sure if by Monday she will just need to remain in bed. At least Hospice got us an electric hospital bed.

I take her blood pressure every morning just to see what it is. Other than one morning last week where it was very low it really isn't too bad. Today it was 112 over 48, her resting heart rate was up at 72. I have one of those oxygen sensors that you put on the tip of a finger and it read 95 which is pretty good. But she is sleeping more now, she only wakes if she is startled. I think it says a lot about the body's ability to keep going.

When the kids were here over the weekend we talked a lot about all the things we need to find homes for here. I found a Facebook group for local garage sale type things you can list for free, sort of like Craig's List which we also have here. So I think the remaining furniture will find new homes. And I'm going to set up an Etsy store for the dolls that will be left over. I found handmade ones like hers on Ebay and Etsy and they typically go for $10-50. They are just to nice to discard or give to a thrift shop and we figure the money will go towards paying off the cremation, etc. She doesn't have any other real debts.

The hardest decision is that we think we decided we will put down her dog afterwards. The dog is 13 or so and not in good health. She has had 2 surgeries for stones in her bladder, a result of my mother in law always feeding her human food, especially dairy products like milk and cheese. If mom had a bowl of cereal the dog got one, too! The dog is like her shadow, follows her everywhere and sleeps in her lap, I don't think she will know what to do when she is gone. She also is not very well house trained and not social with other dogs so it makes it heard for other family to care for her. Tough decision but we feel it is the most humane.

My wife took off Thursday and Friday and figures she will be here Monday or until it's over. I come and go, Sitting in her apartment is like watching paint dry, there isn't much to do. My wife just wants to be here for her mother, she's been doing picture puzzles which is something I never have enjoyed doing.

Thanks for the update Chris. My mother who kept dogs all her life was always adamant that any that survived her should be put down rather than being a burden on anyone. I'd say your decision is the kindest for the dog. All I'd say is could you or your wife (or someone else the dog is familiar with) be at the vet's when the dog is put down.
Otherwise it sounds like MiL is readying herself to go. You are good people. x

My heart is heavy for you all. Glad though that it seems you are all so well prepared.

My Doctor told me any oxygen level over 90 is fine. 95 would be very good.
I agree on the dog, it won't get over the loss and be very difficult for someone else to manage.

I'm glad you're planning for all of this.

We are at 16 days now since she stopped eating and is only having a few sips of water the past 2 days. Hospice gave us these little Q-tip like sponges you dip in water and moisten the lips, we put on lip balm as well. She is talking very little today, only whispers faintly and then drifts off. I took her blood pressure today, it was 72/49 with a heart rate of 62

I suggested to my wife that we pick out a nice dress for her to wear after mom passes, I know she never liked to go out of her apartment if she wasn't dressed properly and with a bit of lipstick and makeup on. I also asked her if she wanted to inquire from her sons if they would like to come by to say goodbye before the funeral home is called for service. We are cremating her and there will be no viewing or service other then a party type family get together later on. I think it's good for closure but both boys said they would need to think about that. Their father died of cancer in 1996 and they didn't process through the death very well.

Not sure what to do with the ashes. My wife's father died 8 years ago and was cremated but at that time her brother had a huge catamaran in Newport Beach. It was 65 feet long and 28 feet across so we took out about 25 family members and put his ashes in the Pacific. But her brother sold the boat. He has one in his part time home in Tahiti and that's kind of an expensive trip to go on. I looked into doing it off of Galveston but it would cost $750 and they can only take out 16 people. My wife still has her first husband's ashes in a nice box on a shelf in our family room and we also have an urn with our first dog's ashes. We don't really need anymore!

The kids are coming this weekend to start picking out things, we might get some things moved out. We only have until the end of February so just 2 weekends. We won't get Social Security or her pension from her husband's fund at Xerox so it all needs to go somewhere.

Waiting for someone in the final stages to die is the same as waiting for a baby to be born, no set schedule and they just do it in their own good time.

you are an inspiration, Chris. Best wishes to all

I agree, monster hit the nail on the head.

If she hasn't had a full thyroid workup, get it done (and do T4 and T3 tests, NOT just TSH). 80% of people over age 50 have some degree of tissue hypothyroidism due to reduced ability to convert T4 to T3. Further, one aged-care facility found (via autopsy) that 26% of their patients had some degree of hidden goiter due to undiagnosed low thyroid. MOST of what we think of as the "symptoms of aging" are actually due to this. It's possible that it's just her time, but even so this is well worth looking into.

The usual levothyroxin (synthetic T4) treatment alone CANNOT fix poor conversion; the patient needs replacement T3 either synth T3 or as natural thyroid, which will probably require chasing her doctor with a stick as most will not do it.

In fact, with ALL chronic or debilitating conditions, thyroid should be the FIRST thing looked at, rather than the last resort as is so commonly the case. Thyroid affects everything. Frex, one study found that about half of all fatal cardiac events were due to the effects of low T3 syndrome.

I would bet she has multiple symptoms, but they've all been dismissed as "due to her age".

My own hypothyroid condition went undiagnosed for 30 years despite 50+ different symptoms. Having discovered that most doctors know very little about thyroid disorders that aren't perfectly textbook, I've had to take up reading the research literature in sheer self-defense.

Wish her the best.

Welcome to the Cellar Reziac. http://cellar.org/2015/seeya.gif

welcome to the cellar Reziac. :)

Reziac, what would be achieved by this at this point?

I'm not convinced Reziac read the thread.


Sent by magic.

I know everyone expects my next post to be about my mother in law actually dying but she is proving to be one tough patient! Today marks 20 days with no real food other then a bite or 2 of some pizza topping 9 days ago! Gandhi went 21 days without food and only some water and survived but at her age and in her already weakened state it seems to go against what one would consider normal. I'm reminded of that scene in The Search For The Holy Grail where the man is picking up the dead during the plague and the one guy keeps saying, "I'm not dead yet!"

It's also quite amazing that she has moments of lucidness and is alert and can talk to a grandchild or her son on the phone. Granted the conversations are getting shorter.

As I had mentioned earlier my mother in law has so much stuff around her apartment, she has always had a problem with letting go of things. My wife figures she just doesn't want to go without all her stuff.

I'm headed over there in a bit, my wife texted me that mom is sleeping but I know I need to take her dog out and then change mom. My wife is not able to do it, it takes more upper body strength then she has. Thankfully without food intake the diapers are mostly just wet. My wife has her laptop and iPad but other than that it's just cable TV which we don't have anymore at home. I've watched it a bit and it only makes me happier that we don't have it anymore. Nothing but reruns and commercials and second rate shows in my opinion.

Oh well, I'll keep you all posted. Here is a picture of her sleeping with her little dog beside her.

Thinking of you and praying for her.
What Monster said - you are an inspiration! ... and "it didn't read the thread.

Well it's Monday and mom is now not eaten food for 26 days! She is weak and sleeps a lot but then wakes and is very talkative. She still only drinks 10-20 ounces of liquid in a day (water or sometimes some 7Up). I've started using some of the medicines in the hospice E kit. A bit of morphine for pain, haloperidol for anxiety. We have packed out most of her apartment other then what is in her bedroom or the bed my wife is sleeping in, a table and some chairs. The kids took quite a bit. I put some of the stuff on Craig's List and sold her electric wheelchair for $300 which is about all it was worth as it was pretty used.

We joke that she paid for a month's rent and wants to get her money's worth so is waiting for the end of February. And then we joke that she should hold out for March 1st so she can get another Social Security check and one from her pension as well. If she dies before Wednesday we are going to be hard pressed to clear out the rest of the apartment but we figure there isn't much the apartment management can do!

I took this picture of her on Saturday. Her dog loves to have her tummy rubbed.

She's a handsome woman, I'll bet she was a knockout in her 20s.

She looks content and comfortable.

You're a good son, Chris.

She does look happy :) Thank you for not palming her off on strangers and letting her do it her way in her time.

Thanks everyone. Today was very strange. Her dog is about 14 and acted really strange all day, at one point shaking and would only lie under mom's bed and not up in it. She had a stroke last year and recovered but it's like the dog senses how bad her master's health is and is bonded to her. Sounds silly but like in that scene towards the end of ET where they bonded in spirit. It would be great if the dog goes with mom, we could then just put their ashes together. OK, just kidding. But it is very strange.

I made a big spur of the moment dinner for my wife, her brother and son and myself. It was homemade meatballs and spaghetti. It turned out pretty well and even better after we opened the 3rd bottle of wine. I joked that the guy who picks up the trash 3 times a week might not know about mom dying so he might just wonder why she is drinking so much with all the wine bottles we keep tossing out.

So we got to talking.... if she dies tomorrow is it ethical to not tell the hospice nurse until Wednesday so we can get into the next month and get the rent covered. Just wondering. Mom always loved a good bargain so she might approve.

You do what the hell you want man.

Well today is March 1st so she will get another Social Security check as well as one from her pension. We spoke with the business office for her apartment complex which is geared towards seniors. They said the grace period is the 3rd so if she dies before then we don't need to bother with rent. But if she goes past we pay for the month and then if she checks out early they refund part of the rent. That seems fair enough and they said someone from her old senior's apartment gave her name as the referral that brought them to check out the new place. If that person signs the lease then mom gets $1000 referral fee!

Here is a picture from yesterday. Her dog decided to come up and share her pillow. As the days go by she continues to loose weight and the liver spots get and wrinkles get more noticeable. She and her late husband lived in the dessert in Arizona so her skin has a lot of character. I actually think the lines are quite beautiful.

Those lines are medals for experiences she had and wisdom earned from them. She's got been there done that all over her face. :biggrin:

What a lovely picture.


Sent by magic.

Her color's better today.















what?

Saturday was a hard day, my mother in law's body was running on auto-pilot in survival mode at this point. She had now gone 31 days without food and almost 3 without anything more than a few ice chips and the occasional morphine I administered; she could no longer really swallow and we had to be careful she did not aspirate. Her breathing was strained, her blood pressure was up and down from 172/135 to 78/39 and her heart rate skipped from the low 40s to 138. Her eyes stayed wide open staring at a spot on the ceiling. The human body tries very hard to keep on going.

The family came again, her grand kids and a couple of the great grand kids. We continued packing things up and after dinner we left and my wife stayed another night. At about 1am she woke up, she said sleeping was hard there but she felt like something woke her so she got up to go check. Her mother had finally stopped breathing, she must have died a few minutes earlier as she was still warm to the touch. She called me and I came back over. I checked her pulse but it was pretty obvious. We called the Hospice nurse who came right over. She had to record the time of death when she arrived, 2:16am. I cut off a rose from a bouquet by her bed and put it in her hands, I tried to shut her eyes and mouth but rigor mortis had already begun. I took some pictures.

My wife called her sons, one came over with his wife to sit with us. The undertakers were busy with another call so it was 4:30 when they got there. They were both large men in dark baggy suits. If they had fedoras and sunglasses they could have been Jake and Elwood from the Blue's Brothers! After they left mom's dog was very confused, she kept looking in the bed as if saying, "Where did you go? I know you were here a few minutes ago!"

When the nurse and left we turned off the lights and went home, it was 5:15 and we got a few hours sleep. We met up with my wife's son's and their wives later Sunday morning and spent the day moving things out. We got a U-Haul and took furniture to both of the son's houses and a lot of stuff to my house. It rained off and on which made it a challenge. We had to finish up on Monday and turned in the keys.

My wife asked about doing a memorial get together at the retirement center for the people mom knew. She asked about using the conference room where they hold events. The Director said that wouldn't work as we would need a much bigger room, he suggested the large dining room. "She knew everyone here" he said. "I think all the resident will want to come out for her". That was nice to hear. Mom wasn't too social but was always friendly to everyone and she was one of the first tenants when they opened 3 years ago. We plan to do something in April when my wife's brother and his kids can come. On Monday one of the hospice nurses called and said she would like to take mom's dog. She's an old dog with health issues and none of the family felt they could take her. The nurse said she had a similar type dog and texted us later that both dogs hit it off and were doing great.... happy ending I guess.

In the end it was a long journey. We are still so exhausted. I will miss her as we became great friends over the past 18 years. Often I was the one who tried to ease the everyday tension between her and my wife when they weren't seeing eye to eye. I took her to her doctors, I was her driver and her advocate. I took her to breakfast or lunch, she loved the hot dogs at Costco. I knew she was lonely at needed someone to talk to.

This was my last picture of her. I have no problem or inner conflict with photographing the dead. The body is like a broken boat you find on the beach after a storm. It made the journey and it's passenger has moved on. For me the body is beautiful in all aspects of life from beginning to end.

You did a good job, Chris.

Please give our condolences to the fam, Chris.

Yes Please, and remember you done good.

:hug:

:cry:

Poetry.

Well done, it sounds like you maintained the perfect balance of compassion and pragmatism. :notworthy

I'm so happy for dog to find a playmate and a caring owner.

You went above and beyond, and she was lucky to have you (as is your wife.)

:flower:

Thoughts and prayers to all of you. You're a damn good man, Chris.

Well done Chris.

My thought are with you and your family. You did well by your MiL. X


Sent by magic.

My condolences, Chris. I know you did your best and I've been sending prayers your way.

I was a tad queasy about the dog, but very happy with the outcome. My mother's dog was put down despite my offering to take her so that hit kinda close to home for me. Plus, I'm a huge dog person. My will covers all current pets, just in case.

Well done.

Ya did good buddy!

Peace and love http://i59.tinypic.com/72tuzr