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In the final month of my mother in law’s life my wife felt like her care was failing her mother.
First she was concerned that her mother seemed depressed. Her mother started not wanting visitors, she wouldn’t get out of bed one day when my son was visiting. She lived for social interaction, so this behavior was unusual. When she was downstairs sitting on the couch with us she spent more and more time with her eyes closed with a full back heating pad. My mother in law also started eating less and less going from 1/2 a bagel at breakfast to less than a quarter, and not wanting cravings such as Barnum and Bailey’s Animal Crackers. We were rightly concerned about malnutrition.
Eventually my mother in law refused to get out of bed. My wife and I, being medical professionals, were concerned about the possibility of bed sores, pneumonia, and blood clots from a lack of mobilization. We also noted at this time her blood pressure was getting too low so the only medication she ever took for this was decreased to the minimum dosage (pretty amazing).
While my mother in law was hospitalized for the final time I asked the nurse if she had any information about what we could expect to see/experience in the coming final days. We received a booklet entitled Gone From My sight-The Dying Experience by Barbara Karns, RN. To our amazement as we read the booklet we realized that my wife was not failing to care for her, but that her mother was in fact preparing for her death.
The second paragraph above describes preparations which occur 1-3 months before death, and the third paragraph describes preparations one to two weeks prior to death.
If we had this information before the sequence began my wife would not have felt as if she was failing her mother, but we could have had advanced notice of a naturally occurring process prior to death and we could have reluctantly embraced it.
Note: Barbara Karns’ has a series of five booklets entitled End of Life Guideline Series which can be purchased on Amazon. This series could be invaluable to many of us older HD readers who are in the later stages of life facing the passing of older relatives, spouses, and ourselves.
Thanks for sharing David. I’m going to check out Karns, as well as the Butler book recommended by Kathy below.
I also recommend reading “The Art of Dying Well” by Katy Butler. She describes exactly this progression in the chapter on Active Dying. She covers the earlier aging stages and is particularly concerned about avoiding excessive medical interventions.
I attended a couple of talks on preparation for end of life recently, and was concerned to learn that my advance medical directive would not be consulted in the ER. Instead you need a MOST/POLST (Medical Order for Scope of Treatment) signed by a doctor. I thought that was only needed when you were nearing end of life, but have now added one to my Do Not Resuscitate order.