My father had a heart attack when he was 84 and in poor health, and because there were no advance directives and my mother did not have a health care proxy document, he received CPR.
Although they restarted his heart, he had to be placed on life support. A truly horrific 11 days of organ deterioration and bloating followed before the primary doctor agreed to unplug him from the machines. Dad passed away within a minute of being unplugged.
This period took a tremendous toll on my mother. Before this, despite slight memory loss, she was driving herself to stores and friends and functioning normally in general. During those days of Dad being on life support, she was so distressed that she could barely eat or sleep, and she went off her meds, which I did not discover until I flew down to see Dad. I thought we would lose her as well, and it was only her decline that finally persuaded the primary care doctor to unplug Dad, even though Dad’s nurses and cardiologist had been urging him to do so for several days.
Mom could no longer live alone, so I brought her back to CT to live near us. One of the first things she insisted on doing was drawing up a living will and making me her health care proxy because she was determined not to end up like Dad did.
Think long and hard before requesting CPR when you are elderly.
Thanks for that additional input, GT. She already has an advance health care directive in place, and I can’t remember exactly, but it says something like she doesn’t want to be kept alive if she’s been in a vegetative state for more than 2 weeks and the doctors don’t think she’ll come out of it, or something like that. The POLST is a little more specific, and so will also help with a “pull the plug” decision. What I’m also concerned about, and I don’t think the directive addresses, is what to do in a 911 emergency; say, she’s sitting in her apartment and stops breathing. Mom says she wants full code, and I know that that’s what the EMTs will do unless there’s written instruction otherwise.
I like the “don’t recognize grandchildren” test. About a month before Dad died (right about when we put the DNR on him), I set him up with a phone date with my D, and although he enjoyed the call, he had no earthly idea who she was. At that point, even his recognition of me was faltering. He knew my face and knew I was a relative, but couldn’t say exactly how we were related and didn’t know my name.
ETA – CT, I’m so sorry about what happened with your dad, but thank you for posting it. I think Mom believes that after CPR, she would just jump up and continue on with her day. But your experience is exactly the nightmare scenario I fear. If you don’t mind, I’d like to print that out and take it with me to the doctor visit next week.
LasMa, hopefully the primary care PA and disabuse your mom of the “jump up” after CPR scenario. My dad’s doctor did a good job of it.
We are pretty close to not recognizing the 4 grandchildren. Dad gets the two boys, mine and my brother’s, mixed up a lot as they are only one year apart in age. I usually have to say, “my children” or “my brother’s children” along with the names. He always knows me though It will be tough when he doesn’t.
My stepmother, who was married to my dad for 30 years and saw me at least twice a week, often said to me: “You are so nice to us! Could you tell me again how we know you?”
After a while it was kind of funny. I am sure it would have been harder if it were my dad.
I recall being very frustrated at the time with Dad’s primary care doctor, who rejected my mother’s requests to take Dad off life support. Finally I realized the doctor was highly motivated to save life and that the way to get through to him was to tell him how badly it was affecting Mom and thus redirect his efforts to saving her instead of him (she was also his patient.)
Dad’s experience profoundly affected my husband and me also, so we also drew up living wills and health care proxy documents for ourselves, and discussed with each other the conditions under which we would not want to be kept going. This includes if we are severely impaired (a massive stroke or head injury, for example)- not just if we are vegetative.
In cases like this, is there someone else to appeal to at the hospital? What should we do if the doctor is taking measures that we think are unjustified, instead of letting our parents go quietly?
CTMom- Thank you for sharing that experience. I am sorry for what your family went through and it highlights how many variables we need to take into account for elders and ourselves. This is not a cookbook and we all do the best we can in the moment.
I think such info can help proceed with a bit more confidence, even though every situation is different. My father’s form now says no trip to the hospital, though his SNF would call me to consider each circumstance as it arose. I decided that if, due to some fluke, they could not contact me in a timely fashion (ie I am on a plane), I would rather have him not go to a hospital, as that tends to set in motion a series of automatic interventions.
This is where it also helps to have a primary care dr. weigh in on the implications of each section of the form, as well as their applicability to a given patient. My father’s Dr. did a good job of letting me decide, while answering my questions and validating my reluctance for major interventions. Straight talk and contextualizing goes along way here; not every situation allows for it.
Thanks to all who are weighing in here- I have no direct experience with elders and CPR- very educational.
Yikes about the primary doctor, CT. This is one area where I feel we’re lucky. Mom’s primary was also Dad’s primary, and she was simply wonderful in helping us navigate the end of life minefield for him, and in helping my brothers see that it was time to let go. She is less “save life at all costs” and more the “graceful exit” philosophy that travelnut talks about.
My husband and two of my children are EMTs. They have described to me what CPR is like and the term ‘violent assault’ is accurate. Yes, ribs will crack/break and most elderly do not ever really recover. It is a Godsend for those who are young and in relatively good health but not so much for the elderly.
My daughter has done CPR many times but her one good CPR save with on a young adult. He recovered and was fine. She did also ‘save’ an elderly adult but he only lived for one week afterwards - in the hosp. So, it was a ‘save’ but not really. And that’s often the case with the elderly if CPR does revive them. Poor quality of life in most cases.
If her PA can not get her to understand the consequences of CPR on an elderly patient, maybe you’ll find some resources on the internet. An article or a youtube video. But you must help her to understand that it is not the ‘magic treatment’ that it can appear to be.
I once read the Stanford ethics report on EOL/End of Life and it allowed for a dialogue with the family. And where I live, the doctor most gently guided DH to a decision for his mother. (She was not on life support, but that was the decision they discussed. No one asked for documentation of her wishes.) I had another, similar situation with another loved one. Granted, I read that Stanford document some years ago.
I think it may be wise to feel out your (or a parent’s) doctor’s own stand, as well, in advance. Sorry you and your parents had to go through that, CTmom.
Btw, my mother took the train to Tucson, hated it, but made it. (Her prior ride from west to east, when she moved here, was smooth sailing.) She’s delighted with her Indep Living place, is meeting neighbors (incl a few men,) said the food is great, the view from her window is pretty landscaping. And she declared to me that she may stop being a loner.
I don’t know how this will really turn out. She’s an odd egg. But so far, okay. Next I have to keep working on my brother to step up.
@Marilyn, hugs, and sending good thoughts your way along with hopes of peace with your mother’s passing.
I am at my in-laws now while H on a canoeing/camping/fishing trip with 2 brothers. Parents continuing to slow down. Both have a lot of swelling in their legs but still add salt to food like fresh tomatoes. The white knee high hose go on FIL every day someone can put them on for him. MIL just put on Digoxin, and she is feeling a little better. Pharmacist BIL does what he can with them. She hasn’t argued with me when I tell her to sit and put her feet up while I do the dishes. They are in a small town, and next door neighbor mows their lawn; several stop in, and they have meals on wheels when they want it. I do think they worry a bit about eroding any further health-wise. If they need to move in with Pharmacist BIL, they would have their same doctors. With us, it would be all new docs. They do so much better emotionally in their own place. We just have to pray they have a happy death and the path there is short and sweet when the time comes.
And my hope is that in 25 years that H and I are in better shape than they are. My BIL (older sister’s husband) is only 8 years younger than H’s parents (he is almost 17 years older than my sis - she married him when she was 25 and he was 41, and it wasn’t for his money as he was a minister), and his legs look great (he has always walked twice a day) - he had a triple or quadruple by-pass at age 70, and just had a good cardiology report - recheck in a year. So it usually does pay to take care of one-self. When back home, will make it a priority to get my daily exercise in and also push away from the food better. To lose 60 lb to my goal (where I was 9 years ago, and prior to cancer). Right now my legs look great and my BP is great too, even with the extra weight.
For those having great weather, get a few rays of sunshine. It not only helps you with Vitamin D, it can help with one’s attitude and mood.
How old are they? At some point, it’s more important that people are able to enjoy their lives than that they follow every persnickety dietary recommendation. Tomatoes taste better with salt.
According to my MIL, so did watermelon, CardinalFang.
I never got that one.
She had a miserable time on the low salt diet, and that fell apart when she later needed a wheat (not gluten, but wheat) free diet – and I learned a deep truth: you can have one diet constraint, but once you introduce a second constraint, all bets are off unless you can prepare all your own food.
In thanks for everyone helping and as my reminder to myself…
Mom is doing MUCH better. Still has to be in wheelchair to get taken to meals. But that causes her to BE taken. Now I honestly am afraid she had just skipped too many meals and the AL place didn’t notice her starving to death!. She loves the extra attention that the private care givers are doing. Her Dr. thinks she can try to eat whatever she wants, but keep up the Ensure to get a bit more calories. I am not sure he put her back on her heart drug that had built up toxicity, I forgot to ask him, but I can ask the med aide.
So I don’t think my brother and I will be dashing up to start hospice this week (was sort of planned to at least discuss it).
I am hoping the private care givers work out. I am somewhat annoyed at promises made (daily updates!..NOT). Contact for all team members…NOT (there are 3 people rotating so there is always coverage). and contract for costs. I need to contain costs so like it to all be in writing!
Take away is that I have to keep in mind, this is a long process. She goes up and down and even though mostly down in total direction, she can rally. We have plans for a little family reunion for her birthday in July and she will love it so has that to look forward to , so it isn’t just waiting in her room to die which is a little bit of where my mind went. It isn’t how she wanted to end up in her last years, but we don’t get to chose that really.
Thank you all for your kind thoughts - such a caring community here online. The funeral was very touching and emotional, but almost everyone who came to shiva yesterday are friends of my brother and SIL; few of them even knew my mother and they don’t know me. One out-of-town relative so we spent a lot of time talking about her family.
In line with this thread, the visitors yesterday who knew Mom most recently were her two caregivers who shared the Mon-Fri day care for the last month or so. I’m very touched that they came to the funeral and shiva. They shared their experiences with her and it was gratifying to know she was so well cared for in her last weeks. It sounds like she really appreciated their care (and she was very hard to please) and had developed a very positive relationship.
Now my brother and I begin the process of trying to clean up the decades of paperwork, decisions and disposals et al. Brother is hoping there are companies that can help with the whole process but I think it’s more likely each “task” will need a separate contact. We are meeting with Mom’s lawyer Monday.
How nice that her caregivers came to the funeral and shiva, and were able to share with you a different perspective on your mother. We often see the worst of our parents, not the side that others see.
Take your time with all the weeding through papers and possessions. It took DH and his 2 siblings 2-3 months to go through everything their father left behind, and he was well organized, but they all lived within a 2 hour drive of him.
It will be tough when he doesn’t.