dealing with husbands family member having stroke

[nursebooboo]

My husband's grandmother had a stroke 3 days ago. She was in bed sleeping when it happened so she laid there for a while with the grandfather thinking that she was just sleeping in late. She is 70 years old and has dementia, and had a hard time getting around.

For the last few years her health has declined and she seemed less and less like what I knew when I first met her.

When we got to the hospital, she was sleeping and her mouth drooped on the left side. She moves her right arm/hand a little but not her left. She has slept since it happened.

They discharged her from the hospital today with no changes to a long term care facility.

So here's where the hard part for me comes in. My husband doesn't understand why she doesn't have an IV anymore, or why they "sent her to a nursing home" and no matter what I say he still doesn't understand. He says that they are going to dehydrate her and just let her lay there and die and that's murder.

Her prognosis is not good and the doctor tried to explain it in the best way that he could, but my husband has no medical background, and doesn't seem to understand. I feel like if this was a patient and I was talking to their family, I would have a lot better answers, but since it's my husband and I have to tread lightly, I am at a loss for words. Anyone have any ideas how to word things?

[blondy2061h, MSN, RN]

Did any of the doctors talk to your family before discharge about what the prognosis and plan was from there?

[TheCommuter, BSN, RN]

Did the doctor send your grandmother-in-law to the nursing home with orders for rehab? Virtually all of the nursing homes in my city offer subacute rehab (PT/OT/ST) to s/p CVA patients who cannot tolerate acute rehab due to a poor prognosis.

[chrisrn24]

Ever since becoming a nurse it is surprising to me how many people don't understand things medical professionals tell them.

My grandma was asked at the hospital if she wanted to be DNR. My mom told her to say no, come to find out my mom thought that DNR meant they wouldn't treat her.

In your case I would try and find out more and explain it to the family in laymans terms. If she is short term, explain that a lot of times people will go to nursing homes for PT/OT but are usually able to go home or go into assisted living. If she is long term, explain that she can no longer reasonably live at home and needs people to assist her.

[Tait, MSN, RN]

My mom still believes hospice is where you go to get morphine and basically be euthanized, and she has been working in public health for over 20 years as either a project coordinator or grant writing. Sometimes there are just topics people can not absorb. I would address your husbands personal issues that might be blocking his acceptance of the medical side of his grandmother's situation. Grief, stress, sadness, loss, and perhaps not focus on the medical side of her situation?

I am sorry for this sad event in your family.

[hiddencatRN, BSN, RN]

It can be hard to be rational when it comes to your own loved ones. I was so angry with my dad and aunts and uncle when they "put" my grandfather in a nursing home, felt like they were just tucking him away out of convenience because they didn't want to deal with him or get him the care he needed to stay at home.

And then I went to visit him, saw that he was basically completely immobile and barely verbal due to the progression of his Parkinson's. He definitely needed 24 hr skilled nursing care at that point and likely for several months prior to the fall that precipitated his admission to the home.

It's still fresh- give him time to absorb it, focus on what they will do for her in the facility.

[nursebooboo]

I called my mother in law to find out a little more about what kind of orders she received on discharge to the long term care facility. She was sent there with hospice orders. So, now my husband's mom is wanting to bring her home so she can have fluids (mind you, she can't SWALLOW) This is so stressful for me because it makes me want to SCREAM! She doesn't understand about aspiration and how much care this lady is going to need. All they can see is that "grand dad is letting grand mom die" Thank you all for the support. I have a feeling this isn't going to be easy for the next week or so

[SaoirseRN]

Sounds like you guys need to have a family meeting with her physician(s), nursing, OT or any specialists involved, sit down and formally explain everything. If it were me, I might speak to the charge nurse and explain exactly what the feelings/misunderstandings are and say that despite your best efforts, they aren't hearing what you have to say.

[nurseprnRN, BSN, RN]

Make sure they include the hospice people and ethics committee people. However, I agree that this is difficult for some of your family members because they are still in the denial phase. They can't believe this is happening.

If she is on hospice then her husband, your granddad, must have signed for it. I would be willing to bet that he knows what's happening, and has been preparing for it in his mind and heart for a long time. Older people do that, as I know you know, but your family might not be old enough to have it in their hearts yet.

It might help to say that the old ones have seen their grandparents and parents, perhaps their siblings, and certainly friends and acquaintances die, some after dementia has robbed them of earthly pleasures and relationships; they know what dementia means; in their quiet nights lying together they may have promised each other not to prolong their earthly lives when they are no longer themselves, as many of us have. Now the time has come. It's granddad's decision now. If you can have a private, quiet conversation about what grandmom and he wanted at the end of life, and this is what he says, then ask what you can do to help him. He's the one who needs it now.

On a strictly pragmatic, cold-hearted view, it sounds as if your grandmom is mercifully beyond pain and suffering. The longer she is comatose after this stroke, the poorer her prognosis. Therefore, what's to be lost by letting her daughter try to give her fluids? Yes, she will aspirate and develp pneumonia, but she won't swallow, and it won't take long before her daughter will stop trying and reality will, painfully, and irrevocably, sink in. She's still in denial; she will need her own evidence, because she can't listen to anyone else's now. They don't call pneumonia the old man's (or woman's) friend for nothing.

Bless you for trying to do the right thing. Now you're a daughter and granddaughter, not a nurse. A daughter and granddaughter with special knowledge, perhaps, but still a daughter and granddaughter. Try to let the nurses be the nurses here. I am so sorry you are having to go through this.

[nursebooboo]

You know, you're right about giving her water - and pneumonia being a friend. I hadn't thought about it like that :) I just hope that she doesn't actually try to take her home that would be bad. I don't think there's any way she will be able to care for her and not injure herself in the process. I guess I need to just stop worrying and let it be what it will be. I just wish I had a magic wand, and for a minute, let my husband and his mother see some of the things I've seen - with family members making decisions to prolong life and end up causing the patient to be clinically alive for a longer period of time. Meaning they die MUCH slower. Seems like it's not about the patient anymore it's more about keeping her alive for the family and not because it's best for her. I worked oncology for a long time before becoming a school nurse and I've seen some of the most beautiful deaths, and I've seen some on the other end. I will absolutely have PLENTY of paperwork about exactly what I want when I can't speak for myself.

I am trying to just be "grand daughter" :) but it is difficult when the nurse inside me is screaming out! hehe I think I will take the advice of just being supportive instead of trying to advise anymore. I tried to explain that death would be better than bedsores and holes poked in her skin, and it fell on deaf ears.

I think if they ask me anything else, then I'm just going to have to tell them that they need to talk to the people you all suggested (hospice nurses, LTC nurses, doctors etc etc)

Thanks again so much! I always think it's a good idea to get a different perspective on things like this.