Help Needed from Hospice RN to ER RN

brighella · Sep 25, 2009

From what I understand, if it hastens his death, it wont be appreciably. The focus on the care is now his comfort. Would she rather have his last hours/days be painful? or peaceful? The same goes if hes not necessarily in pain, but is having some trouble with breathing, morphine helps reduce that air hunger. Another thing to ask her is, if he was still speaking and cognizant, but knew what you and she know, that hes not going to get better, what would he want? We know that what she wants is for him to not die, since that doesn't seem possible at this time, the focus should be on what he would want.

In addition, for those at the end of life, stopping eating and drinking is normal because it costs them too much (physically) to process the food or liquid. If he cant swallow, giving him something to drink could hasten his death through choking/aspiration pneumonia faster than careful morphine administration could. There has been no research to show that the lack of food or water causes discomfort in those at the end of life.

It sounds like he needs permission from your mom to let go. It might help if she can talk to him, tell him that its ok, that you will both be ok after he is gone. If its part of her belief structure, she can talk to him about seeing him in the afterlife, etc. If hes spent a lot of time and energy into caring or supporting her, he wont want to leave until he knows she is cared for. I know its pretty general info that you probably have already, but not knowing the players, its what I would tell my family members. Much love and warm wishes to you in this difficult time.

Sarah

Trauma Columnist · Sep 25, 2009

I am so sorry for what you are going thru. Your father is so lucky to have you to advocate for him.

Have you contacted the hospice to talk with your Mom? Maybe that would give her some measure of comfort too.

sharpeimom · Sep 25, 2009

i'm so sorry for what you and your mom and family are going through with your dad. my mom was a hospice patient before she died. many family members came and went and there were several disagreements about how much of which painkillers should be given and when and it caused a real rift.

despite my credentials, no one really cared much what i thought -- i was just little kathy again with all the relatives coming and going. they listened--sort of--to the hospice nurse and just a bit more to the nun who directed the hospice program, but the problem of pain relief still remained the elephant in the living room. finally, i thought of something. i remembered an old old friend of my parents' who lived in california. he listened to me rant and cry for an hour, then promised to call my mom and talk to her.

he ended up surprising me by flyng 3000 miles and appearing at my mom's door two days later. rick stepped in and gently and tactfully handled the more bullheaded relatives and saw to it that my mom was given adequate doses of pain meds. do you have a friend or relative who could sensitively persuade your mom to give your dad permission to just let go? that would keep you from being the bad guy later on.

hugs,

kathy

sharpeimom:paw::paw:

alicia9178 · Sep 26, 2009

Thank you so much all of you for your advice. My mom is still holding strong to control more or less of the one thing she can. She actually told us all we are NOT allowed to visit at all today, which at first I was mad about, but then maybe she needs to spend time alone with him to say goodbye. Maybe this will give him some peace.

Alicia

sharpeimom · Sep 26, 2009

:icon_hug:

give your mom her time to say her final goodbyes and to begin to let your dad go.

hugs,

kathy

sharpeimom:paw::paw:

tewdles, RN · Sep 27, 2009

I am sorry for your loss. Your dad is nearing death. He is transitioning to a phase of "active dying". It sounds like he may be relatively comfortable, if so, he may not require a great deal of medications to remain comfortable, peaceful and calm during this time. Often times, during this period of time, the hospice focus is on supporting the family, to insure that they understand what is happening and to provide as much emotional and spiritual support as the family desires or needs. Please contact the case nurse and let him/her know what is going on. Family discord is nothing new or unexpected in hospice. All families have some measure of disagreement, especially in high stress situations and this is about as high stress as we can get. Your mom is grieving, I would bet she has spent decades living with this man (your father). She is going to have to learn how to live successfully without him and it is frequently a very frightening thought, especially if your mom is elderly. Hospice may be a "safe ear and shoulder" for your mom, so keep them close.

Good luck.

Werblessed · Sep 28, 2009

How difficult it is when our parents are leaving this world. Especially as nurses as we can sometimes struggle with the role of just being family as opposed to being the nurse, too. I am praying for you and your family. I agree that having the hospice team updated and involved as much as your mother will allow may help her hear the truth of what is transpiring, your father's journey home, in a way that may be more easily accepted. Also, if you are feeling that Dad might not be getting the pain medication adequately, or at all, it might make sense to ask the Nurse from hospice to consider a transdermal Duragesic/Fentanyl patch (if he has adequate SQ tissues) or a SQ infusion so that his comfort is ensured without having to rely on someone giving him medications routinely or as needed.

Mom may also be feeling the loss of control over what is going on in their lives and sometimes this manifests itself in grabbing the wheel, so to speak, when it may not be appropriate. Again, I would speak frankly to the IDT from hospice and allow them to work with Mom so she can find peace in a journey she is making as well.