Ready to let go. But not right NOW.

There comes a time with an aging parent when you have to stop trying to make things better, and decide to just love them, respect their wishes, and be present. I think that time had come with my mother-in-law. At this stage, it's important to distinguish between what COULD be done and what SHOULD be done. Still, it's hard. Damned hard. As I remember well with my own Dad, it's easy to decide in an abstract way that you don't want to prolong life unnaturally choices with a loved one. Nurses Announcements Archive Article

Ready to let go. But not right NOW.

I recently spent 45 minutes talking about death, and hospice, with my husband's sister in Maryland. Her mother -a delightfully quirky 91-year-old activist who still spends her days faxing her congressmen-just signed on with the local hospice.

I'm a hospice nurse, by far the most rewarding work I've done in 35 years in the profession. I'm doing my best to help them navigate these new waters.

Why is hospice nursing challenging?

I understand so well what she's going through-teetering on that invisible line between wanting to cheer someone on to keep trying, and allowing them to decide that it's OK to stop fighting what is inevitable for all of us.

Esther has, by my estimation, months, maybe a year left in her increasingly frail body.

Although she's still very sharp, mentally, she forgets things more, has to stop more often to catch her breath, and can't really muster any enthusiasm for exercising with her walker. She spends more time in bed or on the couch, wakes up later, goes to bed earlier. I see the familiar signs of someone looking beyond this mortal coil.

Considering the quality of those months is, to my mind, far more important than wringing out more of them by pushing her to eat more and take more walks.

There comes a time with an aging parent when you have to stop trying to make things better, and decide to just love them, respect their wishes, and be present. I think that time has come with Esther.

At this stage, it's important to distinguish between what COULD be done and what SHOULD be done.

Still, it's hard. Damned hard. As I remember well with my own Dad, it's easy to decide in an abstract way that you don't want to prolong life unnaturally, to trade quality for quantity.

Yet, when my rapidly declining father broke his hip, I was heartbroken to hear that he decided not to have surgery (in retrospect, this would have been a miserable experience he might not have survived).

I wanted to let him go peacefully, without a lot of high-tech, dehumanizing interventions. I just didn't want to do it YET. No matter how clear we are, in a theoretical way, about wanting a peaceful, dignified end for our loved ones, we're never ready for this moment to be the last we have with them.

That pain is something we sign on for when we let ourselves love someone or something impermanent. Which is, alas, everyone and everything.

Loving the impermanent is one of the necessary pains included in this beautiful, untidy package we call life; I've decided to learn to live with it.

The alternative, to harden ourselves and not get "too attached" (a concept that has taken much of the heart out of medicine, in my opinion) is not one I care for. This is what I love most about working for Hospice-we get attached to, and often fall in love with, our patients; it's a given.

And although I'm aware of how much we bring to patients and families we care for-comfort, supplies, clarification of what's important, understanding of what they're going through and what's ahead-I always feel I've received more than I give.

It's an honor to be with people who are facing their own mortality. Somehow frivolous concerns seem ... frivolous; the specter of death has a way of distilling what's important in life. And being reminded of our universal mortality reminds me not to squander this life I have on resentments, or worries, or acquiring more things.

I'm more aware of the beauty, and the fragility, of the world and our relationships.

So, I answered the questions I hear so often. Joining hospice does not generally cause people to give up and die-often the support we give causes them to rally and live longer and more comfortably; sometimes they even "graduate."

Pain medicines, used appropriately, do not cause addiction or hasten death, but the need for them often coincides with a decline that has already begun to accelerate; ideally medications relieve pain and air hunger in patients' last months, even sometimes increasing activity.

And yes, there are always gray areas: How long is it safe to leave her alone? How much should we push her to eat and exercise?

As always, I suggested she answer these questions from her best understanding of, and respect for, Esther's wishes, and by exploring them with the hospice staff.

We'll fly out over winter break; I look forward to spending some bittersweet, heart-ful time with my beloved mother-in-law.

And I hope to make sure she's comfortable, and help love her out of this life. That's the best any of us can do, and what we all hope for in our last days.

aging1

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thank you for this poignant article that reminds us of the painful end of life choices that we have to help families make and how much more difficult it is when it is one of our own beloved family members.

Thanks for sharing. Enjoy this special time...however long or short it may be. Live in the moment.

Well and beautifully put.

Thank you for this.

Specializes in Med nurse in med-surg., float, HH, and PDN.

What a gorgeously written, deeply heart-felt letter of love. You spoke my own attitude so plainly and simply put; a subject which is neither plain nor simple. I loved it! Thank you so much for writing it.

Thanks. I am not a hospice nurse. I work in OB and am dealing with aging parents. My mom is in the hospice program for the past year. She is 83 and in declining health. She has a caregiver who is at the house 12 hours a day to bathe, feed, and clean her. My dad is there too. He is 88. I know he is very overwhelmed by all of this. He is mentally sharp. He loves to read and very much loved his dog who died several months ago. He can still get around pretty well. I found a sweet senior dog for him and am getting her vetted, so she can settle in with him. He knows if anything happens, I will keep her with me.

I drive 3 hours each way every weekend to visit my parents. They do not want to move here and I cannot move closer to them at this time. At almost 50, I do not have the energy I once did. I work 5 days a week and am finishing a post MSN. Sometimes, I do not know how long I can go on and feel discouraged. Other times, I can go with the flow. I worry about them constantly. It is sad. We have never been close, but now have a very pleasant relationship. There is a silver lining in many of life's clouds. Honestly, I am happy to help and wish I could do more. As my parents get to the end of their life, I realize we have tied up many loose ends and are much more at peace with each other. It is a mixed bag of much good and bad.

Specializes in hospice.

Awwww....I'm a hospice CNA and you're making my eyes all sweaty. :cry:

thank you for sharing this, I'm going through something similar with my father-n-law. He is now in a full care facility and to be honest I love him dearly but I'm having problems with seeing him this way. I'm having a deep emotional problem with letting go. He's tired and is ready for the next step of his journey, but knowing what a strong man he has always been I find it hard to let go, even though he is. Reading this has really helped me emotionally. Thank you.

Oh, I remember that so well. My own parents have both died, and I'm now through the exhausting/juggling/fear, then the grief, and can remember them sweetly. Take care of yourself, my dear. The hard part won't last forever.

Really lovely and articulate piece. My parents are 81 and 84 and have been facing major medical problems in the last two years, so this topic is near and dear to me. Thank you.

I just finished my first quarter of nursing school, and the lecture we were given on "death and dying" pales in comparison to the insight you provided in this beautifully written post. Thank you for sharing!

My father died in June. He was nearly 87, and basically just decided he was done. He was getting increasing frail, and needed a cath due to prostate enlargement. Several years ago he refused any surgery for this (my grandfather died after having some surgery for this) but until about two months prior to his death, he had done ok. He HATED the cath. After the first change (and he was hurt while being done) the doctor told him he would probably need cath for rest of his life. Shortly after the change, he started having some problems with balance, confusion, but was still mostly ok mentally. Fortunately we were able to get hospice to come to the house and talk with him. He refused any treatment for bladder infection (which I was sure was the problem, and I was right). My family and the doctor made it very clear that the infection was very treatable, and he said why? "So in a couple of months something else goes wrong?" my brother lived with him, but wasn't there during day. My sister and I live over 1.5 hrs away; she works and I have MS. Another sister lives much closer, but she owns her own business and needs to work. We were trying to get someone down to visit at least once a week, but it was hard. My dad said, "I miss your mom, and I have lived a long happy life. I have the best kids anyone could have, but I'm tired." His brothers, their wives and all his close friends had already died. Fortunately my sisters, brother and I were willing to let him make the decisions, already we made sure he knew we loved him and would love to keep him around. He decided to refuse all treatment, stay at home and die. He died within five days, unresponsive most of that time. The day he died, he woke up ask for a beer, and later a shot of peppermint schnapps. We thought he was doing better (although I guess I should have known better). My brother left to get some stuff done as didone of my sisters. The other one was getting ready to leave when it suddenly became obvious he was going. We got everyone back before he took his last breath. I miss him so much but am glad he died the way he wanted.

How beautifully put and sentimental, it is almost like a poem, the rhythm of life and death. My last living parent, my mother, is 89 and I just came back from visiting her. Every time I leave her I tell myself, this may be the last time. It is hard. What you touched is that part of me that will never be ready to let her go and the other part that knows letting her go will be the best for her. She and my younger sister have all the legal documents completed and we review them from time to time(very important to clarify things). She asked me before I left this last weekend, to "find a day when you and I can spend some time together." I do have the time now, and I will give her much more than a day. It is hard. Sometimes we really do not know our parents until we are aging parents ourselves. I still have lots of questions(my dad passed about 17 years ago) and I know she is ready to tell me the things that I most likely did not understand when I was younger. I suggest everyone take the time for their loved ones, especially now during this blessed season, but also throughout the year. Time is something we can never get back.