When will they "snow"

[Curious1alwys, BSN, RN]

Sad to say that a month ago I was posting about my father being too "snowed" and now I am here to ask when they will purposefully snow him completely.

He has had a marked decline in the last few days and won't be getting out of hospice now. After all the worry and fret over where he was to go, getting all the equipment to my house, he is declining anyway and can go nowhere. Now, even brushing his teeth....even getting help doing it....appears to be more he can take or even wants. He just wants to be left alone, but likes someone there with him. He barely has the energy to get out of bed. He moans in his sleep, cries out, "Oh God, what is happening to me", or "Ugggghh, God". The nurses say his pain relief is adequate and he says he is not in pain. But honestly, he looks tortured all of the time, every minute. He looks at you like "Oh please help me", I say "Dad, do you want to wear you oxygen?" He either will fall back asleep or say, "Will that help?", like he is willing to do it if it will help at all but then, because of the brain mets, when I put it on him he gets agitated. He knows his mind is going, it is so horrible. He is so young to lose that now.

Anyway, I wonder why he wakes up at all. Can't they put him morphine drip or something? He is on methadone now and ativan, but isn't there some continuous way to keep him sedated? The nurses said something about him possibly working out things with his Maker and just dealing with the committee in his own head. but it sure looks like misery and torment to us. You look in his eyes and my father is gone. All that is left is misery. He looks at us like, "How long do I have to fight this?". It is so, so sad. I stayed with him all night and did not sleep for 24 hours and it about killed me. I hope God gives me the strength to get throught this but most of all I hope Dad does not suffer and that he finds peace and acceptance with his passing. Please pray for that if you pray for me. I know in the end, I will be fine. Please pray for my Dad. :icon_hug:

Thank you if you can answer any of my questions.

Oh, wanted to add.....he is so confused now that he really can't make decisions but we found out about a week ago that while he appointed POA he NEVER SIGNED IT!! So, how does that change things? Where does POA fall if he can't make his own decisions but is not married. If it is oldest child, what happens if the oldest child is missing (we don't know where he is)??

[leslie :-D]

The nurses said something about him possibly working out things with his Maker and just dealing with the committee in his own head. but it sure looks like misery and torment to us.

since your father led his life turning to the bottle, to escape emotional torment, it's not a surprise that he's reluctant to deal with past stressors in his life.

i think his nurse is accurate in her assessment: that he is reliving past events and working through them.

in my experience, this is a common phenomenon that cannot be dismissed. when a dying person does a life review, it is often not voluntary but still, a task that needs to be done.

even when a dying pt. starts sleeping atc, it's not a peaceful sleep; not initially. in order to potentiate the journey ahead, one must face and deal with residual wounds/trauma, even if they have successfully repressed it up until that point.

it is not my intent to journalize my experiences and what i've observed.

to me however, dying takes work.

and there isn't a hospice around, that would willfully sedate your father, knowing that his physical pain is relatively stable.

and even if he was on a gtt atc, the sedation still does not interfere with the 'work' that still remains. the pt. still needs to work through the mental disarray, even if it's in the form of dreams.

so be a support to your dad; let him know you're right next to him; hold his hand.

maybe he'll want to talk, maybe not.

he'll be ok thrash.

he truly will.

leslie

[Cing_angels]

I agree with earle58, and your nurse. He is most likely going through terminal restlessness and possibly spiritual pain. Have you considered having the chaplain come to your home and speak to him? Even if he was not a religious man, this does sometimes help people feel more accepted by God or their higher power- people struggle wether their worthy and where they might "go". Even simple prayers give people strength and guidance that he too is loved and accepted.... Also has the nurse spoke with you about "Terminal Sedation"? It is a choice that can be yours and his- now that you are the only primary care giver ( not eldest sibling who can't be found) you are the decision maker. Good Luck, I wish only the best outcome for you and your father.

[sirI, MSN, APRN, NP]

hello, thrashej,

i just want to let you know that i've been thinking of you. wondering about you of late. i think i can totally relate to what you are experiencing with your father. i went through the very same thing with mine. know that i care and am here for you, too. les has given you excellent supportive advice.

please discuss any type of further treatment with your dad's pcp. he/she is the only one now who needs to be giving you any advice, medically. his pcp along with the hospice nurses will work to make things as easy as possible. it is hard for you to be in any way objective and by you keeping in close contact with his pcp, you can stay abreast of what might be necessary in the future.

as i said, i am here for you as are others, for support. just be sure you stay in close contact with your dad's pcp, o.k.?

{{{{{{hugs hon}}}}}}

[leslie :-D]

Also has the nurse spoke with you about "Terminal Sedation"? It is a choice that can be yours and his

terminal sedation is an intervention used as a last resort. all other interventions need to be tried and evaluated first. it would be highly unethical if ts was casually implemented. it's perfectly normal to be depressed when one is dying. there's a full spectrum of emotions that the pt contends with. much of this is necessary work.

i hesitate when i hear of ts as it is such a powerful and final intervention. if the pt is still eating, then there is the voluntary foregoing of nutrition and hydration; death is usually a matter of only a few days away; and it's usually reserved for intractable pain, severe dyspnea and/or delirium.

i think a visit from a chaplain would be appropriate.

and i'm sure your dad's hospice nurse will continue in providing him w/everything he needs.

your presence means more than he can communicate right now.

leslie

[Cing_angels]

Hi, To respond to Leslie about Terminal Sedation, I agree, however I thought that is what stage her father is experiencing. My apologies for the misunderstanding.

[Curious1alwys, BSN, RN]

Thank you. I understand what you are saying. I had a really great conversation with a wondful, super comforting, hospice nurse yesterday. She was so helpful! She took me aside and we spoke of my father's torment and she told me that oftentimes they are waiting to hear that everything is going to be OK, that we all are going to be OK. I know he told my mother a while back that he was not worried about my sister or I, that we are strong, but that he was very worried about my brother. My brother is not around now and even if he was, would not be able to express himself, I doubt. So...........today I am going to talk to my Dad...even if it is uncomfortable and even if I cry (she said that was OK too). I am going to tell him that we will all be OK, will miss him terribly though. We will take care of my brother and help him when he needs it NO MATTER WHAT. Reassure him. Maybe this will put him at peace atleast to sort through and do his own life review. Poeple come to see him and make jokes, trying to make him laugh, but he is past that point. He wants to be touched and has nothing to say. He wants something real, I believe, because there is no "feeling better" at this point, atleast in this life. I don't even really know if he wants visitors other than us. Because of his brain mets though, now he really can't even say for sure.

They did increase his Ativan to a full milligram and his methadone dose is going up too, so now, he will really really be out of it I think.

Today is going to be a very hard day, but one in which I could possibly give my Dad peace. That makes it a wonderful day, too. Thank you all.

[jmgrn65, RN]

I don't have anything to add, except I will put you and yours in myh prayers. God Bless.