Hey everybody. This put up might be a little bit of a downer. I’m in Chiang Mai to assist handle the ultimate stage of dementia for my mother. She has Lewy Physique dementia. At this level, she is unable to do a lot. She will be able to transfer her eyes and swallow a bit bit. That’s about it. She will be able to’t speak or make any type of determination. Her physique is totally stiff. She will be able to’t transfer in any respect and we have to flip her each few hours to reduce bedsores. The standard of life will not be good. Sadly, she didn’t go away any advance healthcare directive. We should always have talked about this 3-4 years in the past as a result of it’s actually tough to make choices on her therapies. At this time, I’ll inform you extra about what occurred and why everybody wants an advance healthcare directive.
Advance Healthcare Directive
What’s an advance healthcare directive? Mainly, this can be a doc that may specify your medical therapies in case you may’t make choices later. That is actually necessary as a result of your family members won’t know what you need if it isn’t written down clearly. When Mrs. RB40 and I made a will, our lawyer set us up with an advance directive. Nevertheless, I must go over it to see if there are sufficient particulars. From what I recall, Mrs. RB40 will make all medical choices for me. I don’t need a feeding tube or a ventilator if there isn’t a hope of getting higher. However now I see that we want extra particulars. Mrs. RB40 could make choices for me, nevertheless it’ll be means simpler if there’s a clear guideline.
My mother’s situation
My mother’s situation worsened shortly this yr. After I was right here in March, she might nonetheless stroll a bit. We even went swimming a couple of instances. However by summer season, she couldn’t stroll anymore. About 2 months in the past, she stopped consuming and my dad took her to the hospital. It turned out she received a lung an infection. The hospital gave her antibiotics and put a feeding tube in her nostril. She recovered from the lung an infection however developed bedsore on her again after only a few days.
I received right here 3 weeks in the past. I discovered her with a feeding tube, an oxygen tube, saline and antibiotics drip, and a urinary catheter. She was getting antibiotics for UTI (urinary tract an infection.) The UTI cleared up, however her situation was nonetheless unhealthy. Her limbs have been stiff and she will’t transfer in any respect. She might solely transfer her eyes. Lastly, her bedsore stored getting worse. They minimize away the useless tissues and tried to deal with it, nevertheless it didn’t heal. Sadly, the bedsore stored getting worse over the previous few weeks.
Palliative care
I talked to the physician and so they have 2 choices in Thailand.
- Lengthy-term care – They’ll attempt to hold the affected person alive and deal with all the things. That is what they’d been doing earlier than I received right here. My dad needed to maintain my mother alive so long as doable.
- Palliative care – Cease all therapies and let nature run its course. They’ll prescribe morphine as wanted to maintain the affected person comfy.
My dad needed to maintain her alive by feeding tube and hoped the bedsore wound would heal. However I used to be towards that. At this stage of dementia, she received’t get any higher. Within the U.S., medical doctors don’t advocate feeding tubes for end-stage dementia. In Thailand, it’s as much as the household. The physician gave us choices, however not a lot steering.
My dad was afraid she’d starve to demise if we eliminated the feeding tube. However I believe it’s pure. When dwelling beings are near the tip, they eat little or no. There is no such thing as a must extend life if there isn’t a likelihood of getting higher. I wouldn’t need meals shoved down my abdomen on this situation.
A few week in the past, I satisfied my dad to take away the feeding tube. As an alternative of a tube, we fed her by mouth. It labored okay. She ate a bit little bit of liquid meals each day. I do know this quantity of vitamins isn’t sufficient. She already misplaced numerous weight with the feeding tube. After we eliminated the feeding tube, she ate lower than half of that. Additionally, she has problem swallowing and coughs often. This can trigger a lung an infection in some unspecified time in the future.
Sadly, her bedsore received rather a lot worse just lately. We are able to see that she is in ache every time we transfer her. She additionally received UTI once more and the physician prescribed antibiotics and saline drips. Nevertheless, the bedsore wound seems to be really horrific now. I’ll spare you the outline. Two days in the past, my dad lastly agreed that we should always transfer to full palliative care as a result of the wound is so unhealthy. We knowledgeable the physician and he gave the okay. The physician stopped the antibiotics and prescribed morphine each 8 hours. Since then, my mother sleeps much more and eats even much less. She seems to be extra peaceable with the morphine, in order that’s good. I requested about euthanasia and the physician stated they don’t do it in Thailand.
Extra particulars are wanted in our advance directive
All in all, I’m glad I’m right here to assist. If I used to be making all the selections, I’d have prevented the feeding tube because the starting of her hospital keep 2 months in the past. However that’s the issue with making healthcare choices for somebody who’s unable to take action. Completely different members of the family may have completely different opinions. My dad needs to maintain her alive. My brother and I believe it’s higher to let her go. Her siblings have completely different opinions. It will be higher to depart an in depth advance healthcare directive so everybody is aware of what you need.
After I get dwelling, I’ll evaluate our advance directive and add extra particulars. Possibly one thing like this.
- If I received’t get higher, then I don’t need any life-extending measures.
- I don’t need a feeding tube if I can’t eat, poop, or transfer.
- If I can’t make choices as a consequence of dementia or different mind trauma, simply let me go. Please.
- If it seems to be like I’m in ache and received’t enhance, then go for full palliative care.
I’ll want to take a seat down with Mrs. RB40 and speak. It’s been a tough few weeks. Fortunately, I’m retired so I might be right here.
Picture credit score: Nationwide Most cancers Institute
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