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How to prepare yourself for a good end-of-life

Passepartout

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CanuckTravlr

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Thanks for posting this, Jim. Sobering and enlightening at the same time and all-too-familiar for those of us who have watched and helped as parents, friends and loved ones have journeyed through life-end struggles and difficult illnesses. Some very good and common sense things for all of us to think about as we enter the "golden" years of our lives. :ponder:
 

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A good article. Yes, I too believe in a good death.

For me, if it’s not quick like a heart attack, I have a directive of what to do.

Please do not do anything heroic to save me. I have lived a great life, am grateful and am not afraid to die. I am however afraid of a slow lingering death filled with progressive suffering.

So, if it is clear that all I have left is progressive suffering as I march towards death, please do me one last favour to save my dignity.

Please try to wheel, drag, walk me to a beach. Any beach will do. If I can’t get to a beach, please play a beach with the sounds of the Ocean on a TV, Cell phone, etc. Then, if legal, administer a good dose of Sodium Pentobarbital or another life ending drug. If it’s illegal, and as this is my life and my choice, please buy a 1/4 ounce of fentanyl and give it to me.

Thank you.

Too many times we think quantity is more important than quality. Well, that’s not true in my case.


Sent from my iPad using Tapatalk
 

rapmarks

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Ten days ago my next door neighbor was playing cards and something happened and they called 911. She was in intensive care for nine days on a ventilator. Her kidneys and liver were not working. We all thought she would not survive. Sunday night her kids said she was alert and responsive. It is so frightening to realize you can be going about your business and be knocking on deaths door the next minute. The end of life was pretty bad for my parents and my aunts. Many of my friends have lost their husbands, some very suddenly. It won’t let me read the article, I got as far as father being 79. My husband is 78 now
 

moonstone

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Good article! I think it is very important for people to have a living will or some sort of document expressing their wishes and not just a will for instructions after their death. If your wishes are not written down you cant be sure they will be followed. I worked in long term care for many years and sat with dozens of people as they passed away. A lot of family members asked that I or another staff member be in the room as they didn't want to be alone with their loved one when they passed. Then others didn't even want to be in the building when their loved one passed, they said their good byes, said ''call me when she/he's gone" and went home! Many family members had no idea of what their dying loved one would want, or how they would want to be cared for, in their final days and hours, aside from being pain free. I always asked if they wanted any type of soft music or white noise (ie; ocean waves, rainfall...), scents in the room, decreased lighting and most would just say what ever you think.

It is also important to have all your wishes and arrangements written out early in life as many people never know when they are leaving this world. In the last 3 weeks we have lost 2 friends to massive heart attacks, one was 55 one was 62 and both guys were in very good health as far as we and their families knew. The 62 yr old friend had a will, but the 55 yr old did not. He was a farmer and had never married, maybe he thought it wasn't necessary.

I pretty much dragged my 81 year old parents to get their wills done 7 years ago. They had wills drawn up just after my youngest sibling was born in 1964 and thought that was good enough! They had no living will either and after their lawyer and I explained what it was for they both made a very detailed one. My mom wished to be cared for at home after seeing her mother rapidly deteriorate in a hospital after a fall. Unfortunately a year after my mom made her living will she was diagnosed with vascular dementia and within a year of diagnosis we had to place her in a long term care home since she had become physically abusive towards my dad and any home care workers that tried to come into the house. She had been wandering and getting lost as well as turning on the gas stove without letting the burners ignite for months and my dad just couldn't look after her any longer on his own. I was still working full time then so could only give him a break for 3-4 hrs a day. I still feel bad that we couldn't honour my mom's wishes but she has no idea that we aren't now.

My dad and my mother-in-law (both are 88 and living alone in their own homes) have a signed and witnessed formal DNR hanging in a highly visible spot in their home in case an ambulance is called by their 'help pendants' and they are unable to speak. My dad's DNR is also copied into his file in his local hospital records in the event he is brought in by ambulance from somewhere other than his home as he still drives himself around town.


~Diane
 

pedro47

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Jim, this is an excellent article. Hospice, is the best care for the end of life of a loved one IMHO. The only sad part of this journey; it is the toll, we have placed on that love one or others caring for the patient. Know one see the pain of their love one face daily, their mind & body function weakening, the physical toll of our love one body during those last months, weeks or days, hours except the person or persons taking care of that love one.

That person or persons, who are taking care of that love one has no life. Their life, responsibilities and duties are to care Mom, Dad or Brother and that is hard and very sad. This care is 24/7 until the end. That person or persons are the one who administers pain relief drugs, feed, wash, bath, and hold the patient hands. Plus, the other duties as needed hourly and daily. Many times it is that person who is caring for Mom, Dad or Brother is the one that pulled the sheet over the eyes and body of that loved one. Then their job is to call the hospice service for the last time and the funeral home to pickup the body.

My spouse and I have DNR on file with our physician and hospital .

Thanks Jim for this article.
 

WinniWoman

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Has anyone read the book "Final Exit"? I have kept that book on my shelf for years. Of course, I worked in home care and with hospice a good part of my life so I get it.
 

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In my CCRC we had 43 deaths last year out of approximately 600 residents. Some are quick and unexpected. Some are plain old age (we had a lady die the other day peacefully die at 102). Others are the result of some catastrophic health issue like a fall. The ones that are most interesting to me are those people who are trucking along normally but who all of a sudden age 10 years in 3 months. Basically you just watch them die...

My instructions to my kids is that if I am on my last legs like in intensive care in a hospital or I have dementia or alzheimer's, stay the Hell away. I want their last memory of me to be when I was relatively vigorous with all my faculties, not as one who is wasting away. Will they listen to me? Who knows? But at least I told them the way I feel about it...

George
 

WVBaker

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Would I want to be kept alive under these circumstances?

The short answer is no. The long answer is hell no.

However...

Just when does refusing any medical treatment(s) cross that line into suicide and/or euthanasia? :ponder:
 

rapmarks

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They wanted to put a pacemaker in my mother at age 94 after she had suffered, basically lost her mind, and been bed ridden for six months.
When my aunt was taken from nursing home to hospital after a stroke they called me at 3 am to discuss giving her the clot busting shot. I wanted them to give it to her but they decided they didn’t know when she had the stroke so it might kill her. I told them she would rather that happen than to be totally debilitated but they refused.
Neither had any quality of life left at this point but lingered for months.
My aunts had orders that if they were on the floor having a heart attack we were to let them die and had dnr signs all over their home. It wasn’t that easy.
I believe all the heart medication is keeping people alive. Most of my older relatives died between ages 61 and 71. But five of them lived to between 88 and 96. I believe a heart drug came along at some point that kept these five people alive, something that wasn’t available until the nineties.
 

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Has anyone read the book "Final Exit"? I have kept that book on my shelf for years. Of course, I worked in home care and with hospice a good part of my life so I get it.

I just read the blurb on that book and it sounds very heavy. I'm not sure I could/ want to read it. My wife is a nurse and has specialized in Home Care for most of her career. We have watched her parents suffer a long slow end of their lives and it is not pleasant to experience. I guess for those that need to have control over their end of life, there are options.
 

easyrider

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Getting ready to check out Jim ? Maybe check in ? As good as most of us plan our trips I doubt that most of us have planed for that last trip. I know I haven't. Good article.

Bill
 

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Excellent article, Jim. Thanks for posting. I'll re-emphasize that it's good to have conversations with your loved ones now about how you want to live the end stage of your life. DH and I have seen too many family and friends go though the agony of making decisions about end of life care after accidents or sudden illnesses. Our kids think we're morbid that we stated our death wishes (their term) when they were in high school, and have a notebook with our thoughts and directives. Trying to think and act rationally when something terrible happens out of the blue is crazy difficult to do, no matter how stoic you think you are.

We came home from a few months in Mexico earlier this year, to discover I had an ovarian tumor the size of a football. I'm not a large woman, I just thought I'd gained a little weight around my waist on vacation. :rolleyes: We've always been healthy and active and were enjoying early retirement, so this totally caught us off guard. By far, the hardest discussion in my life was to tell my husband and my GYN/Oncologist exactly how much I wanted to have done if surgery confirmed the worst (which was really bad). The standard procedure was to explore and remove anything that might prevent cancer from spreading. I'd always said I wanted no heroic measures, that quality of life is the most important thing to me and all that BS, but until I had to really face that decision, they were just words. I am blessed that my husband of many decades held my hand, listened, and respected my decision. Thankfully, the tumor turned out to be benign - and I'm still here on TUG, planning many more vacations!
 

b2bailey

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My daughter is facing her father's end of life. While in the hospital, the doctor told father he should consider having a DNR on file. He refused. He always was a very selfish man, amazed he continues to be that way.
 

Brett

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Good points in this thread.
Just this year my mother went from independent living to assisted living to 'memory care' - - it can happen faster than you think
 

pedro47

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Prepare your daughter, seeing her father being hook up on/to life support apparatus.

That is a heart breaking moment when you see it for the very first time. This came all be avoided when you have a DNR document in place. IMO.

Her father could be on life support for a hour, a day, a week, a month or longer until someone in the family make a decision to pull the plug.
 

moonstone

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We just learned this morning that another good friend has passed away at a relatively young age. Brenda retired in May and turned 60 in June. She decided she needed more time to look after her aging mother who fell and broke her hip earlier in the spring. Brenda's husband retired in August and they went on a few short camping trips with more planned (2 with us) for next year. 17 days ago she began experiencing bad pains in her stomach, a trip to Emerg with many tests confirmed pancreatic cancer that had begun to spread. An Oncologist told her not much could be done at that late stage. She got a prescription for pain management and went home to get things in order. She lasted 3 days at home before returning to the hospital where she died yesterday. So Sad!

That makes four friends in 3 weeks that have passed away. The oldest was 73 the youngest was 55, 2 women from cancer, 2 men from heart attacks. My 88 yr old dad was saying he was saddened that so many of he & my moms friends have passed but they were all in their 80's and 90's. DH & I are just in our early-mid 60's! Life is so short! :bawl:


~Diane
 

WinniWoman

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My daughter is facing her father's end of life. While in the hospital, the doctor told father he should consider having a DNR on file. He refused. He always was a very selfish man, amazed he continues to be that way.

My husband hates to even talk about stuff like this. When the FA told us to write out a letter of instruction, for example, I got right on mine. Not him. Has has yet to make one up.

That said, he (and I) does have an old Living Will and Durable Power of Atty and when we move we will both be updating those.


I do tell him if he does not make his wishes known, then I will decide for him and he might not have wanted what iI decide. Oh well.....
 

WinniWoman

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We just learned this morning that another good friend has passed away at a relatively young age. Brenda retired in May and turned 60 in June. She decided she needed more time to look after her aging mother who fell and broke her hip earlier in the spring. Brenda's husband retired in August and they went on a few short camping trips with more planned (2 with us) for next year. 17 days ago she began experiencing bad pains in her stomach, a trip to Emerg with many tests confirmed pancreatic cancer that had begun to spread. An Oncologist told her not much could be done at that late stage. She got a prescription for pain management and went home to get things in order. She lasted 3 days at home before returning to the hospital where she died yesterday. So Sad!

That makes four friends in 3 weeks that have passed away. The oldest was 73 the youngest was 55, 2 women from cancer, 2 men from heart attacks. My 88 yr old dad was saying he was saddened that so many of he & my moms friends have passed but they were all in their 80's and 90's. DH & I are just in our early-mid 60's! Life is so short! :bawl:


~Diane


OMG! So sorry! Very sad to hear these kinds of things. I always say what is the point of anything in life? Really makes you wonder.
 

PamMo

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Oh, Diane (Moonstone), that is such a sad post. It's sobering to watch loved ones die, and heartbreaking to think of the future they planned, but never got to see. Your story of your friend, Brenda, made me gasp.
 

Passepartout

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I am so deeply sorry for all these stories, but they just reinforce the concept of making preparations sooner rather than later, to 'cross over' on our own terms instead of being pressed into heroic, painful, and in the end, fruitless and expensive attempts to add low quality days, hours, or minutes to the inevitable outcome.

A note about a dear uncle. Uncle Richard found out far too late to do anything about it that his time was short due to lung cancer. When the day arrived, the gathered family asked how to comfort him. He said, "Just be with me. I've never done this before!" Full of humor to the end.

Jim
 
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Let's see - my BIL passed at 47 from melanoma. My sister-in-law was in denial. Literally as he was slipping away, she called 911 and had him on a ventilator. He lasted a few days. I thought that was torture and "what was she thinking".

My other BIL - passed at 60 from a heart attack (the brother). We would have all done the same, my sister-in-law called 911. They brought him back but was also put on life support/ventilator. She was also in denial. After a month, she was finally convinced he was not waking up and brain dead.

My dad passed 79 years. We/he knew he had lung cancer but wanted no testing, treatment, etc. So we had no clue how long he had. His final months, we put him on hospice. We or should I say, I, more or less took care of him at home. We had aides for a few hours but we did everything.

While my dad was diagnosed, my sister 46 at the time (not married/living at home), was also diagnosed with lung cancer. We knew she had 6-9 months. She tried chemo and radiation but in the end, she said, I want to be put in hospice like dad and no more treatments. Along with other family members we but mostly I, took care of her.

Now my mom was also going through breast cancer treatments and before she finished had open heart surgery.

My mom's house had three oxygen tanks and three hospital beds going. My dad passed first and three months later, I watched my sister take her last breath. The only thing she asked was that she did not want to die alone and for sure, she did not. She was surrounded by all of us. For 6 months between all three, I was there almost 24/7. Mostly my husband and I took turns. I was giving enemas, washing, cleaning them, blood, them getting sick and everything around them. The hardest 6 months of my life and I would do it all over again.

My father-in-law - who was never sick, became ill. In the hospital for infection, passing out, dehydrated. They put in a new pacemaker but we knew it was probably not needed. He declined fast.

He went home. After my husband visited him and came home, my mother in law called. He passed while the aide was there. After a few minutes or so, the nurse came in for a follow-up and apparently called 911. (we did not know this but no matter). My husband and I got there in the meantime and there was crying and calls made (family). I told my husband and mother in law let's straighten his body out so he does not get "stiff" that way (I knew from experience). Now EMS, police and Fire department come in. EMS touches him and say he is still a bit warm so they picked him up from his chair and threw him on the floor.

What a scene that I never hope to experience again. By law they have to work on him I believe she said 15 minutes.......don't quote me on this. My MIL is screaming to leave him alone, he has been dead for a while. My husband had to be held back and taken outside by the cops since he was also screaming. They were telling all responders about the will - no artificial this, or that, life support, etc. It meant nothing since it was not a DNR. Long story short, they did not bring him back.

Since that incident, my mother in law made sure she had a DNR where everyone could see it. One should also carry it with them.

My mom passed after being in the hospital for three weeks - due to an infection on her leg from diabetes. Because of other issues, she went downhill.

My mother in law one morning was waiting for my husband to pick her up to take her for a haircut. She had called the neighbor and told her to call her son (my husband) why she did not call us is beyond me. Long story short.........she bled to death. Her vein popped/burst on the side/bottom of her leg. That was another story and we pray she went quick and did not suffer. (her sister is now having issues with the same leg that starts bleeding).

We all wish we could go while we sleep. Please God let it be quick and painless.

I do not want to be a burden to my kids or possibly husband some day. I say, As long as I can walk and wipe my "b...tt", I would like to be home with an aide. If I am alone, lonely and can still take care of myself....maybe I can live with one of my children but only if I have my own separate entrance/privacy, etc.

I have no problem if they put us in a nursing home as long as they don't forget about us. Come to visit and oversee what is going on. Take us out, pay someone to spend time with us if they can't., etc. etc.

Family members should know what one's wishes are. No one wants to suffer.

Sorry I know it's long. I had 5 deaths within 18 months including my best friend/next door neighbor (54 yrs. old) of over 25 years (colon cancer). (My mom and mil were a few years after one of the last 5 and two years later my mother in law).

Enjoy life and let's be thankful for today. A blessed day to everyone.

Thank you for the article.
 

Big Matt

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Interesting how we treat our pets at the end, but keep loved ones around at all costs even if pain is unbearable. I know what i would like for myself at the end.
 

rapmarks

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AnnaS, you are one of a kind!
 
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