What Was "The End" Like?

[Anonymous]

Anonymous wrote:What is the easiest way to get a DNR for my dad who barely speaks English? I have a DPOA for him. Do I need to take him to a notary public?

To add, he is 80 and doesn’t show signs of death approaching but he definitely wants a DNR and I agree due to his age

[Anonymous]

Anonymous wrote:If you're asking about a person's last moments, there is inability to breathe, sometimes due to cardiac arrest, or sometimes due to fluid in the airway. When patients are under heavy meds or asleep, they might not react, and go peacefully. Other times, the body fights as it starts to shut down, and it's traumatic for the patient and the onlookers.

Death is usually not pretty, OP. Just like birth. Both, unless medication is involved, tend to be painful, even if only for a brief while.

Modern society has stopped being present for deaths, which are often walled off from society and happen in hospitals under long-term medical care. Deaths before modern medicine used to happen most often at home, surrounded by relatives and neighbors, and after very brief illnesses. Death was a social affair, and last moments were familiar to all. There was very rarely this long walk towards death that our elderly undertake nowadays, accompanied by years of medical support and interventions, and an end either missed by relatives or attended only by a very few.

While it's wonderful that we can prolong life these days, and alleviate some types of pain, it's also important to think about what we want before and in our last moments, and how much, or how little intervention we desire from the medical establishment. Too many people are kept barely alive, in what must be agonizing pain (except they can't show it), before their final release, just because doctors have a sworn duty of preserving life, and the patient has not indicated a preference for receiving less supportive measures. For ex: think about a terminally ill patient or a very elderly frail patient who has a cardiac arrest and whose ribcage gets smashed during resuscitation because they have no DNR. Even though there is no long-term hope for them.

Make plans.

"Other times, the body fights as it starts to shut down, and it's traumatic for the patient and the onlookers." What does this look like?

[Anonymous]

Anonymous wrote:

Anonymous wrote:What is the easiest way to get a DNR for my dad who barely speaks English? I have a DPOA for him. Do I need to take him to a notary public?

To add, he is 80 and doesn’t show signs of death approaching but he definitely wants a DNR and I agree due to his age

In MD they have a MOLST form that the doctors fill out. I filled it out for my dad and dropped it off at the doctors (Kaiser) to sign. His Kaiser doctor sent it back to me signed and had put it in his file. I filed it with the hospital and his assisted living facility.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you're asking about a person's last moments, there is inability to breathe, sometimes due to cardiac arrest, or sometimes due to fluid in the airway. When patients are under heavy meds or asleep, they might not react, and go peacefully. Other times, the body fights as it starts to shut down, and it's traumatic for the patient and the onlookers.

Death is usually not pretty, OP. Just like birth. Both, unless medication is involved, tend to be painful, even if only for a brief while.

Modern society has stopped being present for deaths, which are often walled off from society and happen in hospitals under long-term medical care. Deaths before modern medicine used to happen most often at home, surrounded by relatives and neighbors, and after very brief illnesses. Death was a social affair, and last moments were familiar to all. There was very rarely this long walk towards death that our elderly undertake nowadays, accompanied by years of medical support and interventions, and an end either missed by relatives or attended only by a very few.

While it's wonderful that we can prolong life these days, and alleviate some types of pain, it's also important to think about what we want before and in our last moments, and how much, or how little intervention we desire from the medical establishment. Too many people are kept barely alive, in what must be agonizing pain (except they can't show it), before their final release, just because doctors have a sworn duty of preserving life, and the patient has not indicated a preference for receiving less supportive measures. For ex: think about a terminally ill patient or a very elderly frail patient who has a cardiac arrest and whose ribcage gets smashed during resuscitation because they have no DNR. Even though there is no long-term hope for them.

Make plans.

"Other times, the body fights as it starts to shut down, and it's traumatic for the patient and the onlookers." What does this look like?

The patient fights desperately for air, making all kinds of gurgling noises, with or without physical flailing, depending on their degree of fitness. Some fluids might leak from various orifices. It's very distressing for witnesses, but even more so for the patient themselves, who needs painkillers and sedatives before they get to that stage, to make the end easier for them.

[Anonymous]

My grandmother broke her hip at 89 and became less active. She had been living in a retirement village for some time, but was not on any real medical care or supports (and had DNR notes posted absolutely everywhere, as she was a social worker with a lot of experience). She was still completely present though, and I brought my newborn to see her every week. It required a hotel across the street. So we would stay for an hour, have a night out without her and then come back in the morning for an hour before driving home.

The final time I was there, at the end of a perfect one hour meeting, as we were about to go, she said that she loved us so much and that we had been such an important part of her life and to always remember how much she loved us. I was like, grandma, what you talking about, we will be back in the morning. And she said that she loved us and good night.

In the morning, she just wasn't there anymore. Her body was alive, but she wasn't really there. We spent a couple days looking at other rooms that would work for her new state, and in the meantime, she got into hospice and they helped her pass a few days later.

My step-father has alzheimers. We have been watching it for years. It is absolute hell. They finally approved him for hospice today.

[Anonymous]

Nurse gave lethal dose of morphine.

Narcan was used by assisted living staff.

Person lived two more weeks in hospital with appropriate morphine. They began shaking after their spouse said for them to go and died seven hours later.

[Anonymous]

My dad was 80 and had Parkinsons, very advanced. He really declined in the last 4 weeks, stopped talking and wasn't eating much. We put him in rehab, but it was soon clear there would be no coming back.

We were in the process of planning discharge (obtaining a hospital bed and hospice for home). I visited the day before he passed (I saw him most days), he said my name clearly and smiled at me : ) he also held Mom's hand and said her name. I think that night, his brain died-like, his heart was still going but next morning he was not responsive. At all. We had him transported to the hospital, and from there, to a hospice and he died peacefully that night with us there. He was warm, clean and comfortable. Really, he just stopped taking breaths.

[Anonymous]

My grandmother was well over 100. Basically every year after 100 there was one more hobby she couldn’t do anymore and she was basically bored to death. She got a cold and announced she was going to die, doctor put her on hospice and she stopped taking her maintenance meds. Was gone in a week. (The hospice folks give you anti anxiety meds pretty freely so that speeds it up).

My father died in his late 90s. His heart had been getting gradually weaker — he was just tired a lot and didn’t have stamina. Had a bad turn that may have started with eating something that didn’t agree with him and his heart started to decompensate quickly. The ER put him in hospice (they don’t want people dying in the hospital so they are really quick to hospice)—hospice gives a combo of haldol, Ativan and morphine (“ham”) on regular intervals with increasing dosage, so if you’re a sick old person that will basically slide you into oblivion pretty quickly.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you're asking about a person's last moments, there is inability to breathe, sometimes due to cardiac arrest, or sometimes due to fluid in the airway. When patients are under heavy meds or asleep, they might not react, and go peacefully. Other times, the body fights as it starts to shut down, and it's traumatic for the patient and the onlookers.

Death is usually not pretty, OP. Just like birth. Both, unless medication is involved, tend to be painful, even if only for a brief while.

Modern society has stopped being present for deaths, which are often walled off from society and happen in hospitals under long-term medical care. Deaths before modern medicine used to happen most often at home, surrounded by relatives and neighbors, and after very brief illnesses. Death was a social affair, and last moments were familiar to all. There was very rarely this long walk towards death that our elderly undertake nowadays, accompanied by years of medical support and interventions, and an end either missed by relatives or attended only by a very few.

While it's wonderful that we can prolong life these days, and alleviate some types of pain, it's also important to think about what we want before and in our last moments, and how much, or how little intervention we desire from the medical establishment. Too many people are kept barely alive, in what must be agonizing pain (except they can't show it), before their final release, just because doctors have a sworn duty of preserving life, and the patient has not indicated a preference for receiving less supportive measures. For ex: think about a terminally ill patient or a very elderly frail patient who has a cardiac arrest and whose ribcage gets smashed during resuscitation because they have no DNR. Even though there is no long-term hope for them.

Make plans.

100% this. I spent the first decade of my nursing career in long term care. I have been with about 30 or so as they died (literally died)

Personally I nursed my great aunt at home as she died of Covid and my father is dying of dementia very slowly now.

It varies. You want a DNR maybe even before you think it’s “time”. Resuscitation is VIOLENT.

It’s good to have hospice or a palliative care doc on board at the end for meds. They DO NOT speed up death but they decrease pain, anxiety, and shortness of breath or “air hunger”

I just don’t believe that they don’t speed up death. You take an elderly person in heart failure and give them a significant dose of haldol, Ativan and morphine and that doesn’t speed up the end result?? I’m not being critical — I think this is the cheat code to our stupid anti-euthanasia laws — but it just seems to me disingenuous to say that these drugs do not speed up death for a person in very compromised health. (In fact, I think haldol is generally contraindicated for elderly with dementia due to the increased risk of death, isn’t it?)

[Anonymous]

Horrible. In the ER every 1-2 weeks for about six months. Stabilized and returned to the nursing home. Rinse, repeat.

Last ER visit turned into cardiac arrest, then ICU with aspiration pneumonia, seepage bleeding from new and old wounds, and finally the DNR and cardiac arrest from choking to death.

Just horrible and protracted.

[Anonymous]

Horrible. In the ER every 1-2 weeks for about six months. Stabilized and returned to the nursing home. Rinse, repeat.

Last ER visit turned into cardiac arrest, then ICU with aspiration pneumonia, seepage bleeding from new and old wounds, and finally the DNR and cardiac arrest from choking to death.

Just horrible and protracted.

and this is why even if hospice meds speed up death (and I do not know one way or another, but I dont think they do), its preferable. Once my mother was clearly never going to recover in a meaningful way (advanced dementia) it made hospice the only choice after she fell and broke bones. But it would be harder decision for someone who was fairly with it before whatever illness/fall, and who could potentially recover, but in the end just decompensates. MIL had a couple major falls and surgeries, and came back from them--though more frail, still with it and generally capable of enjoying life, though mostly from a wheelchair. However, in the end, she had UTI/sepsis, and just never recovered strength and died in rehab, probably from choking/fluid in lungs from not being able to sit up.