I think MIL is dying

[Anonymous]

My in-laws are in their 90s. They live in Germany, we live in DC. They always said they would not be a burden to my DH (only child) and they would go to an assisted living type of place when necessary. They finally did so last spring. I think it should have happened before because doing their own grocery shopping, cooking etc was way too much for them. So it was a good thing, given the circumstances.
For the last three weeks MIL has had an excruciating back pain. She was even taken to hospital, they said she has arthritis in the spine and. It much can be done other than pain killers and they sent her back to the home.
However that place is not able to assist if people are permanently so ill, as it seems that she is going to be. So DH, FIL and the home they are in now have started the conversation about whether they should move MIL elsewhere, so she can receive proper care (and, I imagine, she won't be such a burden because they will be more prepared).
My DH was visiting them this weekend. I only see her on skype about once a week and she barely talks to us any more and she looks like she is suffering a lot. It looks like she is really at the end of her road and, if they move her, being separate from FIL, will make things much harder for her. I feel her body is giving up, maybe for the best.
I feel helpless. What can I do for her? Even more now in the holiday season when we are all doing charitable things and donations, but I can't even help her or FIL.

Thanks for advice or for just reading me.
I have been very lucky so far, I am 39 and never been had a close relative in this situation before. So I am lost.

[Anonymous]

Are you German, OP?

I am so sorry for your MIL. It sounds miserable. Do you want to visit with her? What kind of palative care can they give her?

[Anonymous]

So sorry you are going through this, OP. I wish I had some good advice to share with you. I hope your MIL is able to die as peacefully as is possible.

[Anonymous]

OP here. Thank you for your words.
Yes I think I need to put my thoughts in order, you have said it - dying in peace and with some dignity is going to be the challenge I think and this is where I would like to help.
No I am not German, they are.
Never been close to her, partly cos of the different 'culture', way of thinking. I am having issues with DH because he seems so cold and detached. I understand he must be scared too, but taking to him and considering options seems impossible, he seems to leave it all in the hands of FIL (who is also frail and does not make the new decisions) and dows not want to get to involved.
Yes I am afraid that she won't die in peace and then we will all realize we should have done more and it will be too late.
But do what?

[Anonymous]

^^ sorry some typos
Meant that it's difficult talking to DH and that frail FIL does not tend to make the best decisions, can't just be left in his hands.

[Anonymous]

Then you step in, OP - don't be afraid of demanding better care for your MIL.

My husband and his 3 brothers were raised to be resilient and strong but are completely clueless about empathy and nursing, so I have been progressively more direct with my wishes for my MIL. Thankfully she is not yet at the end of her rope, but she had to have major surgery for a life-threatening condition, and DH was so cold about it!
I insisted he call her more often, and I made him call up his brothers so that they could stagger their visits and manage her medical care better. These are doctors, pharmacists and bankers we're talking about, and they couldn't synchronize their schedules for their mother without me!

Your MIL needs good medical care and skilled nursing, with visits from her family.
Your DH should be on top of all medical reports, check that FIL is doing his best for her, and research facilities for her care. Guilt him into it, it's his job as an only child.
You can Skype with her, even if she doesn't respond much, she needs human contact and your children will cheer her up. It doesn't matter if your stock German phrases are awful.
Lastly, if work and finances permit, you could visit her as well.

Good luck.

[Anonymous]

Anonymous wrote:
Then you step in, OP - don't be afraid of demanding better care for your MIL.

My husband and his 3 brothers were raised to be resilient and strong but are completely clueless about empathy and nursing, so I have been progressively more direct with my wishes for my MIL. Thankfully she is not yet at the end of her rope, but she had to have major surgery for a life-threatening condition, and DH was so cold about it!
I insisted he call her more often, and I made him call up his brothers so that they could stagger their visits and manage her medical care better. These are doctors, pharmacists and bankers we're talking about, and they couldn't synchronize their schedules for their mother without me!

Your MIL needs good medical care and skilled nursing, with visits from her family.
Your DH should be on top of all medical reports, check that FIL is doing his best for her, and research facilities for her care. Guilt him into it, it's his job as an only child.
You can Skype with her, even if she doesn't respond much, she needs human contact and your children will cheer her up. It doesn't matter if your stock German phrases are awful.
Lastly, if work and finances permit, you could visit her as well.

Good luck.

Agree with this PP.

My grandfather passed away last year at 93 after a battle with pneumonia and other complications. He had been in an independent living facility in his own apartment, but after getting discharged from the hospital he went into the assisted living wing. When it becomes apparent that this was probably the end and he wanted to be at home we pushed hard to get him out of that wing (shared rooms / overstaffed nursing) and back into his own apartment ASAP, even though it mean paying for 24 hour nursing care (so some concern about the cost if that went on long term), and even moved him before there was a hospital bed ready in his apartment because it felt so important to just get him home.

And making that stand was hands down the best decision of my life to date. He only lived 2-3 more days, but they were in the comfort and peace of his own familiar surroundings, and he was able to die with dignity. And when he had a last gasp rally the night before he passed (which is apparently not uncommon) he spent it in his own living room surrounded by his children and grandchildren, and we got the great gift of having one last night with him.

At some point death comes for us all - it is a great blessing if it can happen in dignity and surrounded by love.

Best to you and your family OP as you all go through this end of life journey.

[Anonymous]

OP,

I'm so sorry that you're going through this. I don't know about the German system but the US has come a long way in palliative care. The conventional wisdom was that doctors would held back on narcotics b/c they were afraid that their patients would become addicted, which didn't make much sense b/c people were close to death.

So basically if she's very and is in pain, she should be given as much painkiller as needed so she doesn't have to live what's left of her life in pain.

In terms of a visit, I really get the read on it from your DH. Sometimes when people are sick, a visit is the last thing they want b/c they are in so much pain, it stresses them out vs. cheers them up. So your DH will probably give you the scoop as to outlook.

I would send her flowers, cards, maybe folded origami animals enclosed. Digital picture frame with the kids pictures in it.

[Anonymous]

The Post had a good article about this today: http://www.washingtonpost.com/news/storyline/wp/2014/12/12/warehouses-for-the-dying-are-we-prolonging-life-or-prolonging-death/. You and your DH need to have an honest discussion about what's next. It's not really clear from your post, OP, what you think is best for MIL/what the family is looking for. Do you/they want hospice care to help her die with comfort and dignity, or do you want a more aggressive approach? I hope it's the former, for her sake.

[Anonymous]

Anonymous wrote:The Post had a good article about this today: http://www.washingtonpost.com/news/storyline/wp/2014/12/12/warehouses-for-the-dying-are-we-prolonging-life-or-prolonging-death/. You and your DH need to have an honest discussion about what's next. It's not really clear from your post, OP, what you think is best for MIL/what the family is looking for. Do you/they want hospice care to help her die with comfort and dignity, or do you want a more aggressive approach? I hope it's the former, for her sake.

Thanks but we are very, very far from this. I need to understand better what quality of life palliative care could offer.

[Anonymous]

So sorry, OP. Palliative care can offer increased comfort and quality of life even if you do take a more aggressive approach. They are comfort experts.

Hang in there, OP. This is one of the toughest parts of life, but it comes for all of us eventually. It is a privilege to care for them and walk with them during this time. So many of us lose our parents and partners far too young. I know it is tough, but hang in there and you will look back on this knowing you did everything you could to make her last days good.

Send her beautiful cards a few times a week, so at least she can have something pretty to look at and be reminded that you care.

[Anonymous]

OP, arthritis can be very painful and debilitating, but I don't see anything in your post to indicate that MIL is otherwise in very poor health/likely to die soon. You may want to think of this more in terms of aggressively managing her pain and helping her live well rather than end of life planning. I think other posters' advice about trying to get involved in decision making is good. Sending her flowers also might provide a bit of cheer. Hang in there.