An impending death

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OK... I'm facing a crisis. Not me PERSONALLY, but my wife--and of course since my wife is going through this I do feel emotionally affected.

My wife is OK, btw. This has to do with her grandmother, and never in my life have I been this close to this kind of issue. I'd considered posting to the Haven instead, but I think given what's going on it might be a valuable topic to discuss here.

OK, here goes:

Two years ago Mandi's grandmother decided that she was no longer comfortable living in her nice, spacious, 3-bedroom house in a quiet town. She'd had some falls, though nothing really serious, and the expected health problems associated with an approaching heart attack and necessary triple-bypass surgery. Her mental faculties were also in noticeable decline, but nothing unexpected of an octogenarian, and certainly nothing as alarming as severe dementia or possible Alzheimer's. We'd suspected she'd had a series of mini-strokes, but, again, nothing that severely affected her quality of life.

Just last year, she had a very severe stroke and had to deal with the subsequent confusion while her brain rewired itself to try to grasp reality. She was perfectly aware that something was wrong and the world as she saw was not as it really was/is. But she still recognized her granddaughter, me, and her great-grandchildren. More recently, as the mild dementia has progressed, we noticed that she still thought it was Christmas even though Valentine's was fast approaching. She would also mistakenly call me "Chuck," who was her son-in-law and Mandi's father (my father-in-law). BTW, she HATED my father-in-law! They did NOT get along.

She suffered yet another stroke very recently, not to mention her dementia aggravated due to other health problems, such as problems urinating (refusing to do it), accumulating excess fluid, and so on. She apparently retreated into a world dominated by her memories of her husband and has confused her thoughts/daydreams/dreams with reality, not distinguishing one from the other. Mandi was eventually able to hold meaningful, coherent conversations with her, however, and she seemed to improve.

But she is not eating, consuming fluids, or taking medications.

...

So Mandi, having long ago obtained power of attorney upon moving her to assisted living, decided what was best was to transfer her grandmother to the "memory unit" of the facility where she'd have more round-the-clock care, easier access to dining, games/therapy to maintain mental function for as long as possible, and as much physical activity as she can handle. But this also means that Mandi had to go down this week to help her move from one section to the other.

...

So Mandi talked to me over the phone, since I've been left alone to care for our children during this ordeal, and she informed me that she instead has decided NOT to move her grandmother. The reasoning is this: Wanda no longer wants to live and has given up. While they can still move her to the memory unit, it would do absolutely no good because she'd only refuse to do what the nurses tell her to do, i.e. no meds, no food, no liquid, no activity. Mandi was already prepared to consult with a hospice ANYWAY to assist, giving her the best quality of care anyone could reasonably provide both from an outside source in addition to the assisted living facility itself. But apparently Wanda is interested in nothing more than someone hanging around to care for her every need and make her feel comfortable until she dies. Mandi has acquiesced to her grandmother's desires and is making such arrangements as necessary, which will not only involve assisted living staff and hospice, but also social workers and so forth. Mandi does not believe her grandmother will live very long from this point.

...

My wife lets me play devil's advocate with her, though I can't be as forceful with her as I am in the PPR forum. So, of course, I argued against her decision based on a number of factors.
1. Is her grandmother really terminally ill?
2. Is her grandmother really competent to make such end-of-life decisions?
3. Are we really so certain this is the end?
4. If this is NOT the end, is letting her die prematurely something we can live with and keep a clear conscience?

It wasn't a long debate, obviously, because what mattered the most was that Mandi have my support, if not my approval, and now is not the time or place to do/say something to upset her more in an already-difficult situation.

Wanda's mind is already made up, it seems, as is Mandi's.

And yes, maybe I am a little emotional about it. But I just CANNOT understand how it is we can "just let her go" like that. I don't KNOW that it's the right thing to do or not. It's not ME, nor is it my own mother/grandmother or one of my children, so I suppose I shouldn't be so affected by it. But JUST GIVING UP on a human life? I could understand if death really was imminent, such as with end-stage cancer, sepsis, or prion disease. I watched my own grandfather glow bright gold when cancer spread to his liver. So yes, I understand that when it's over, it's over.

But I'm not convinced this really is the case. Maybe I'm wrong. Maybe she has a right to die with the dignity she has left. I don't know. I don't have the answer. Maybe there's NOT an answer.

I suppose what I'm asking is whether it is right to just "let go" in this type of situation when life really can be extended for who-knows-how-long? Is it right for the grandmother to give up the way she has? Is it right for Mandi to allow her to? If we all knew with any certainty that she could live 2 more years or 10 more years if she'd just eat and take her meds, would it be wrong to give up NOW?

Those are some things that have been bugging me about the whole business. I have no particular love for her, but I do value the life of other human beings and I feel I ought to hold some kind of compassion for someone who is elderly and dependent upon others for her care--not to mention she is the last remaining member of Mandi's family. It's only natural to be concerned, right?

I don't think either of them should give up, not on themselves or on each other. I think we're only taking it for granted that she doesn't have much more time.

But it doesn't really matter what *I* think, does it? So...

What does PPR have to say about it? Not just what I've expressed, but anything that would relate to it. I'll be happy to answer any questions if that will help.

Like wow.

I have over the past 10 years or so had to deal with a suffering and finally dying mother, an uncomfortable and suddenly painfully dying mother-in-law, and a father who is fairly comfortably hospiced and so Alzheimer out of it he might as well be dead - he is totally inaccessible. This is not counting the sister in law's cancer operation nd the brother in law's heazvy heart work. But I read your account as trumping that.

Forget personal opinions and public policies and doctrines and arguments. Not relevant. If I were in your shoon, which God spare us, the mandate is simply to support with all physical mental emotional spiritual modes - from providing space and relief to intensive prayer - la esposa.

And for her grandma - again such support as is possible, intensive prayer - and leaving outcomes to be worked out between her and God, who works very mysteriously, not being a tame lion, and can deal with worse.

We will put some prayer time on it.

Lately the Republicans and a good many Democrats seem intent on doing away with taxes, their general policies towards real health reform and their enthusiasm for the military policies and funding indicate a deep fondness for death. Although I am in my middle eightys my own inclinations are otherwise. I saw my wife die last year, one of my sons died in 1996, and my parents died miserable deaths in the last century. It reaches you eventually that your own turn will inexorably arrive and as it approaches it is difficult not to run the tongue of your mind over it, like one of those holes in your gums after a tooth has been extracted. Religion is supposed to candy coat the pill but the deep central bitterness is never removable. Watching someone else approach that finality, like watching a huge mass of ice in Antarctica break away and slowly crumble and dissolve into the sea. It is always somewhat awesome since it always reverberates with one's own final demise. Holding on and trying to hug the crumbling mass to keep it in shape is always terribly painful and totally frustrating.
Although there is nothing obviously wrong with me I tire too easily lately, I am losing weight and I need to sleep far too much. At my age my nostrils quiver at the slightest scent of death and the odor is not pleasant.
All you can do is hold hands and offer small comforts.

The beast is insatiable.

I'm so sorry to hear about this AngelRho. These are always hard choices.

It is so extremely important to have an Advanced Directive so that you don't put these choices on your family, and to make them when you're healthy so that no one questions your mental capacity.

The ugly fact of life is that death inevitably follows. I feel thought does need to be given to quality of life. If you're considering that she might not mentally be able to make this choice, then what are you trying to keep alive? A body that's ready to move on ?, because the mind wouldn't be hers anymore....

I watched my grandfather fight emphysema for 15 years. He had surgery twice to remove parts of his lungs. In the middle of his decline he had and, miracle of miracles, survived a ruptured aortic aneurysm. Every year I watched my grandfather dwindle, unable to do more and more of the things he loved. The last year of his life, he was miserable, barely a shell of the man I knew in my youth. I seriously believe that he held on for so long simply because he feared what would come next. One day, he told my grandmother he was ready, they called hospice. They called the family together, everyone said their goodbyes and in a way, it seemed like my grandpa wanted permission to quit fighting, which he received. My grandpa died within days.

As long as someone still has fight in them, sure they can hold on for weeks, months, even years. But once that determination is gone, they're done. As much as I miss my grandpa, I regret that he felt the need to hang on so long. If I could have saved him suffering, I would have been willing to say goodbye sooner. My only solace is that by hanging on to life, he reached the point that he no longer feared death.

If your wife's grandmother is ready to go, there's nothing you can do to force her to live. IMO, the best thing you can do for her is ease her suffering and make sure that she's spiritually ready. It's not fair to question her right to determine that she's ready to move on. If you reached that point where your body and you mind are failing, and you were ready for whatever God had in store for you, would you want someone to be sitting where you are today, trying to decide the validity of your choices?

It's never easy. I'm very sorry you're going through this.

My last experience with death was last May when the last of my immediate family moved on; I told the story in the Members Only section so I won't repeat it here, however if any members wish to read it here is a link to it.

There are a couple of things I didn't mention in that thread. On the morning of her last day after my brother-in-law and I had met with her doctors and found out that any further treatment would be futile and only make her last days more uncomfortable, she woke up with the two of us sitting by her and asked “what did the doctor say?”. When she was told the look of acceptance on her face was very touching. A couple of hours before the end she was visited by a nun who told her the journey she was about to start could be beautiful if she lets it. I think she agreed.

The point I am trying to make here AngelRho is it not your place to question your wife and grandmother's decision. If you were an atheist and thought that there is nothing beyond this life I could understand it; but you're not.

Wanda may not be competent to know the full consequences of her actions, but she IS competent to know what makes her happy right now. Would you force her to endure a few more years of a life she clearly does not want?

We're all going to die. Wanda will die, too. None of us know when, and none of us can control much about it. Towards the end of a long life, the most medical practitioners can do is extract a few more years or months, at exponentially increasing costs of quality of life and of suffering. Wanda and Mandy seem to believe that quality of life is more important than quantity. It's not disrespect for life; it's respect for a different aspect of life.

Sorry dude but this was way too tl;dr to me so I'm assuming it's about euthanasia based on the other posts. Don't do it. Life is known to throw so much crap at you at once that if you fail to tackle it all at once then you feel like it's all over. But the thing is, nothing was meant to be tackled all at once, it's just simply a panicking way of reacting. Life is definitely worth living even though it doesn't always feel that way. It's always worth riding out the storm. I can't say I know what it's like to be terminally ill, but I have certainly gone for long periods of time truly thinking that life isn't worth s**t.

Choosing NOT to accept radical medical intervention, such as forced feeding, is a very far cry from suicide.