September 28, 2023

Hey everybody. This submit can 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 somewhat bit. That’s about it. She will be able to’t discuss or make any form of choice. 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 attenuate bedsores. The standard of life isn’t 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 troublesome to make selections on her remedies. At this time, I’ll let you know 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 remedies in case you possibly can’t make selections later. That is actually vital as a result of your family members may not 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. Nonetheless, I must go over it to see if there are sufficient particulars. From what I recall, Mrs. RB40 will make all medical selections for me. I don’t need a feeding tube or a ventilator if there isn’t any hope of getting higher. However now I see that we’d like extra particulars. Mrs. RB40 could make selections for me, however it’ll be method simpler if there’s a clear guideline.

My mother’s situation

My mother’s situation worsened shortly this 12 months. After I was right here in March, she might nonetheless stroll a bit. We even went swimming a couple of occasions. 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 dangerous. Her limbs have been stiff and she will’t transfer in any respect. She might solely transfer her eyes. Lastly, her bedsore saved getting worse. They lower away the lifeless tissues and tried to deal with it, however it didn’t heal. Sadly, the bedsore saved getting worse over the previous few weeks.

Palliative care

I talked to the physician they usually have 2 choices in Thailand.

  1. Lengthy-term care – They’ll attempt to hold the affected person alive and deal with every little thing. That is what that they had been doing earlier than I received right here. My dad needed to maintain my mother alive so long as potential.
  2. Palliative care – Cease all remedies 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 gained’t get any higher. Within the U.S., docs 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 residing beings are near the tip, they eat little or no. There isn’t a must lengthen life if there isn’t any probability 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 a substitute of a tube, we fed her by mouth. It labored okay. She ate somewhat little bit of liquid meals every single day. I do know this quantity of vitamins isn’t sufficient. She already misplaced quite a lot of 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 sometimes. It will trigger a lung an infection sooner or later.

Sadly, her bedsore received lots worse just lately. We are able to see that she is in ache each time we transfer her. She additionally received UTI once more and the physician prescribed antibiotics and saline drips. Nonetheless, the bedsore wound seems 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 dangerous. 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 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 choices, I’d have prevented the feeding tube for the reason that starting of her hospital keep 2 months in the past. However that’s the issue with making healthcare selections for somebody who’s unable to take action. Totally different members of the family can have completely different opinions. My dad desires 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 assessment our advance directive and add extra particulars. Perhaps one thing like this. 

  • If I gained’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 selections resulting from dementia or different mind trauma, simply let me go. Please.
  • If it seems like I’m in ache and gained’t enhance, then go for full palliative care.

I’ll want to sit down down with Mrs. RB40 and discuss. It’s been a troublesome few weeks. Fortunately, I’m retired so I could possibly be right here.

Thanks everybody for letting me course of my feeling right here. I believe it’s useful for me to jot down this down and share it.

Picture credit score: Nationwide Most cancers Institute

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Joe began Retire by 40 in 2010 to determine the right way to retire early. After 16 years of investing and saving, he achieved monetary independence and retired at 38.

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