End of life and unfinished business.

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My mother in law has moved in with me with end stage renal disease and after a lot of agitation was taken off dialysis last week. I have to take care of Dad too who's even older. but the point is that my sister in law who has always sucked out everything from her mother and abandoned her when she was ill (mother in law has no insurance and a lot of money problems which her son, my husband, is grappling with) visited her yesterday and left her absolutely demented. she turned around on me and started abusing me (for keeping her alive) and is staying alive now purely due to a boiling fury against the world, her daughter, son in law and me. my husband is already losing weight with this strain and exhaustion from full work load. Mother in law refuses to listen to pastor or help, and i just don't know how to cope for the few days left. her body's gone but her will is keeping her alive though she says she wants to die.
how do i talk to her? i'm falling ill myself. any tips for staying calm - she's so pathetic but looks at me with such concentrated hatred, i can't even look at her let alone speak and take care. she's utterly helpless and cleaning her diapers has become a kind of crisis, she fights everything.


Is MIL on hospice care? It may be kind of late, but they would be a comfort to you and your husband.
Thanks Jeanne. We are not in the US- found this site after becoming desperate over last few months. I've lost everything, money, health, career, peace of mind. there's no hospice for home help but there's some kind of palliative care in the hospital to which she refuses to go. i don't think they'll do more than talk to us for a few moments anyway i'm tied at home now.
Call the doctor to order hospice and get those folks in place ASAP. They can assist in care and the social worker, nurse and pastor may not be able to help her, but they can provide you and your husband with support.
People with ESRD no longer receiving dialysis have a limited amount of time available. Once the body can no longer filter toxins, death is imminent and realitively quick. Having hospice there means she will be cared for and her pain will be managed. She may also need placement in a skilled facility to provide care for her in the weeks/days of her final care.
I'm sorry for how difficult this is for your family. Try to stay focused on each other and hold tight through the storm.
kmartin, I am so sorry that hospice is not an option for you.

Your MIL is not in her right mind. Try not to take the looks of hatred personally. Do the best you can to provide for her needs. Consider it an act of mercy to be as kind and patient as you can with this poor dying woman. If it is more than you can handle, she may have to go to a hospital in spite of "refusing" to go. I hope you can keep her home, but you must take care of yourself and your husband (and your father).

Warm hugs to you.
Thanks to Jeanne and gerontologist. its just that after doing so much with so much love or at least care, to be met with resentment and rejection is such a shock. i'm still shaking inside. my sister in law will twist everything; so far i've been the one to take care in every emergency (many of them!) but all i've had is scorn and belittling comments especially from relatives. yes all i can do hold tight to my husband, there's no one like him, and he's not too fit physically either.
it does help to vent, but it is so difficult...
just another question, please - as gerontologist wrote, MIL has limited time. one of the reasons why she's so furious with me is that I've followed doctor's orders and kept her on a strict diet and she complains i'm not feeding her. should i give in and give her what she wants, sugar and salt (her diabetes and BP are quite out of control already) or keep to her diet - i think i'm afraid i'll feel guilty as a murderess if i give the food she wants; but nothing's going to cure her anyway.... so what is best?
ESRD is always fatal but it can take longer than expected. Diet is one factor. Without hospice I would try to employ one or two empathetic women who would make your patient the center of their universe for the time remaining. You are doing too much alone. This is difficult for you all. Our prayers are with you.
kmartin, the diet thing is a very personal decision to make, and I send you hugs as you struggle with it. I don't think there is a "right" answer. I'll share what I did, but I don't mean it is what you should do.

My husband was a "foodie" (as am I). When we were dating he brought me things like a beef and corn casserole or apple cobbler instead of flowers. We entertained often, and our parties always involved food. We took cooking classes together. We remember vacations by the restaurants we discovered. In our everyday meals we watched salt intake and followed a heart healthy diet. After he developed dementia he had swallowing problems. Nine years ago he had a swallow test and was advised to have a feeding tube. Oh my goodness. No way was that going to happen. And he got by OK. This last summer, as additional problems developed he had another swallow test. The speech therapist advised a very restrictive diet to avoid aspirating. She was shocked when we agreed to practice the physical/mechanical advise but decided not to follow the diet. It is the patient's right to make decisions about quality of life. And, incidentally, both my husband's geriatrician and his world-renown dementia specialist supported the decision to ignore the diet restrictions.

So, in your situation kmartin, I would give the MIL exactly what she wants to eat. Her extreme reaction to the restrictions is a strong indication that this is a major quality-of-life issue for her. Following the diet isn't going to keep her alive, it is just interfering with the pleasure of what little time she has left. She is doing to die. There is no question of "murder" on your part.

BUT ... that is my take on the situation. You need to consult your own religious beliefs, philosophy about life and dying, and your conscience and do what you decide is best. Make your decision in love, and then don't feel guilty no matter what the outcome is. I am so very, very sorry that you have to make such a huge decision. Do your best. That is all any of us can do.
Thank you all, especially Jeanne for sharing so much, it helps so very much, though the decision is still mine and remains difficult. I have to say that while i'm still kind of dazed, my husband has reacted strongly- its tough for him, but he's taking very strong measures to make my sister in law take over - he too was so stunned at the hatred that came pouring out and this has to be stopped at all cost. there's a long history of ill will behind this. i hope i've done all i could. all your hugs and helpful thoughts and prayers have really had an effect. i hope i'll be able to say very soon that the problem is settling.
(((((((((((((hugs)))))))))))))) A long history of ill will is hard to deal with. I am sure you are doing all your can. You are a caring person.

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