father on trach/vent 41 days. Communicates for a minute and then unconscious again. Dr will not say temporary or permanent. Still in ICU but thinking of moving to palliative care. What do you think?
I think there are likely a lot of variables here, and that you may get conflicting opinions from treating physicians.
Some underlying issues to address first:
1. Why is he trached and on a vent? What were the conditions precedent? Is he in a medically induced coma?
2. If "the doctor" won't say whether it's permanent or temporary, (a) what kind of doctor is this? Pulmonary? Cardiac? PCP? (b) What do other treating physicians say?
As an example: my father experienced multiple complications at 85 (after overworking to "lose" himself just after my sister died), was induced into a coma b/c of pulmonary issues, and was intubated, then trached. After 3 weeks he came out of the coma, and spent the next 6 months trached, unable to speak at all most of that time. He was dysphagic when he eventually was released after a month of rehab, including speech therapy. All total: August to March of the following year in institutions.
After a few months of tube feeding, and intensive dysphagic exercises, he was able to begin eating again. PT helped restore physical function. He lived to be 99.5 years old.
So, there is a possibility, depending on your father's history, how the current situation arose, co-morbidity issues, mental strength, quality of doctors, and of course you and your ability to provide a lot of support once he is decannulated and released.
I would get all the facts suggested above, consult ALL the doctors, and raise all the issues you can, then consider whether or not PC or possibility of condition reversal is appropriate.
This is and will be a challenging time for you. Make sure that you get as much rest and peace as you can, while you can.
You would be the one to best know his wishes in this matter, as his family. I would never want this and I have made my wishes never to receive artificial feedings, or intubation and ventilation at this point, and have made my wishes clear to family and written them in my advance directive. This is a very long time, at an advanced age, to be on this heroic measure. I personally would be moving the elder I loved to palliative comfort care at this point. These are very personal decisions best made by us before need and by our families, who know us, when we can not longer make these decisions ourselves. I am sorry you and your family are going through this.
What are long term goals and prognosis? Palliative care is great and will help a lot. Hospice is great and will also help you a lot. I suggest talking to Hospice/Palliative and see what they say and what the prognosis and what extent you want to go. What were your fathers wishes? What would he want you to do if he were able to tell you. What would be the perfect answer for me might not be the perfect answer for someone else. Also have a long discussion about "tube feeding" as I am sure this will be addressed. With the "newer" POLST form there is a section on "Medically Administered Nutrition" (tube feeding) the selections are Long term medically administered nutrition, including feeding tubes OR Trial period of medically administered nutrition, including feeding tubes (then it gives a line for length of time) OR No medically administered means of nutrition, including feeding tubes (this option also gives a line for additions instruction eg, length of trial period) There is no "right" or "wrong" decision it is a difficult one and you are going to be pulled in two directions. Your HEART will want you to make one decision and your BRAIN may tell you to make another. While you may want to listen to your heart pay close attention to your brain that is the one that will make the right decisions.
Hi, sorry for ur dad's condition. If he's been conscious on occasion, the Dr may need to get dad's own permission to remove vent, (unless he has already signed DNR papers upon admit). Also, unless ur the designated health proxy person, u may have to get all ur siblings to agree with u about extubation, ect.
Some underlying issues to address first:
1. Why is he trached and on a vent? What were the conditions precedent? Is he in a medically induced coma?
2. If "the doctor" won't say whether it's permanent or temporary, (a) what kind of doctor is this? Pulmonary? Cardiac? PCP? (b) What do other treating physicians say?
As an example: my father experienced multiple complications at 85 (after overworking to "lose" himself just after my sister died), was induced into a coma b/c of pulmonary issues, and was intubated, then trached. After 3 weeks he came out of the coma, and spent the next 6 months trached, unable to speak at all most of that time. He was dysphagic when he eventually was released after a month of rehab, including speech therapy. All total: August to March of the following year in institutions.
After a few months of tube feeding, and intensive dysphagic exercises, he was able to begin eating again. PT helped restore physical function. He lived to be 99.5 years old.
So, there is a possibility, depending on your father's history, how the current situation arose, co-morbidity issues, mental strength, quality of doctors, and of course you and your ability to provide a lot of support once he is decannulated and released.
I would get all the facts suggested above, consult ALL the doctors, and raise all the issues you can, then consider whether or not PC or possibility of condition reversal is appropriate.
This is and will be a challenging time for you. Make sure that you get as much rest and peace as you can, while you can.
This is a very long time, at an advanced age, to be on this heroic measure. I personally would be moving the elder I loved to palliative comfort care at this point. These are very personal decisions best made by us before need and by our families, who know us, when we can not longer make these decisions ourselves.
I am sorry you and your family are going through this.
Palliative care is great and will help a lot.
Hospice is great and will also help you a lot.
I suggest talking to Hospice/Palliative and see what they say and what the prognosis and what extent you want to go.
What were your fathers wishes? What would he want you to do if he were able to tell you.
What would be the perfect answer for me might not be the perfect answer for someone else.
Also have a long discussion about "tube feeding" as I am sure this will be addressed.
With the "newer" POLST form there is a section on "Medically Administered Nutrition" (tube feeding) the selections are Long term medically administered nutrition, including feeding tubes OR Trial period of medically administered nutrition, including feeding tubes (then it gives a line for length of time)
OR No medically administered means of nutrition, including feeding tubes (this option also gives a line for additions instruction eg, length of trial period)
There is no "right" or "wrong" decision it is a difficult one and you are going to be pulled in two directions. Your HEART will want you to make one decision and your BRAIN may tell you to make another. While you may want to listen to your heart pay close attention to your brain that is the one that will make the right decisions.