Let me introduce my step-father:
This is a man whose own family has used him up and cast him out. An incredibly hard worker his whole life and the most intelligent and compassionate of humans. He and my mother married just short of 10 years ago and he was delighted to find that my siblings and I welcomed him so completely. He has been a huge part of my life, even walking me down the aisle at my wedding.
Back then, he had many health conditions from a life of traveling and wining and dining for work. He was overweight, had diabetes, gout, and had suffered multiple heart attacks. My mother did her best to encourage a healthier life style and keeping him on track with the doctors' and nutritionists recommendations.
18 months ago: He has come down with pneumonia. Not the first time. He becomes septic and is hospitalized. Also not the first time. But this time, his kidneys have failed. He eventually makes it into a rehab where he is getting PT to help him regain his strength and is adapting to a life on dialysis.
He has been bed ridden ever since. Eventually he makes it home where my mother adapts to a life of being his in-home caretaker. She does an amazing job, as well as the nurses, therapists, and the rest of the team caring for him. They have a home dialysis set-up and a hospital bed.
He was doing well in his PT until they noticed a sore on his foot. He is told to stop the PT until that is healed and begins to lose all his built up strength again. The sore gets worse and worse and will not heal. Eventually, they do a done scan and find that he has a bone infection. It is determined that he will need to have his leg amputated.
At this point, we are shocked. It feels like every time he takes one step forward, he get pushed back two. Still, we are positive and coping. There are many current medical advancements that will offer him a mostly normal life. He is only 68yo- this is not the end.
Last week: the nurse that visits him at the house notices his blood pressure is abnormally low. He is taken to the hospital with critical heart failure. Now it is a race to get his heart stabilized so they can safely remove his leg. They put a catheter in his heart and he is approved for the surgery. It is successful.
Only something has changed in him. Obviously, he has gone through a great loss, and I'm personally surprised that he isn't immediately seen by a therapist. Due to COVID we are unable to visit to lend our support but with his shift in personality, I'm starting to think that is a good thing. He is bound and determined he is going home. NOW.
He refuses his medication and his dialysis. He is completely defeated. As it turns out, one of the doctors has put it in his head that he is never leaving the hospital because of his heart. Eventually my mom gets to Zoom with him while a doctor and a nurse are both present and she gets him to agree to let them administer his meds and dialysis. He refuses to verbalize that he wants to die, but admits knowing he can't survive without treatment.
Before the Zoom call, he was talking conspiracy theories. He has done this before while being in intensive care but this time is different. He isn't on any major pain-killers (which I know can cause anger and disorientation) but is talking nonsense. My mother is scared and confused and being torn down by him either being angry with her that she doesn't understand his delusions or the fact that she says he can't come home yet. We both tell him that as soon as his heart is well enough we will bring him home but by the way he talks, he just want to come home to die.
He has a heart scan today that will determine whether his heart is doing better or worse after getting the leg removed. Function had gone from 55% to 16%. He needs good news. We all do.
He keeps talking about exercising his rights. My mother is his POA but he is coherent enough to fight her. How do we determine whether he is in his right mind to make a decision to refuse treatment?