My mom (81) is wheelchair bound and has a massive infection in her leg. I have to choose between amputation or end of life care. Thoughts?

No, with hospice it won’t be a horrible death. As her ‘pain is agony’ she will probably have morphine for the pain, probably continuous IV with a little pump called a morphine driver. It will make her very sleepy, but she won’t be in pain. The morphine damps down the body’s functions, and this means that her death will be quicker – probably around 24 hours rather than days of pain. She will still be able to hear if you speak very loudly close into an ear, so you can still say goodbye or give her your love during the process.

It sounds as though the only choice you and your mother have is amputation followed by poor quality life and a painful death at the end of it, or a painless death that brings the end on more quickly. Don’t be afraid that ‘you will choose poorly’. Once your make this basic choice, hospice are the experts in doing it right. I went through this with my mother’s death, and I am confident that it was the best choice. I also talked my daughters through the same thing with their father, my ex. Once again, no regrets - in fact he said 'is there any way to make it quicker' on the morning before he died in the night. The end is always emotionally difficult, and some people are distressed that things can move quickly with hospice. Hospice doesn’t kill them, it just speeds up the inevitable.

Very best wishes to you and your mother, Margaret

Have you asked your mom what she wants? I think the decision really is hers. If she is ready to give up, then by all means get hospice involved. But if she wants to keep fighting then you may have to put your feelings aside and go with the amputation.
It will be difficult either way, but your mom deserves to be able to decide for herself. Just because you think that "her time here should be done," doesn't mean that God is ready for her life to be done. He and He alone has the final say as to when He will call us home. I wish you wisdom and discernment in this matter.

Is your mother not able to understand or participate in this decision? If she is not, then quite honestly, with all the pain and the good likelihood that she will died from the surgery and blood clotting problems in any case, I think you should opt for peace and for hospice care, with good medications to see her below the level of suffering. That would be my decision for a Mom no longer to participate in any decision making who is living in agony.
If your Mom is able to help make this choice for herself, please allow her to do so. This is now YOUR and YOUR MOM'S decision only. She put you in charge of making it for you and trusted you to do so. Honor her wishes and the wishes you heard expressed by her all her life. If she is requiring fentanyl for pain relief she is in agony. As an RN, given this age, the prognosis for surgery is not good in any case, and I hope the doctors are being honest with you about that.
I am sorry you have to make this decision along. That is always difficult and there is no way to make it pain free. Not everything at this stage has an easy or a perfect fix. Do what you believe in your heart is BEST FOR YOUR MOTHER.

If your mom is cognizant this should be HER decision not yours.
The doctors should be talking to her and giving her the options as well as the supposed outcome of each decision.
Now if your mom is not cognizant or if she is unable to respond for any reason then this becomes your decision, or whoever she has chosen to be her POA for health. Technically her husband, if she is married, should be the one also making this decision if she is not able to. If mom is married and you elect no surgery is there a possibility that your father would override that decision?
If you choose Hospice they will do everything in their power to control her pain and keep her comfortable.
there is also the choice of both amputation and then Hospice. The amputation will control the infection and given the other things going on with your mom the choice to operate might be an end of life decision as well.
The best way to help you decide is what your mom would want given the current conditions, if she can not make this decision for herself.

I am surprised amputation is even being considered with CHF and diabetes. I think you need to ask the surgeon what an amputation entails. Its not just removing the limb and everything is hunky dory.
My girlfriend was a juvenile diabetic. She had her leg removed to the knee. She refused rehab and was in excruciating pain. Because she was diabetic the stump was hard to heal. She never was able to wear an artificial leg. There will be therapy. Will your Mom be able to do it with CHF. My GF also suffered from phantom pain.

Personally, I think this will be a shock to an already weakened body. I bet if you asked the doctor "would you recommend this for your Mom if she had the health problems my Mom has" he would say no. Drs are obligated to offer all options. They are also obligated to tell you everything that can go wrong. You say Mom has had health problems the last 30 years. Maybe it is time for her to leave this world peacefully and pain free.

JoAnn raises a good point about your mother's diabetes.  I would be concerned about complications, and even whether or not there's the possibility of healing b/c of the diabetes.  

Your post reminded me of a gentleman in rehab at the same facility as my mother.   He was a noncompliant diabetic, refused to give up foods that aggravated it.   I don't recall if his first below knee amputation had been done when Mom was first there, but I do know that the second took place while we were still visiting.     Once he was out of rehab, he went into dialysis 3x weekly. 

We didn't even know him beyond a casual acquaintance at rehab, but it was very, very difficult to see him (or anyone else) in that compromising position.

I can't imagine anyone finding any hope or reason for living in those kinds of circumstances, and that would be my primary concern for your mother...the agony of the amputation and the following agony of living with it.

 I would go with hospice; in the long run, you'll save her a lot of pain, grief, perhaps confusion, and she can end her life w/o that kind of emotional and physical trial.  And remember that you're doing the best you can for her, saving her from the ordeal of surgery and attempting to adjust to a more compromised lifestyle with no hope of improvement.

I hope you can be comforted knowing that she will be getting pain meds (perhaps morphine) and a GOOD hospice will be attentive to her needs to minimize that pain.

I also hope you can remind yourself that you're thinking of her best interests, in a situation in which she's probably not able to make that decision herself.

Only chiming in to say I’m sorry you’re going through this. Your mother is blessed to have you and I’m sure she knows your love. Wishing you both peace

I think these days, the Doctors want to give us all the available choices - which is fair - our right is to know & choose when we are able. But makes me wonder if days past, or in different cultures, Doctors made the decision for us, what would they choose? lntervene as long as possible, or let be.

Knowing how my Mother would have chosen for herself in the past would help me now, if faced with making this decision for her - this awful dilemma.

I wish you strength for the road ahead, wherever it leads. There is no right or wrong, just different paths. 🙏

Julieannmomof3, the added info of the infection in her blood stream I think I would opt for Hospice and keep her as comfortable as possible.
((hugs)) If you have all the information and possibilities the decision you make is the right one at the time. You make decisions out of love and wanting what is best. Don’t doubt.

I think the kindest thing for your mother would be to get her onto hospice comfort care now, after 30 long years of suffering and pain.

My sister in law is 64, diabetic with Lupus and now possibly Leukemia. She just had her right foot amputated up to the knee after a 2 year bone infection that would not heal due to diabetes complications. She's now suffering with the stump not wanting to heal and a delay with getting the prosthetic, just to be hit with Leukemia testing! She's ready for hospice at this juncture and the family is planning for it now. Enough is enough for the poor soul. We all believe in life after death and eternal peace once we leave the Earth to be with God, so that's what we hold onto.

Wishing you the best of luck with a difficult situation.

Research all hospice organizations. They aren’t all the same. If possible, please select one that has an ‘end of life’ hospice facility or house. It will take the weight of the world off of your shoulders to know that she will be well cared for 24/7. You can visit as often as you like.

I agree with you about not exposing your children to this if you aren’t comfortable with it. It can be frightening and disturbing for them. How old are your children?

My mom recently died in a hospice house. She died with dignity and free from pain. Her care was excellent.

Wishing you peace as you navigate your way through this difficult time in your lives. I will keep you in my thoughts and prayers.

Hugs to you. Had my dad in a hospice facility for the final 2 months of his life. He was well cared for. They provided him with a level of care it would have been impossible to achieve at home even with their help.
With all of your mother's illnesses, if amputation was done would she have a chance for recovery and better quality of life? If the answer is no, then hospice is probably the better choice. It's hard to let go, it's worse to extend suffering. Let experts help you and her through this transition.

I read your personal response comments subsequent to your initial post. I think you are getting stronger and your heart will help you make the best decision for your mom. Whether or not you consider your father helpful, you still have him and your family to fall back on. Many of us do not any friends or family for the same. God Bless You.

If you choose hospice, the goal is to make her as comfortable as possible. Eventually, she will die of sepsis - overwhelming infection of her bloodstream if you choose this course.

If you choose amputation, there is not guarantee that she will live much longer since her CHF and diabetes tends to make surgery and healing harder to accomplish. The benefit is that she will not have horrible pain for a rotting leg.

Both. Unless she is within hours or days of dying, The amputation is essential for preventing gangrene from spreading and causing her death to be more painful. Death from Gangrene is not a peaceful death. Hospice because she is dying and she needs the support that they can provide

Hospice is a wonderful blessing for the patient and family. The loving thing to do for your Mother at this point is to find a hospice company with a facility where you can visit her and let them gently ease her into a peaceful final rest. Heartfelt prayers for you, doing what is best for her.

Speaking as a person who is a no-code and wants only comfort measures ...

as difficult as it is, please help make her as comfortable as possible with plenty of love too.

Oh, poor you! Whatever you decide you will second guess yourself.
1. Your mother has so many medical issues. Think of all the strain on her body if she does have the leg aputated. Can she withstand the procedure? How will it affect her other issues? Are you willing to have her go to a rehab facility? After considering all this, I hope you see the futility of amputation.
2. You need to have a sad conversation with your Dad and Mom. End-of-life care is just that. Lots of medicine to keep her pain/infection down...and then death. You have the POA --do mom and dad accept that?
3.Hospice in the home is wonderful! The nurses trully care about the patient AND the family! That is good. Your kids have an opportunity to see her, and to witness death. Death is not be horrible. The drugs given allow the patient to die easily.
4. Quote yourself: I believe her time here should be done and she should be at peace. (good solution. repeat it often)

Is mom able to state her wants? If you are able to, talk to your mom and take her wishes are and then try and honor them to the best of your ability. If mom is unable to give you her wishes then make the best decision you can. This is a very hard decision; make sure you have all the facts about amputation and how it will affect your mother - but no matter what decision you make - if you keep your mom's best interest at heart - you will not make a poor decision.

Hospice is designed to let their patients face the end of their life as pain free and with dignity. If mom will be in hospice in your home, know that you will be doing most of the work - hospice will send out nursing (RN and LPN) as needed and bath aid, chaplain, therapists (music or some such). But they won't provide aids to do the heavy lifting between visits - it will be on you and whoever else is available to assist you. Before mom does in-home hospice you may want to check on all your options or hire (on mom & dad's dime) to assist you. If your children are old enough they may be able to pitch in on small tasks to help their grandmother.

I pray that you are blessed with peace, grace and love as you face this decision and the journey ahead.

This is a very difficult situation, and no matter what choice you make, you will likely be second guessing yourself later. Please try not to be hard on yourself for having to make this choice. Given her various existing conditions along with the infection now spreading, and you say she's not coherent, hospice is likely the lesser of the two evil choices you have to make.

Several commenters are/were in nursing or had a friend/relative in similar circumstances (infection/amputation) and they've had a difficult time with it. Given your mother's other medical issues and age, amputation will likely be even more difficult for her.

Be kind to yourself, no matter what you choose to do.

I think you have answered your own question. My 93 year old mother with dementia was hospitalized with Covid and give a poor prognosis due to previous bouts of pneumonia and COPD. My sibs and I discussed it and chose palliative care rather than have her endure a respirator and pointless treatment. Even if she had survived her life would have been miserable. And she had told me many, many times that she did not want drastic measures to prolong her life if she couldn’t enjoy it.

And palliative care and hospice will ensure that she does not suffer.

Imho, perhaps your mother is able to state her wishes. Even so, make your decision as you may want to second guess yourself, which is extremely difficult. I am sorry that you're facing such a hard choice.

What would she want you to do? Talk to the hospice staff about how they would keep her comfortable if you choose end of life care. If you chose surgery and there would complications could you live with that choice?

This is a terrible decision to have to make, and you are likely to feel guilt no matter what choice you make.

Amputation might keep her alive longer, but it seems pointless and even cruel to keep anyone alive just to wait for "the next bad thing" to happen.