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She was recently diagnosed with a bowel obstruction and is refusing surgery. I do have an activated POA and can make all medical decisions for her. She is only 77 yrs old, with Alzheimer's/dementia. Should I honor her wishes? Or go against them. She fractured her femur in January and now has a hard time walking due to her refusing any physical therapy. When I attempt to get her moving, she gets very nasty and argumentative. She can barely move now, I can only imagine how it would be after abdominal surgery. She is very non-compliant. What do I do?
Another thing is she really isn't my grandmother, I just call her that. She lives with me due to her entire family abandoning her. I have been taking care of her for 3 years. I just recently started speaking to her daughter.
The doctor told me that if she is not going to have the surgery, she will be placed in Palliative Care.

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That's really good. I'm happy for you.
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Thank you everyone for your comments and encouragement. She had the surgery and is now in a sub-acute unit at a nursing home. I went to visit her yesterday and she is perfectly content there. I just spoke with her on the phone and she sounded so happy. So I guess in the end it turned out alright. I must say she was a little upset with me yesterday because she thinks I am out of her life and can't tell her what to do or make decisions for her, but I corrected her and told her she is not rid of me. she actually told me to go home! She was upset because I told the CNA she needed a shower, found out she refused one the night before. I told the her and the CNA no more refusal, if she does, I need to be called and if need be I'll come up and give her a shower! Keep in mind prior to me getting involved with her care she hadn't showered or bathed in over 3 years! But at least she is happy where she is at.
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I agree with orangeblossom5 sweetie hang tough u have done so much for her. Hugs for you and your family. God Bless.
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My mother expressed that she wanted to die more than once in her final years. She was tired of living, I guess, especially when she couldn't call the shots anymore. The final time it came about was when she turned yellow and the doc wanted to put in a stint to relieve the bile from her liver. She stated to us as a group, "Your just extending MY life!" It was rather a shock to hear that, but we gently disagreed and told her that it was her choice, but it might make her more comfortable. She chose to have the stint put in, and yet died two weeks later. We certainly did not know how long she had, and the doctor's best guess was 3-6 months. Of course, if we had crystal balls, we would have never suggested it. That was five years ago and I don't regret how it happened, because we did the best we could. 77 may be young, but Alzheimers is hard. Keep asking questions and letting her know the answers, but it's her call. We all wish we could keep out loved ones from crossing over, (or whatever you believe) but it's out of our hands.
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I pray that my children honor my wishes. I would hope that for everyone.
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I'm happy to see so many rational people here on this site. When did we get to a point where everyone has to be kept alive at any cost? This is why we all need to discuss our wishes before we get to that inevitable time when we are not thinking clearly. I recently had to make that decision when the medics wanted to take mom to the hospital. That's when it really hit me, this is it, this is when I say no thank you, we'll just stay here in our nice comfortable home & see what happens. Turns out, she got better but even if she had not I was OK with the decision because I know she did not want to go to the hospital.
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Honor her wishes. I have experience with doing both; keeping them alive and letting them go. It's best to let them go, but before you do, give them a comfortable, caring ending. It's the respectful and kindest thing you can do for someone you care about.
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I think you got the POA because you are most familiar with granny's wishes. As her voice, try to decide as she would... and who would want such a diminished "life" as she will have in the best of circumstances, and possibly even worse if surgery further affects her negatively?Also note that healing from surgery at 77 is different from 57 or 67. God bless you for taking this role to heart. Aside from money, western medicine focuses on fixing each symptom instead of considering the whole person. I think you know in your heart what's right, so follow your heart.
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First of all ... big hugs and prayers to you for being a caregiver when no one else apparently would. I can't know the right answer for you, but I can give you some insight from my experience.

My mother is 84, in relatively good physical health, but has Alzheimer's and is progressively declining mentally. She is at the stage where she sometimes knows there's something wrong with her, but can't comprehend what is happening. She gets very scared, and sometimes lashes out in bouts of frustration and anger. It's all part of the disease. During more lucid moments, she will comment that she doesn't want to be like this anymore and doesn't understand why she can't go be with my dad (he passed away 7 years ago).

If Mom were to face a life-threatening illness, I don't think we (my siblings and I) would opt for extreme measures but rather look to comfort and quality of life. Mom has had some stints in the hospital and nursing home for a few not too serious falls, and her mental decline each time was markedly greater. I couldn't imagine putting her through any more than is necessary. And if I ever develop this awful disease, I would hope my daughter would do the same for me.

Give your granny all the hugs and love and comfort you can. And God bless you all.
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This is a very difficult decision to have to make, but something that I came to realize with my sister's battle with cancer that it got to a point where I felt selfish for helping her fight a pointless battle. She was tired and gave it all she had but in reality she had no future and no quality of life left. I know that this is totally different but ask yourself this question. If she gets through the surgery and things are fine what lies within her future? Her quality of life is going to be compromized with the dementia and will be another long tough road to have to travel and it will not be pretty for either of you. If it were me I would abide by her wishes and leave it in God's hands. Wishing you both the best of luck. Hugs to you.
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Just because modern medicine can keep people alive, does it mean it always should? If I knew the outcome, I would make the same choice as she is making. I would rather go out with my mind and some dignity.
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Well, yeah, but this is one case where deciding against a realtively simple, limited surgery helped put off a not particularly dignified death. Donna Rae sure did the right thing by encouraging "grandma" to think about the real-life consequence and make a decision appropriately. It seems to me it turned out she was more afraid of going home on hospice and dying than she was of the surgery and just needed to realize she was facing one or the other, and putting it off was not going to make anything better.

We lost my father in law many years ago to an abdominal aortic aneurysm for which he refused intervention. That surgery was more risky than this one, but even so, it had an 80% chance of success. My brother in law wanted to force him to have it done, but for better or worse, he was of sound mind and that would not have been legally possible. He lived a few more years, independently, before it ruptured. And we of course have no way to say for sure whether things would have been better or worse had he done things differently.

I have to admit I am happy to read this story turning out this way instead!
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If a person wants to go, they should be allowed to make that decision. Too many families and too many doctors are bypassing the fact that every human being should be allowed to have their dignity.
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I absolutely agree with purplesushi. Just because doctors CAN do something, doesn't mean they SHOULD. She is 77 years old. She has Alzheimers. She is in pain from the broken leg. She has a hard time walking. Sounds like she doesn't really want to go on, so why should someone else make that choice for her? SHE knows what her quality of life is, and apparently she's not afraid for this to end. What does she really have to look forward to?

My mom is 90. She has a myriad of health problems, as well as dementia. She is tired. She is done. She sleeps most of the time. She told me a long time ago that she doesn't want treatment if she is diagnosed with something life-threatening. She knows that there is a better place, and she's not afraid to go there. If your "grandmother" doesn't want treatment, and her daughter is on board, just say no and let her go.
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3 years ago you saw the conditions she was living in and got involved - you are surely going to Heaven my dear! I have a similar situation with my "uncle" but he does not live with me, so I guess you'll get to Heaven faster than me LOL - hope I made you smile for a minute. If I were in your shoes right now, I would put in a call to the lawyer who did your POA and HCP. Maybe I'm paranoid, but I suspect the nosy girls figure she hasn't much longer to go and hope that putting her in a group home will hasten her demise - are they expecting an inheritance? I cannot imagine any court of law that would overturn your authority, so stand tough! I believe in your capacity as POA you might forbid them to even come near her. Your lawyer can clarify this. You certainly don't need any more aggravation from either of them. In another thread awhile back, I read that somehow, a woman had made her lawyer her POA, and she forbade the daughters to visit their mother at all. BTW, did you and your husband change your minds about transferring her to a facility after rehab and instead are bringing her home? I was thinking that you finally realized you had done enough.
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Ugh - that really sucks! I would ask them to ask Granny what SHE wants to do - where SHE wants to live - who SHE wants to care for her. How many times have they called you in the 3 years you have been caring for her to ask how she's doing, etc? None? I don't know that I'd hold my tongue completely - I think I'd let them feel just a little bit sh*tty for ignoring her!
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Today I received a call from the Social Worker to tell me that her great-granddaughter called her wanting information. I was really upset! This GG, first of all lives in Boston, is in town until Tuesday, she has done nothing for granny in 3 years! I told the SW do not release any info regarding granny's condition or plans for after surgery. Both her and the daughter want granny placed in a group home instead of coming home with me. These two have done nothing for her in the 3 yrs I have been taking care of her! The audacity! They did nothing for her prior to me getting involved. This woman is not my grandmother, I just call her that. She is my son's best friend great grandmother. 3 years ago I saw the condition she was living in and became involved. How dare these people! It took me three years to get granny healthy, a secure place to live and she's happy. Now these people want to step in, like everything is okay! I'm pissed but will hold my tongue with these people. If they want information they will have to come to me for it, cause I sure as hell am not giving my permission to have any info disclosed to them. For three years I have gone thru hell with granny, going thru withdrawals, (she was addicted to pain pills,) her demented moments, moving her twice prior to her moving in with me, going thru hip surgery in January.......time to stop writing because I'm getting myself all worked up! Thanks for listening!
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I realize that our granny's obstruction is not in the bowel, but I figure there are places on the feet for the intestines as well.
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Donnarae, what a good person you are to care for this lady :-) It's probably too late for this now, but .. well, this is good info for anyone, anyway, and who knows... my mother suffered, before her accident, from diverticulitis and diverticulosis. She's complained of her stomach aching numerous times since she came home, but her internist just keeps saying it's this or that and has even said that he hasn't taken any pictures lately, but never actually sets her up for it. In the meantime, my mother has a massage therapist that comes to the house twice a week (a family friend who gives her a great deal for $50 a month!) ... the massage therapist also works for our chiropractor. Chiropractor told us both to massage mother's tummy in a clockwise motion, which we did, in a circular motion, making sure that we reach the area right where her tummy folds over (mother's kinda heavy). She figured if there was something not moving along properly, this might help. Right now, she's not having stomach pains. Another thing is this, our massage therapist went over to her own mother's house after she'd had some sort of surgery and hadn't been able to poop for about 10 days. There are places on the bottom of the feet that, if you massage, they correlate to different organs in the body... so, she massaged the area, on her mother's feet, that correlated to the bowels... within 20 minutes after she'd left her mother, she went! I agree that if she doesn't want surgery, she shouldn't have it. Some folks would just as soon have life over and done with, especially if they feel they have nothing to live for. You will certainly be Blessed for taking care of her.
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purplesushi, I couldn't agree with you more regarding our modern medicine (western). They are trained to treat symptoms, not necessarily prevent them in the first place.
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Purplesushi.....I agree with you 100%. I'm going through the same thing with my 9 year old mom. It's heartbreaking.
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Well, she is a little bugger, isn't she?! LOL
All the best as she recovers. Please keep us posted. I will keep her in my prayers. Hugs, xoxo
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Well she had the surgery today. For the past two days she couldn't make up her mind whether to have it or not. I finally put my foot down today and told her she had until this afternoon to maker her decision or I would. I told her if she didn't want surgery we would disconnect the NG tube and bring her home to die. Well within a half an hour the doctor called stating she decided to have the surgery!
The surgery went fine, they found 3 adhesion's in her small intestine and removed about one foot of the intestine. Her prognosis is good! Now we will see how her recovery goes. My husband and I made the decision that she will not be coming home, after rehab she will go to a CBRF...too much stress....Thanks for all your comments and well wishes....
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As I get older and see what my mom is going through with the perils of the aging process, I appreciate more and more the need for us to "ignore" all of these life-sparing medical "procedures" when no REAL good comes from them. When it is obvious that the end of the road is near and that surgical procedures are only going to prolong the inevitable (vs. giving you a shot at actually LIVING a productive and happy life..of course that would be different!) I don't think we should be so quick to rush to the OR. Face it - modern (western) medicine is more concerned with profits than quality of life. It sounds like your Granny is one of the smart ones who is seeing through the smoke screen....good for her.
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It sounds like she understood the choices and the decision. I would honor her choice.
I respect and appreciate your dilemma. If you are religious pray on it, clarity and strength may come to you. I will do the same for you.

L
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Ferris1:
She has been on IV fluids since last Wednesday, they gave her a suppository and Miralax, nothing has helped. They had her swallow contrast today for a bowel follow thru and she vomited it up. She has had an NG tube in since Saturday and it's still draining.
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My husband has had several bowel obstructions, but they all were resolved with lots of fluids, suppositories, fleet enemas, and that nasty citrate drink they make you drink before a colonoscopy. Perhaps a second opinion is in order and maybe her bowels can be unobstructed without surgery. It is worth a try. Make sure she is getting lots of fluids to move things along. Good luck and thank you for caring for her for 3 years.
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Thanks for all your support! I did speak with her daughter tonight and of course her knee jerk reaction was for her to have the surgery. I pointed out all the pro's and con's. Explained to her that there is a good chance she will not come back from this, as she is not the same since her surgery in January. I pointed out that if something should happen and she ends up in a wheelchair, in a nursing home, sitting in a corner drooling on herself, waiting for someone to clean her up, she would never forgive me. After point all these cons to her, she agreed that she should not have the surgery. I will be visiting granny tomorrow, I will keep you posted!
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my mom doesnt want kidney or any other surgery. its hard for me to comprehend but if i were 81 yrs old with multiple health problems it might make more sense. she refused chemo after a masectomy 32 years ago and the cancer never returned. shes stark ravin nuts too and refuses to see a shrink. hard to tell what these old timers are thinking.
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Wow what a horrible circumstance for you to have to make a decision. I agree to consult with drs and get their opinion and prognosis should she have the surgery. I don't know how far along she is in dementia or Alzheimer's and whether she can comprehend the decision; if not you will have to make the decision. I'm sure you are close enough with her over the last 3 yrs that you understand her wishes and best positioned to make the compassionate decision.

You have our support. Don't let the daughter cloud your judgement. She will still have quality time in the next few wks to make amends or find closure if she chooses to do so. Sad, but we all have interesting family dynamics that aren't always well understood by outsiders. We aren't always kindest to those closest to us....
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