Questions from dying MiL

[MamaToABeautifulBoy]

I have posted fairly recently about my MiL who was given 6 months to live just over 6 months ago. I received some very supportive and helpful emotional / psychological advice which I’m so grateful for.

I am now seeking further, perhaps more medical based, advice. I asked my MiL if there is anything I can do to help allay her fears. She asked me to try and establish what signs she should look for when the time is near. She also asked me to find out whether she can expect to experience pain. Her original cancer was ovarian but has spread to her liver. She is 80.

She doesn’t want to ask her nurses directly as she fears they may be too frank. She is obviously terrified about the future. We all feel so helpless.

She doesn’t want to discuss this with DH or her other son or daughter or her DH. They are a ‘sweep it under the rug’ type of family.

Does anyone have any advice or experience of this utterly horrendous situation and what my MiL can expect over the coming weeks or months?

There's quite a lot of 'stages of death' stuff online, some from hospices, some from 'death doulahs'. I found it very helpful as a carer, to know that what was happening is normal - the progression is fairly predicable, the timescale absolute not so.

I was with both my parents as they made the journey through the last weeks, and both of them were comfortable and calm throughout. I'd second what other people have said about asking MiL's palliative care team, but if she wants something she can read and they don't have that, you'll be able to find something.

Best wishes to you and her and the rest of the family.

PS, I'm in Ireland but I think it is true in the UK as well, that pain control is now seen as very important and her palliative care team should do what they can in the that regard. Do you have a hospice home care service if she wants to stay at home? My father died a little more quickly than expected just as he was about to move from oral morphine and on to a morphine pump with 24 hour hospice nursing at home, but I know from other people how helpful and supportive that can be.

The Kathryn Mannix book is a very good and reassuring read

Good luck to you and your family, OP. I hope all goes smoothly for her.

Just watched a Kathryn Mannix TED talk where she explains about what happens and it's very good. We're getting close to the end with my dad so I want to know more about what will happen.

I agree Dr Kathryn Mannix is very reassuring - she was also a guest in 2018 on You Me & The Big C podcast - the episode 'About Death' I strongly advise OP to listen to - it is literally what she is asking about. You can find it on where you get your podcasts - unfortunately I think it was almost the last podcast Rachel Bland did.

Look up ‘dying is not as bad as you think’ on you tube- part of a BBC series. It’s a shorter version of the TeD talk above- also by Kathryn mannix.
https://m.youtube.com/watch?v=CruBRZh8quc

With my Mum, there wasn't much notice that the end was near. She had breast cancer that had spread to her liver, bones.

Her health deteriorated slowly over the course of 5 years, and she ended up in hospital a couple of times, but over her last couple of months she actually felt comparatively healthy.

About a week before she died she got a bit of a cold, spent a couple of days in bed, and complained about a bit of brain fog. And then she started sleeping a huge amount and then barely woke up for the last 48 hours of her life.

I won't go into details of what those last few days were like as others on this thread have already, just wanted to explain that you can't assume that there is a point where you go "Ok, this is it". You might get a months warning, you might get a week, or she might just die in her sleep one night with no warning at all.

Most patients are offered more than adequate pain relief. That has been my experience the last three times we have lost loved ones. Two in a hospice and one in hospital.

Ask her to think about legacy, her wishes and if possible the life left not lost. It’s such a beautiful mindset if it’s achieved. None of us are guaranteed tomorrow, or next week or next year.

I am so sorry you are all going through this 💐

Pain is always managed and the amount of relief will increase towards the end. THis makes you sleepy and generally you slip into a coma and then pass away. WIth regard to what to look out for I would look at the sites recommended but keep it very generic and say even when poorly we don't always know for sure. I would recommend talking to someone outside of family such as a priest or vicar - they don't need to be religious to do that. I also saw someone refer to a death doula as well, so someone who knows lots and can help people with the fear aspect of approaching end of life and talk different things through with them

This is a rather lovely video by the amazing Kathryn Mannix.

Only here to echo a lot of what's already been said. My Grandad spent some time in hospital before being moved to a hospice. My Mum was constantly worried he she wouldn't be there for him, the doctors couldn't give timescales but I would say the last week or so I could tell he was fading away. There wasn't one specific thing, he didn't suddenly take a bad turn or anything like that. As others have said there was less eating, less drinking, less being awake, until there was no more.

My husband died at home in May this year. Towards the end he had a syringe driver to manage possible pain. He lost interest in food and drink and slept more and more. For the last few days he wasn’t really communicating and his breathing became erratic with several harsh breaths then a longer period of silence before it started again. There was never any indication of pain or even discomfort. I woke to go to the toilet one morning, heard him breathing, kissed his head and whispered ‘try to rest love’. When I came out of the toilet 2 minutes later there was silence. He had died peacefully in his bed.

Nurse here, I look after majority of pallative/end of life patients. I really urge her to talk to her pallative team and advise them she's doesn't want frank discussions.

I can usally tell through discussion how to direct the conversation and how gently the dicussion can go.

Our main concerns as health professionals is comfort and to be pain free as possible. In our team we usually call our pallative patient at least once a month depending on how they are.

Her GP may have prescribed anticipatory medication (sometimes called JIC - just in case medication). These usally for the last few days and are for pain, anxiety and secretions. Usually admnistered via injection or syringe driver and are used when it become unsafe for your gran to swallow.

There are many different types of pain / anxiety medication availabe: patches for pain and tabelts when dissolve in the mouth.

The main aim for all patients and their loved ones is that they are comfortable, informed and cared for.

If you gran is happy to give consent for your to talk to her nursing/pallative team then that maybe that is the best way forward and you can advise of her fears.

Take care.

If she can see a palliative care consultant they are marvellous. They will discuss in whatever detail she is comfortable with and they can make it possible to do things the way she wants.

I've completely welled up reading this, couldn't ask for a better more peaceful way to go xx

From my limited experience the district nurse/Macmillan nurse provided a syringe driver which kept the pain under control.

Is there a local hospice or hospice at home service?

@Unexpectedlysinglemum - it was pretty much as good a death as you could ask for. Although my next door neighbour was nearly 100, had been sitting in the garden on a lovely spring morning, decided to go for a low down after lunch and died. That’s the death I’ve asked the universe for.

She has asked that you do this for her, bravo to her for asking and for having a relationship with you that she can ask this of you when she cannot ask this of her own children. While many on here have advised that she speak to hospital staff, she wants you to do that, and you can.

It might also be an idea to ask her if there is anything she would like to do or say before she dies.

There are a few things my mother is afraid of, that she is unable to speak of when asked directly. I have tried to take care of these for her and I hope it makes her less fearful of dying. Writing this makes me feel that I still have moe to do on that front. She fears a vengeful god and I believe with every fibre of my being that we are released from everything of this world when we die.