Horrible topic but I need to ask

[hdtaw]

Hello all, We found out about two weeks ago that my nan (86) has stage four cancer, it's also spread to her bones and lymph nodes etc. They are not offering any treatment and she would like to die at home so we took her home from the hospital.

My mum and I have moved in with her because we don't want her to be alone (my grandad passed away two years ago) and in the first week she was up watching films with us, Eating three meals a day and drinking cups of tea etc and now she has gone downhill so fast, She has refused food for the last four days, and the only drink she will have is water when she has to take her meds, She is also choosing to stay in bed and is sleeping through the day and only really wakes up when we wake her to give her her medication, She has been this way for four days now. Its also getting harder to wake her up, as in we will say her name over and over and it takes a while for her to wake up.

Anyone with experience of looking after someone with this stage of cancer? How long is it likely to be now before she passes away? I know no answer is set in stone but if she hasn't eaten for four days I'm thinking she might be near?

Awww, love to you all and to your lovely Gran 💕.

I have done this with both grandparents who chose to die at home. If she has been prescribed morphine then she is near the end and this of course will also make her sleep a lot. I often used to sit with them, put lipbalm on lips, give a foot massage, be there at times of waking etc and I look back on it as a precious time. I am glad to hear that you now have the support and I expect as she gets closer to the end they'll set up a morphine pump which usually very much spells the end (as in a few short days). Sing or play songs she like, hold her hands, keep her pillow nice and cool, spray some nice smells, talk to her and tell her how much you love her and just do everything you are doing. I am so sorry she became ill but what a privilege to die in her own bed surrounded by those who love her most in the world. Hugs to you xx

So sorry to hear about your Nan. It is such a difficult situation to be in but also a massive privilege to help a loved one through end of life.
From experience, my DF refused food towards the end of his life, it probably won’t be long now your nan is refusing food. The main thing is that she receives adequate pain relief, hopefully the nursing staff offer a morphine drive that provides continuous relief. This is where you can advocate for her.
I helped my MIL when her mother was dying of stage 4 cancer. It was more a case of just being there, in fact she was surrounded by family when she died which was lovely. We quietly chatted and just held her hand until she passed. I can’t think of a better death than to be surrounded by family in your own home.
When my DM died of stage 4 cancer she was in hospital but in a dedicated terminal unit. She knew she was about to die ( ex nurse) and asked that all her close family were invited to see her. It was a difficult few days but again she quietly slipped away surrounded by loved ones.
Sorry to be a little depressing but although very sad it’s a part of life that we all face at some point. It’s normal and natural and being prepared is a great help.
The actual end can be gentle and peaceful particularly if pain relief is good but be prepared for your Nan to fight it at some point. It can be distressing to watch, but it is not necessarily due to pain more just fighting death. I think it is called terminal delirium, it’s just another thing to be prepared for.
Thoughts are with you x

I talked a friend through this with his mum. I think perhaps two weeks max, from memory. Iirc that's also how long it took my mum (3 weeks maybe?) But she was crazy strong, 66 and four stone in the end.

My friend's mum was getting out of bed in the middle of the night and was walking around confused, arms outstretched. Something to mentally prepare yourself for - though people are so very different and I hope you don't experience that. She was 59 so still quite physically strong, I guess.

You can get a gel to lubricate her mouth that will cause saliva production so her throat and mouth are less sore. Agree re lip balm.

I am so sorry for your family. The best piece of advice I got from kindly internet strangers was to get a recording of her voice in case I ever forget it. It has never left me but it's reassuring to me that that video (without showing her, she was painfully thin) of her will always exist for me to fall back on.

Mum said hilarious things on morphine. Well, she thought her slippers were a small puppy that refused to get up onto her bed to say hello to her. - stuff like that. So, expect the unexpected when morphine levels are quite high.

Best of luck OP. You are good people.

Sorry to hear this, if she's only having water it will depend but I would say 2- 4 weeks based on my experience. I hope you have some medical professionals to offer assistance and advice too

me and its a horrible situation, you do your best by managing the pain.

I found that when they can't eat the end is near.

Op, you are doing everything right. Hold her hand, let the MacMillan team lead the way. This clip is so informative.
Sending kind thoughts your way.
(I’m a nurse who has nurses many people through this, including my own very dear Dad ❤️)
[[https://m.youtube.com/watch?v=CZDDByT0Vr0 m.youtube.com/watch?v=CZDDByT0Vr0

https://m.youtube.com/watch?v=CZDDByT0Vr0

If you watch this clip it is so moving. It explains what happens when someone is dying in this way, so beautifully. So peacefully. It’s how it was for my dad, and hopefully how it will be for your nan.

I’m a hospice nurse and echo much of the advice given here. Usually at end of life the majority of medications are stopped. Syringe drivers can be used to deliver morphine and medications for agitation and respiratory secretions. The district nurses will be able to advise and organise that with the GP.

Respiratory secretions sound gurgly or bubbly and usually indicate the end. It can sound unpleasant but your Nan is unlikely to be aware. It means she is unconscious and her throat muscles have relaxed.

At end of life the body stops needing food and fluids. This is normal and nothing to worry about even though it can feel cruel. Continue offering fluid as long as she can tolerate it but stop as soon as her swallow stops and/or she becomes unconscious. Moisten her mouth. District nurses should be able to provide a mouthcare kit and a moisture gel like biotene or oralieve.

Her pressure areas will need monitoring still as her skin may deteriorate rapidly as this stage. You can reposition her by titling her slightly to the side and putting a pillow under to support her. It doesn’t need to be a lot, just enough to take the pressure from her spine and sacral area. Watch her face for signs of discomfort when doing this. Good continence care is important in this respect too.

She will be eligible for fast track carers. Ask DNs or GP for referral. This will give you and your mum vital support.

When death is imminent you are likely to see changes in her breathing pattern. Your Nan might start having short pauses, these will become longer. Or her breaths might slow down gradually.

Hold her hand. Talk to her. Let her know you and your mum are there and that you love her. What you are doing for her is wonderful.

Most of all, you and your mum need to look after yourselves. Take breaks, try and eat and drink healthy foods if you can. You will need your strength for the coming weeks and months.

Some practical advice. When your Nan dies, call her GP surgery. They will arrange someone to come and verify/certify the death. If not already discussed or planned, have a conversation about which funeral director and if your Nan wants a burial or cremation. These conversations are hard but better known beforehand than trying to make decisions in the immediate aftermath.

Best wishes to you all.

I had this with my nan. Eating like a bird and seemingly starting to go downhill but not alarmingly so in so much as other family went for a mini break that weekend.

Then the day before, she was more chatty and alert and asked me for a bacon sandwich which she ate all of! Woke up the next day and refused to take a drink and so i couldnt give meds. She wasnt able to to speak to me and just kept batting me away. She was gone that night.

My FIL was given 2 weeks by GP and lived 3. DH and SIL nursed with help from mcmillan who topped up morphine when needed. They came when called to help with FIL pain. SIL has nursing training and this made a huge difference. To do it without any training will be very difficult.
Google end of life steps as it helps to know what’s going on as it’s quite frightening to deal with and watch.
DH slept on a put you up bed in the lounge with FIL so he had someone 24/7

My MIL was only 9 days from diagnosis to death with a prognosis of 3 months. She slept much of the time but then night before she died she was up watching TV. On the day of her death, the syringe driver had been put in a few hours before.

My grandad was different, he was a few months even though we were at his ‘death bed’ several times. He was skin and bone by the end but thankfully very little pain.

Sending you strength at this awful time, you’re doing an amazing thing for your Nan. ❤️

Hi op sorry to hear this sad news. When my nan went through the same thing I think it was 6 days from becoming essential unconscious to her passing away. We put a smart watch on her and could see her heart rate which was super high for the last 4 days and took turns sitting with her. When it was near the end the person on watch knew that her breathing had suddenly changed to much longer gaps and her pulse dropped low so we all gathered around her. She passed away within 5 minutes, she just didn't take a breathe again after her last one. It was peaceful thankfully.

I hope yours is pain free and glad she has yous with her.

Sending big hugs your way!

Hi Op, I’m so sorry you and your family are going through this. My dad died of terminal cancer in 2022, it took two weeks for him to pass after he stopped eating. Once he was unable to swallow his medication the district nurses put a driver in which pushed medication through a cannula. That was much better and more comfortable for him.

He was still able to drink, but we needed to limit the intake a bit because as his chest began to relax the fluid started to build up.

He slept a lot towards the end but we always played music for him and when he was alert you could see he enjoyed the sounds.

If you’re not already getting support from carers and district nurse I’d give them a call asap, they were brilliant with my dad and it was a comfort knowing we had the support

It's natural. I found this BBC talk very informative, reassuring and helpful. Sending you love and strength.

If she's stopped eating its time to call in the GP, they will be able to give an indication of how long and should prescribe some morphine to keep her comfortable. It can be quite distressing without this.

You're doing a beautiful thing, your Nan will be so soothed by having you there.

Apologies, I can see she is already on morphine. I'm pleased you have decent nursing support around you OP.

Really sorry to hear this. A good friend of mine just lost her mum to cancer. She was in a similar condition for around a week before she passed. Her breathing changed (I believe they call it a rattle) 3 days before she passed which is quite a while as usually when the breathing changes like that it’s quite close. The nurses should be able to advise you but it does sound like it’s close now. Sending you a big hug, you’re doing an amazing thing for your Nan, life is tough but she will have her family with her and I’m sure that will mean so much to her

What an amazing thing for an amazing lady to die in her own bed surrounded by the people she loves. Such a wonderful thing you’re doing for her op sending you hugs and strength x

You are doing a lovely thing.
If she's sleeping all the time, then she's absolutely NOT suffering.
She's just sleeping.
It's just very hard for you looking after her.
Be kind to yourselves
I hope she goes soon.

I am so sorry you are going through this. This is just my opinion. I am a nurse. It’s difficult to out right say the end is near but the prognosis of a stage 4 cancer that has spread like this is not good. We get so caught up in the technicalities of it all. I say to you love her through this process. Keep her as comfortable as possible, make sure she is as pain free as possible even if it means calling the doctor to see her. If she isn’t eating try things that are easy to eat like yoghurts and encourage her to have sips of water every so often.

But just love her through this process spend time with her. It’s the best honour you can give her. I am sorry you are going through this 💕

🌸🌸🌸 For you op

When my Dad was like this, the doctor at the care home gave me a prescription for morphine patches and said she would turn a blind eye if I wanted to put more than the dose on him. That is what eased his pain and helped him drift off. He had been the best father possible and I was glad to do that tiny something in return.

Hi OP sending virtual hugs.

You are doing a lovely thing being there for Nan.
My Dad had exactly the care and treatment described by @CaptainSensiblesRedBeret ( you guys are amazing btw), and died peacefully in his sleep.

My Mum was told in advance which number to call when he died and 2 lovely nurses came in the middle of the night within the hour to pronounce death. They and and all the health professionals were a mine of advice and support so please lean on them as others have said. Even had a follow up visit ❤

Take care