To think something is not quite right about my elderly aunt's way of looking after her brother

[Yashy]

I have an aunt (68 years old) who was living with and looking after her brother ie. my uncle (76 years old). He sadly passed away at home a few days ago.

They are from Mauritius and don't speak English very well.

This aunt has previously expressed her suspicions and conspiracy theories about the NHS eg. Things like they just want to kill old people and if you get kept in, they'll try and kill you.

My uncle doesn't like going to hospital as there is a language barrier and he often gets depressed spending weeks in a ward. My aunt's preference is for him never to go to hospital.

He once had a stroke in the evening and she didn't call the doctors until the next morning. I'm not medical but I always thought something like that needed urgent medical attention.

A couple of weeks ago doctors said his organs were slowly deteriorating. They estimated he had 4 months left to live and said he should receive palliative care at home.

I went to visit her after my uncle died. She was telling me about the events leading up to his death saying that he got very unwell and she sat by his bed holding his hand. Her sister (another aunty of mine) was saying they should phone the paramedics but she said "what are they even going to do?" and "they will just take him to hospital and he doesn't like it" and "it's better he stays home, he is happier here". And then he got worse and worse and basically died. My cousins (her children) were also listening to her tell this account and replied with "You did brilliantly mum, he was lucky to have you with him"..

AIBU to think the whole thing is nuts, she should have called for medical help and maybe he might have lived!?

Maybe medical intervention would have prolonged his life for a bit but what sort of life would it have been?
A few more months in a hospital bed, which it sounds like he would have hated

I am sorry for your loss. Just wanted to remind you that your aunty comes from a culture where looking after elderly relatives is something the family does and is culturally expected to do and it is seen as a privilege and sign of respect.

Similarly it is a culture where people don’t go to hospital to die, they stay at home and are cared for at home.

YAbu. He didn't like hospitals and I can understand why.

The NHS is keeping people alive far past the time when is sensible in my view. My nan had had a number of strokes and was then kept alive on medication in a care home for 3 years not able to do anything.

Your uncle is at peace now.

A couple of weeks ago doctors said his organs were slowly deteriorating. They estimated he had 4 months left to live and said he should receive palliative care at home.

I don't think you understand what "palliative care" is, OP. It means not trying to prolong life, but making it easier until the end comes.

It is quite probably that your uncle also had a DNR notice, which stands for Do Not Resuscitate. So the paramedics wouldn't have done that anyway.

He was terminally ill and hated hospitals. Why make his last few weeks unbearable? Sounds like she was acting in what she believed were his best interests.

Completely agree!
As a nation we really need to have a look at ourselves. It's just plain cruel the way we keep elderly people alive for years longer than they would have naturally lived just to live in more pain, fear and suffering. And I'm not even taking about assisted dying, that's a completely separate issue. I'm taking about medical treatments to extend suffering as long as possible.

The way things are going with A&E departments I think there will be more people preferring palliative care at home rather than long periods on trolleys in corridors.

I'm a doctor and what your aunt did was exactly what she should have done (and what I would do for anyone I cared about, and would want them to do for me). She respected his wishes to die peacefully at home with a loved one beside him. There's no indication from your post that he had any symptoms that meant he couldn't be managed at home - even if a patient is for palliative care only with a plan to die at home, if they had symptoms like uncontrollable pain, then absolutely, calling for help, and potentially being admitted to a hospital or hospice for control of that symptom is appropriate.

With gradual organ failure as you describe, even when admitted to hospital, the underlying problem is not going to be fixed, and admitting him to a hospital where there is a language barrier, nowhere comfortable for his sister to sleep while she is with him, and potentially unpleasant experiences like getting blood tests/having a catheter put in that won't alter the prognosis, attached to pinging machines, or being in a ward where there is noise from distressed/disturbed patients and multiple machines and alarms going off all night, staff moving about etc is not peaceful, and that's not even considering the fact that he may wait for hours in A&E, or worse, in the back of an ambulance as there is no room in A&E or in a corridor, when he didn't need to be there.

At the end of life we focus on symptoms and quality of life, not prolonging a poor quality of life at all costs. A decent amount of my job is drawing a line under people's well meant but futile interventions, and stopping them.

I appreciate that this is because most people don't work in healthcare and a lot of people have little understanding of the realities of dying and death, but you are being unreasonable.

I really think more support needs to be put in place for families as well as an emphasis on how hard it might be and what to expect caring for a dying loved one. When my grandfather was in hospital with cancer, they were getting ready to release him home but another nurse or doctor flat out said that my grandmother wouldn't manage him at home. At the time it seemed very blunt and your natural instinct is to say "of course we'll manage, we love him-we'll all care for him!" but now I realise what can happen I appreciate her being truthful about the reality.

He died in hospital before he even got a chance to come out and I think even the nurses struggled and had to put him on a morphine pump-then he died very quickly. It's insane to me to think anyone even contemplated he could be released home-unless they had a plan for lots of palliative support in place, which I don't know if they did. So I don't think family should be put in the position of caring for someone unless they're being heavily supported at home-professionals know what to expect and need to be more open with family about the reality of the progression of a disease.

Obviously cancer is a different illness to the man in this case, but anyone dying at home can be a traumatic and overwhelming experience for loved ones. It's quite possible the aunt has regrets about what happened herself, or questions if she could've done anything different-but I don't think family questioning the care she gave will help anyone-especially in hindsight.

Hello everyone. I really appreciate everyone's responses. It's made me feel very differently and think very differently to when I wrote my first post. And perhaps made me feel more at peace too.

I wanted to address a few points that feel important to clear up:

• some of you have said to stop picking and to leave the situation alone and let my aunt grieve: this whole thing is just something that was bothering me in my head. I would never voice it as I too would like my aunt to grieve in peace.
• im sorry I thought 68 years old was elderly.. it was a naive belief

I’m sorry for your loss and perhaps isn’t the time to read by opinion which is based on my recent loss.

Lived for what? Just to continue slowly dying? We have a culture in the UK of keeping people alive for as long as possible it’s something Chris Witty raised as one of the big concerns of NHS care. Pneumonia used to be called the old man’s friend now dying people with it will routinely be admitted to hospital and treated with IV antibiotics only to be returned home a couple of weeks later much weaker and worse than before. I watched my Mum go through this. I’m not sure we have it right.

Pleased to read your update OP. I'm glad this thread has helped you.

That's good to read OP. There's absolutely no reason not to be at peace with the manner of your uncle's passing, even while you're grieving for him.

As someone who cared for a dying relative last year who was told they had months and now has another ill relative I think she likely followed his wishes. My relative had a dnr and wanted no life sustaining interventions. What would be the point of getting medical help for him or putting him in a hospital when he was dying anyway and possibly would of lived for longer in pain and with no quality of life. Sometimes life quality is more important than quantity and if he didn't like or want to be in hospital why send him there.

Yes, my FIL was diagnosed with cancer when he was in his 80s. They wanted him to have chemo. He just wanted to die quickly and fortunately did.