Traumatic brain injury

[Tinkerbell36]

My father fell at home last week (I found him) and has a traumatic brain injury; fractured spine and fractured ribs and is in his late 80s. He has been living alone as widowed and is very lonely (brother & I visit weekly and call daily). He very nearly died at the weekend but has improved this week. However he is totally confused now due to the brain injury (previously an academic) and on high oxygen & IV antibiotics for chest infection. He has a DNR and I have Power of Attorney. My dilemma is that he has spoken very openly with me about his wishes and he’d be furious that he’s being treated. Because he’s not completely incapable the doctors aren’t listening to me. I don’t want to loose my Dad as I love him so much but I know this isn’t what he wants. He doesn’t have an Advance Directive as he thought POA would cover it. It’s such a heartbreaking and difficult place to be. Thank goodness covid restrictions are gone and I’m so thankful I can visit him every day. Anyone been in a similar situation?

Not quite similar, but along same lines. DF (83) had catastrophic accident that caused brain bleed. Surgeons didn’t operate. Went into coma, died four days later. However, doctors were v supportive and listening. Could you put your concerns in writing and added to his notes? Sympathies. Good you can be near him.

So sorry OP, how upsetting a situation. How bad is the TBI ?
He is obviously very injured, but brains can recover. How he is now may not be how he is in six months if he survives this. Both my parents had falls and strokes and initially it was shocking to see how impaired they were but week by week there was a big improvement, so maybe you and he both need to give this more time . The spinal injury is as much of a worry as the brain I imagine.
What are the doctors saying about the extent of the injuries and his chances of survival?

Hello, I don’t have any experience with this as a relative but I do as an ICU nurse. You are doing so well, thinking about his wishes and wants as the person that knows him best. You are right- even if he were to get through this stage rehab for someone in their late 80’s with extensive trauma would be long and arduous with probable poor results. Ask to speak to the medical team about it and enquire about long term prognosis and raise your concerns. Tell them what you and him had spoken about, let them know what he would consider an acceptable standard of living (mobile/living at home/nursing home etc.) The medical team can sometimes focus on what they can do now rather than the long term outcome- one of our consultants used to say ‘just because we can doesn’t mean we should.’ If you feel you are not being listened to then speak to the PALS team at the hospital, they aren’t just for complaints and would be able to support you in communicating with the team. All the best, it must be so hard but you are doing so well and thinking of him and his wants.

If you have POA the medical team should be talking to you as though you are him. But you need to be proactive. Grit your teeth and do it for him. Take a copy if the POA and start calling. Ask for treatment to move to a palliative approach immediately. Let them raise any issues with that - sometimes it can't be done suddenly- but say that you want a palliative care team to review today or tomorrow to advise how to get onto that basis.

Thankyou all so much for replying. I’m on my way to the hospital and will ask to speak to the palliative team who were involved at the weekend. They seem to listen to him as he sounds plausible but believes he’s going back to his house with his wife which is going back 10 years.

My father has now been moved to palliative care following a suspected blood clot yesterday however despite this he’s rallying and chatting away (totally confused due to his bled), but he’s comfortable and getting the most incredible care.

Bless him. Glad he's being kept comfortable x

Chatting away and getting incredible care.
These are the memories that will make it easier.
Well done your lovely dad.