Opinion needed from medical professional asap please.

[shadypines]

MIL has terminal cancer, Macmillan nurse and GP visiting fairly regularly. FIL only just coping, very stubborn though and DH is at his wits ends with everything.

Anyhow my immediate question is that MIL has become suddenly more confused over the last 48 hours, she previously hadn't been confused. I am thinking this is due to mainly dehydration and a chest infection/temp. GP visited yest and said 'it's up to you whether you go in hosp' but GP is obviously saying she is poorly enough to need it.
But I am wondering how is this right if she is confused, I mean to leave the decision to her? I can see the scenario playing out that she will get worse and worse and need urgent middle of the night admission after a fall or something. She has stated not to go in but DH says then at other times she will suddenly say she does need to go in! It doesn't sound quite right to me, prof opinions would be welcome. Thanks

I would imagine her wishes and the wishes of her main carer would perhaps trump medical consideration if she is at the end of life? That they view she may be more comfortable at home. But of course FIL, with your support, can seek urgent help if overwhelmed or worried.

This is very tough. If her wish is to die at home then at some point the decision will have to be made to stay at home come what may. We knew when our last visit to the hospital with my dad was because we only just manage to bring him home. I think it depends at what stage of the illness she is at.

It does sound like you could do with more support. In our area Marie Curie nurses can do overnights for families.

I can understand that if she made that choice when lucid but I don't know if she did, so now that she is confused I am just wondering how she is in a fit state to act in her own best interests? I know it's a tough one but it just seems that things will get progressively worse at home.

I suspect that they will get progressively worse in hospital too and the choice is being given because she’s at the end of the road and it’s now a choice about where you are at the end.

As above, the answer kind of depends on what she wants and how close to the end of her terminal illness she is. Surely if Macmillan are involved then she will have discussed with them what she wants if she becomes seriously ill so that when a crisis happens there's a rough plan in place? If she goes into hospital she will probably end up having drips, blood tests, blood pressure measuring, and oxygen mask, urinary catheter, will probably get more confused and disorientated (because of the new environment/noise/disturbances) and may still not survive the illness - is that the sort of stuff she would be prepared to put up with? If she would want all of that for the possibility of a bit more time then it may be worth going in. Apologies if that's a bit blunt, but that really is the bottom line.

If FIL is really struggling it might be worth exploring whether she could go into a hospice instead of an acute hospital?

The best medical intervention now is about comfort. What matters is where that can best be done.

My mum kept pushing for treatment for my dad, when he really just needed to be comfortable and left alone.

if she goes into hospital she will probably end up having drips, blood tests, blood pressure measuring, and oxygen mask, urinary catheter, will probably get more confused and disorientated (because of the new environment/noise I hear what you are saying but surely on admission doctors treat each patient on merit? They don't throw the kitchen sink at everyone who comes in the door without assessing them? I should have said I am a nurse myself so rest assured I am not talking about 'aggressive' treatment, as this is not appropriate no constant blood tests or BP monitoring, no not at all. I am thinking along the lines of just basic care like rehydration with IV fluid if necessary and at least with a catheter she is not struggling with toileting so much. The trouble is I don't know what the Mac nurse has discussed, do they leave notes in the house? I haven't a clue and of course couldn't look without FIL permission. As pickle says if she was admitted to hosp it would need to be for intervention only to maintain comfort. To my way of thinking at least she would have professional people looking after her to get her a drink, a painkiller, help her wash, rather than a nearly 80 yr old man run ragged which is how it is at the moment.

Sometimes being medically trained makes these situations harder as it becomes so frustrating when it's close to home. I do appreciate everyone's input btw!

I'm a DN.
We look after lots of people in your mum's position.
Has she been fast tracked? That would give you instant access to carers for her, to help your dad out.
Has the GP diagnosed the source of the confusion? What's the rationale behind the hospital admission?

Apologies, MIL and FIL

Catheters can be placed in the community, treatment is often sadly over zealous in a&e whilst the facts are being established, and care (as I'm sure you're aware) may have to be provided in a bay. It's not for everyone. I have had patients who did want to die in hospital, but by far and away most wanted to remain at home.

I'm so sorry that this happening - we often feel the need to do something, anything, when actually the best place to be is at home with good palliative support from GP and district/Macmillan nurses.

Sorry for your situation. As PP have said, your MIL can be "fast tracked" to get carers in, though that tends to be only 4 times a day with no night provision. Marie Curie do a night sitting service but generally in the last 48 hours of life I believe. I think your MILs wishes not to go in hospital before she became confused were clear. If she went in, there would be a real possibility of her dying in hospital. I think her needs could be met at home with good MacMillan and Distict Nursing Care. Or perhaps a hospice? There she could have total nursing care, but with a focus on interventions only to make her comfortable. The GP may able to treat the source of the confusion (for example with antibiotics if they feel it's infection related.) However in your MILs situation it may be a case of accepting that if this doesn't work then good end of life care such as pain relief and medicines to relieve any agitation and respiratory distress, rather than going into hospital, is the better option.

It’s easy at this stressful time to fall into black and white thinking, that is, should she go to hospital or stay home. Sounds like you’re getting more options from posters on this thread. Hospice, different nursing and other visits, moving to a different care model in the home, reinvolving the GP.

With a few phone calls, you should be able to adequately research these other options. Then have a sit-down with your DH and his dad. Let them know what you have found out, and be persuasive about the option you think might be best. Pick a good time for him, leave him with notes/brochures so he can digest them. Emphasise that no option is a ‘forever’ solution or can’t be changed. That’s it’s a small decision, based on her needs that day. A couple of days respite for him will be vital if there are bigger decisions to be made.

I think it’s very loving of you to get involved, just let compassion be your guide. Good luck.