Do hospitals let you know when someone is dying?

[AKAanothername]

My DH is currently in hospital, he has inoperable pancreatic cancer and it has now progressed and is causing all sorts of other issues.

The worst issue at the moment is that his sodium levels are at 111 and they are struggling to increase them, he's also suffering from malignant ascites and portal hypertension.

The doctor has mentioned putting a DNR in place but, although I've tried my best to explain it to him, I'm not sure DH fully understands this (he's a little confused at times due to the low sodium).

Reading between the lines, it seems that they are actively treating what they can but they are expecting one or other of his organs to start failing and it's unlikely that he can recover from this. DH is unable to 'read between the lines' and he's fairly confident that he'll be out soon (not sure whether that's just bravado or what he's really thinking).

I know that the cancer can't be treated, it's terminal and I think that the current issues mean it will be sooner rather than later. Will the doctors actually tell us this or am I supposed to keep second-guessing them?

I really need to try and prepare his mum for this, I've been keeping her updated and she knows he's very unwell but I don't want to tell her that he's likely to die soon unless it's confirmed.

You need to go to the hospital today and ask to speak to his consultant.

I’m so sorry you’re going through this, you sound like his rock. Have you got support from friends/family?

In my experience of having recently lost a parent in hospital yes they do. A very kind consultant took me to one side and told me my sister needed to get there quickly. They also discussed withdrawing things like taking blood or routine obs. She never explicitly said “your dad is dying” but made it very clear that all they could do was keep him comfortable and let nature take its course.

is there a palliative care nurse/doctor involved? We saw a couple of them and they were excellent for advice and guidance.

You should arrange a time to speak to the consultant or registrar. They will let you know what’s going on as they think reasonable but there is every reason to be proactive and ask for a chance to discuss directly. Try the ward or the consultant’s secretary.

It may be that they’ll not be able to give a clear timeframe, but it sounds like you’ll benefit from as clear an update as can be given.

I’m sorry your husband is ill. I hope he’s being kept as comfortable as possible.

I'm sorry you're going through this. My recent experience losing my Dad to pancreatic cancer was not well explained and in fact, I want to make a compliant however they did make it fairly clear when he was actively dying. They told us that if anyone needed to come see him it should be now and not to wait, for example.

It's very hard because nobody really knows when exactly but yes, ask the consultant.

The consultant told us that there wasn’t long left and to prepare ourselves. You need to ask to speak t9 the consulatant. I’m so sorry.

They told me when I asked the question I am sorry you are going through this, pancreatic cancer is so cruel.

We had a similar situation with my dad. He was admitted to hospital with a blocked bowel caused by multiple adhesions following extensive surgery a couple of years earlier. He also had lung cancer.
The doctor told us that they would not be able to operate on the bowel due to his other health issues, that he would most likely not survive the surgery / anaesthetic and that they would be treating him palliatively. He said he had spoken with my dad about his already and dad was accepting of it.
When we spoke to dad afterwards, he skirted round the issue. He said he knew he wouldn’t be going home, but was enjoying being in hospital with all the lovely staff! Everyone had a chance to visit him, and he died in his sleep 3 days later.
Have you asked the doctor what your Dh has been told? I would tell your MIL what’s happening, so she can be prepared. Sending love x

They should do but if you aren't clear just ask to speak to the consultant and ask directly. You can ask how long do they think he has left and whether they think he will be able to go home first, etc.

I'm very sorry you aand your DH are going through this and I hope you have the support you need.

Very sorry about your situation. A hospital should tell you when it is time to ask friends and family to come and say goodbyes if that is what you want. You might have to ask quite directly about this though. Your DH may be coping with his predicament in his own way. My dad was absolutely convinced that he was going to get better from cancer at some point and was hugely surprised the day he could no longer get up. You need to speak to your husband’s doctors because you need direct answers.

I think they would take time to explain if it was towards end of life stage. Would mil be able to attend with you?

I would say yes they would definitely tell you but I'm not sure how much notice you will get. I'm so sorry he sounds gravely ill and the fact they are only now talking about DNR would make me think they are not thinking ahead. I would be asking for palliative care team to be involved. They are generally better at the difficult conversations.

In my experience - yes, they’ll let you know. Even if they don’t expressly say what’s about to happen they’ll say you need to make family aware and they’ll pre-warn you if breathing etc is likely to become difficult. However I would ask his consultant just so that you’re absolutely clear what’s happening.

I’m sorry OP x

Thank you for all the kind words, I'm very fortunate and have lots of supportive friends and family.

The hospital asked me to go in a couple of days ago so that I was there when the doctor came and asked about the DNR. It was from that meeting I realised how bad the current prognosis is, that and the fact that any nurses I speak to are all overly sympathetic and slightly pitying towards me.

Low sodium can cause fatigue, confusion and irritability and unfortunately DH seems to have all those. If I try and talk to him to explain things he just gets annoyed because I'm not a doctor, but when he does see a doctor he gets a bit confused and doesn't seem to fully understand what's being said.

I'll ask if I can speak to the consultant when I go in later today.

Echoing others. You need to ask to speak to his consultant or whoever is most responsible for his care at the moment.

It was different for me as my husband died at home, so I was much more involved with his care and with those coming to the house to monitor and carry out.his palliative care. His Macmillan nurse told me when it was likely that he'd die within a couple of days, and the Marie Curie nurse who sat with him overnight, told me when she left that it was likely to be just a couple of hours. They were both right.

I'm so sorry that you're going through this. I wish you all the peaceful end that he and we were able to experience.

The palliative care nurse went to see him last Friday but I wasn't around when she saw him.

A DNAR doesn't mean that death is imminent though, it just means that should the heart stop they won't actively resuscitate. They won't perform CPR. Which for anyone in the terminal stage of an illness, makes sense. CPR is brutal, and if there is little to no chance of survival or quality of life then its unnecessary.

Definitely speak to the team though and ask for clarity on the prognosis and expectations.

MIL lives on her own, three hours away, she can drive but it's a long journey for her and she will need to stay with me if she comes. I love her very much, but she will be an emotional wreck and I'm not sure how well I will be able to deal with that.

In our experience from losing MIL not so long ago, you will be told nothing concrete unless you push for a meeting with the consultant.

Has she seen him recently. Ultimately with PaCa time is limited any and there is an argument that she should be seeing him now, while he is still able to talk and not wait until the last minute when he may be unconscious or heavily sedated.

Op I'm so sorry for you, your husband and his mum 💐 I didn't get told how near to death my husband was because I never asked any of the consultants and he went to most appointments on his own. He was trying to shield me from the pain I think. I only realised how bad things were when he was rushed to the palliative care home. Please speak to the consultant and they will give you a clearer picture

He last saw MIL at the end of April, we would usually visit every six weeks or so before that.

It's really difficult weighing up what he wants versus everybody else. He doesn't want visitors, he doesn't want people seeing him in his current state.

He's always been very protective of MIL, especially since FIL died a few years ago, although she's known about the cancer and the various treatments he's had, he's always played down the seriousness of it in front of her.

I do have an experience of this, 20yrs ago my boyfriend had bowel cancer. Expected it to be treatable, but went downhill very fast, the hospital called to say he had 24-48 hours and we should come and spend time with him.

I was shocked they could be so specific, and they ended up being right.

Yes, I got a call to say if I wanted to see my mum I needed to go now
That was later afternoon. I went back at 10pm as I had a feeling and she died just before midnight

Not all doctors are good at dealing with end of life situations or comfortable discussing them. If they are not being proactive about telling you what you want to know, as others have said, the best thing is to ask to arrange a meeting with the consultant and ask them specifically. You might have to be quite insistent about what you want to know. A DNR order sounds like a good idea in this scenario, it doesn’t mean stopping all active treatment, just that there won’t be CPR in the event his heart stops - and as a pp said CPR is brutal and unlikely to be beneficial. This is another thing you can ask the consultant to clarify for you.

Im sorry you are in this awful situation.