As I've mentioned in earlier posts, my mother has some sort of undiagnosed blood disease, probably leukemia or a precursor to it. She has been feeling progressively worse over the last few months as her white blood cell count has steadily climbed. She has no energy, no appetite, nausea, extreme weakness. We went to her primary doctor on Friday and my mother again refused to have a bone marrow biopsy to diagnose the problem, admitting that she doesn't want to know the diagnosis. She just wants to live as well as she can while she can. She insists that she wouldn't seek treatment no matter what the diagnosis is, but I'm not sure that's entirely true. At least some types of leukemia can be treated with a pill form of chemo, and if that's what she has, maybe she'd at least try the treatment to see if it improves her symptoms if not offering a cure. I accept that that's her choice to make, but my sister and I would really like to know what we're dealing with here so we know what to expect in the foreseeable future. We would like to be able to plan for Mom's needs and our own availability, as well as whether to seek involvement from other family members. Plus, my understanding is that hospice won't provide services without an actual diagnosis (or prognosis, anyway). Mom's doctor did mention hospice as something to think about, but I don't see how we get there from here. Has anybody been in this situation or have any light to shed on this issue?
* she doesn't want to know the diagnosis
* She just wants to live as well as she can while she can.
Yes, there are underlying conditions, however there could be something easily treatable that would allow mom some "comfort" in her remaining time. "Living" with "no energy, no appetite, nausea, extreme weakness" does not equate to living "as well as she can while she can." Those other conditions might not be causing this and might not be enough to say she is on the cusp. IF a biopsy is the only way to determine what is going on and IF that is an invasive painful diagnostic, then perhaps leave well enough alone and spend the most time with mom while she is still with us. Perhaps, as some have suggested, there are alternative tests that could be done that might reveal what is causing the blood issue. Again, IF that underlying condition were easily treatable, or at the least the symptoms were treatable, which might improve her current quality of life, why not try it? Others suggested talking with PCP about her other conditions - what is the prognosis for those? Unfortunately doctors do not have crystal balls to determine how long one might last with ANY condition. There are no guarantees in life - even "healthy" young people die from previously unknown conditions or accidents. We live each day thinking we can go on as is, but a wrong move by anyone can snuff that idea out in an instant.
Just as an example of treating a condition that might not extend life, but *could* make it better: SueC1957 related a story about Maggie, who was told she would go blind in about a year due to macular degeneration - question, was this before they had treatments? Our mother, long before dementia set in, developed this in one eye, then later in the other. SHE has treatments, which have preserved her eyesight. Because the first doctor she saw missed the condition, she lost some eyesight in that first eye, however she CAN still see. This was MANY years ago! During a recent treatment the doctor asked if we wanted to continue with treatment because of her dementia and age (currently 94) - yes, absolutely, because she loves to read things (has no real hobbies, so reading is it!) and as long as we can keep her eyesight well enough to do this, she is content. What her life (and ours or the care-givers) would be like if she lost her eyesight? Probably a nightmare! Her hearing is bad (nothing on one side, the other not much better, so between talking, lip reading, writing on a Boogie Board and pantomime, we can carry on "conversations." With no eyesight? HOW would one communicate?
CarlaCB - do you and/or your sister have DPOA and medical directives in place? If so, you *could* perhaps, with doctor advice, start hospice. Mom does not need to know that this is hospice - just tell her that her care-giver and you need help taking care of things. At least you could get some medical equipment to make life easier for the rest of you and some palliative care for mom, which might make her more comfortable.
The latest on this is that Mom's doctor has again talked to us about hospice, and again Mom didn't want to hear it. It could appear to the outside as if Mom has accepted the inevitable, but I don't think that's the case. I think she's just crossing her fingers and hoping for the best. Or purely in denial.
PUSHING to get a diagnosis and possibly a treatment/cure for the blood problem, is NOT going to cure all moms other illnesses.
Her breathing will be compromised from the Chronic Obstructive Pulmonary Disease (that only gets worse as time goes on), Congestive Heart Failure (which she's already been to ER multiple times to get rid of the fluid) and anemia (Procrit, IV Iron and possible blood transfusions). She has no energy because of that. Diabetes in later stages compromises circulation also. The diabetes probably caused the kidney disease and toxins build up.
There are multiple body systems affected. One gets worse and it affects the others.
So, the folks who are pushing for a diagnosis of the blood problem have to understand that these other problems aren't going away. There will be no "It could be that it is something simple, curable, and we can work on treating it! THEN you can feel better and live again!!", because she's STILL got all the other incurable problems. Finding a diagnosis for the blood problem WON'T cure the rest. I wish it were that easy.
At this point her mom is very weak. Think about that-not having the energy to stand and walk. The diseases beat you down until you give up from the exhaustion. Have you ever been THAT sick? I have (pneumonia at 35 years old).
I'm thinking she's tired of fighting the inevitable. At that point, it's just not worth it to her.
CarlaCB,
Enjoy your mom now. No one knows when the end will be here but, like Rosses said, your mom has accepted the inevitable. You don't need a diagnosis. Be near her, spend time with her, treat this as if this is it. You'll handle the changes as they come, as best as you can. And don't rely on this one diagnosis (or lack of) to see that your mom is a very sick woman. Any time, IMO, with her will be well spent. If you wait for what you think is the end, you just may be too late.
Mom;
It is possible that you have something benign that just needs simple treatment to make you feel better. Why not allow the testing to be done and they can discuss everything with us first. If you do not want to know, we don't have to tell you. That's your choice. It could be that it is something simple, curable, and we can work on treating it! THEN you can feel better and live again!!
If we don't know what the issue is, we cannot help you or prepare you and ourselves for what this will bring. Meanwhile you suffer. It could be a chronic condition that just requires treatment all the time to make you feel better (like diabetic treatments - feel better but it never goes away.) THEN you can feel better and live again!!
If it truly is something that cannot be cured, it likely CAN be controlled and if nothing else we might have ways to at least make you feel better/more comfortable. THEN you can "live as well as you can while you can."
You will not likely be able to "live as well as you can while you can." if you choose to bury your head in the sand and not seek out a diagnosis. You already suffer from "no energy, no appetite, nausea, extreme weakness." ALL of this *could be* a treatable condition, IF we know the cause behind it, AND also could also be curable! You are assuming the worst and you could be wrong. If we get to the bottom of it and can find ways to make you feel better, THEN you can feel better and live again!!
I’ll be in the minority group, as it very frequently happens, and I’m absolutely ok with it, as my perspective in life is more focused on the heart and emotions than on material and practical aspects.
I’m in your same situation, my mom doesn’t want anymore tests, anymore doctors and has been cutting down her daily medication. And WHY should I expect anything different? For my practical convenience? Absolutely not..
Do we have the right to be able to plan according to our circumstances? Theoretically yes, but not if to be able to do so we force someone that’s already tired and ill to do something they not only don’t want to do, but don’t have the strength, physical or mental, to do it.
We live in a society that’s very “practical” and not very “human”. A sick person is many times seen almost as a robot, that should submit themselves to whatever a doctor suggests...”for their own good”..But is it for their own good?? Is it fair to expect others to change their choices to make ours easier? I don’t think so.
I know your desire to know your mom’s diagnosis is not coming from a bad place, I understand that perfectly well; but I believe you are missing the essence of her point Carla.
Like others have mentioned here, your mom has lived a long life and unfortunately is not in good health. She’s probably accepted death as part of her journey and simply wants to be left alone and be at peace.
She has the absolute right to do so, and there should be no practical matters that impede that. If her decision implies sacrifices for you and your sister as a result of having to plan for the unplanned, well, at some point love means sacrificing -if not always-.
You wonder if you should move closer, since you don’t know her exact diagnosis. Yet, I don’t think you need that diagnosis to know the answer to your question. As it is, your mom is very ill, tired, not eating not able to move easily...so, Carla, If you’re able, I’d encourage you to make changes that allow you to be closer to your mom and help to provide her comfort and make her feel loved. A diagnosis is not needed to understand that.
SueC gave you a good answer, specially coming from a nurse.
Look at this time as a golden opportunity to care for your mom, be close to her and show her your love! one day at a time, for a year or 30 years, time is not the focal point here.
Much love, strength and wisdom for you :)
My mom was hard headed her whole life regarding doctors. She made it to 80 despite them.
Your mom would be eligible for hospice in my state (MN) under 'failure to thrive'. It doesn't have to be a doctor's cancer diagnosis or something like that. My mom never had a diagnosis. The hospice doctor could tell she was dying (low weight, low BP, mental, etc.) that approved her.
You are on such a hard road. My thoughts and prayers are with you. It is so very difficult and I understand.
Real story-When I had to move in with my mother from my state (Maryland) to her state where she was living alone (Massachusetts), I got the opportunity to look at her medical documents she had received from doctor visits. One actually said that she had skin cancer. When I asked her about it because she had never brought it up in ANY conversations we had had, she said "no, I don't have skin cancer." So there it was -- a document stating the truth, but the elder not wanting to believe it!
Jeanne, in answer to your last question, Mom does have a live-in helper. She is an unpaid caregiver who basically watches over Mom in exchange for free housing and has over time become extremely invested in Mom's welfare and very devoted to her. That said, my mother's total helplessness is starting to become overwhelming to the housemate, and I have started to step in and relieve her more regularly than before. Since Mom no longer goes out, I have to go to the house for a few hours or overnight to make Mom's meals, help her up, and do whatever she needs so her caregiver can get out and attend to other things. I've offered to stay over every weekend if the housemate wants (her boyfriend lives a few houses down the road and they're always happy to have time to spend together). So we're working on those arrangements.
I call them both every morning now, but it is starting to weigh on me that I'm not there every day to see Mom for myself. If Mom were close to dying, I would definitely uproot my life to be there more. If it's a year or more out, I'll finish out my current lease and then see about changing things. How much I need to be there depends on how much Mom needs me to be there. I guess there's just no way of knowing that in advance and I just have to wait for the future to unfold and let me in.
Your Mom has CHF, AFIB, COPD, diabetes, kidney disease, and severe anemia. Would she be accepted into hospice care? Has she been evaluated? If she has nothing else except the listed diseases at their various stages, what is her prognosis? I know that the medical profession is very reluctant to give life expectancy, but it seems that this one is an important part of your decision factors.
And then, add possible blood cancer without chemotherapy etc., and what is that life expectancy?
What if you hear "she could live as long as two years with the cancer, but her kidney's are not going to last that long. Perhaps 6 to 8 months for that"? Would that change your mind about the value of testing? Perhaps you could ask, "Given her kidney disease and her comorbidities, would you approve hospice care for her? That will give you some idea of what they are thinking.
Do you have a cutoff in mind? If mother has less than x more months as a life expectancy you will move near her, but if she is likely to live more than x months you will bide your time and move later?
You are not asking for anything most of us haven't wanted. There are many practical reasons it would be valuable to get a time-line prognosis. When I had the front lawn landscaped I wondered if it would be worthwhile to also replace the sidewalk with one on an ADA recommended incline? Coy wanted a walk-in tub. How much longer would he be likely to be able to use it? I really do understand the practical considerations in wanting answers. I think most of us do. No criticism implied that you would like test results. We all would. Usually we don't get what we would like in that regard.
How valuable would it really be in making decisions to have that information?
Carla, I think what I would do is first get a hospice evaluation. They are probably as skilled as anybody to guess her life expectancy at this time. You wouldn't have to commit to using it even if she is eligible, but why wouldn't you?
I would get the hospital bed and a bedside commode. If she goes on hospice, they will provide these, probably same day. If not on hospice, her doctor can order them and they should be covered by Medicare. It will take a little longer that way.
I would start the Medicaid application now. Better safe than sorry.
I can't remember your caregiver arrangement, Carla. Is someone with Mom all day? If she goes on hospice she will need 24-hour care provided or hired by the family. Would that make a difference in how soon you would want to move closer?
Sorry to write at such length, but I really do empathize with you. I hope you get some information that will help you make decisions.
My mother is almost 87 and is in very poor health overall. She has CHF, AFIB, COPD, diabetes, kidney disease, and severe anemia. Her quality of life is poor and getting worse. She hasn't been able to walk more than about 50 feet with her walker for a long time. Her recent issues have made everything worse. Now she has extreme difficulty or needs help getting up from a chair, can't walk further than the bathroom with her walker, and has to be wheeled out to the car to go anywhere. She no longer goes anywhere except to doctors' appointments, and cancels most of them because she can't get up the energy to leave the house.
Nobody in the family is advocating for my mother to seek treatment for whatever the disease is, unless maybe the treatment is a simple daily pill with no side effects. We know she could not withstand surgery, chemo or radiation and her quality of life is lousy enough as it is. We all accept that she's nearing the end of her natural life. I'm amazed she's lived this long with all her impairments, actually.
Still, it's very uncomfortable not to know whether she has 2 months or 2 years, and how quickly and in what direction her needs will change. Should we be applying for Medicaid, or is it already too late for that? Should we/can we bring hospice in? Should we be working to make her house more wheelchair-friendly, or will she be bedbound by next week so it doesn't even matter? Should we be getting a hospital bed for her living room so she doesn't have to get out of her chair to get in bed? What if she can't get herself to the bathroom? (She's already given up showering, and just gives herself a little wipe-down while seated on the toilet).
The biggest issue for me is - should I find a way to move closer so I get there faster and be there more often? My sister lives only a few blocks from my mother, but she's so heavily scheduled and frankly not inclined to involve herself with Mom any more than she already is. I know she's not going to stop in to check on Mom every day, but if I were there, I certainly would.
I'm not trying to pressure my mother into anything. I just wish I had a better idea what to expect.
That was about a dozen years ago. Today, at age 73, I can very easily imagine me making such a decision. Possibly not in the next few years. Probably in my 80s and absolutely in my 90s ... and maybe sooner.
Breast cancer? Sure. Let's get the results as soon as possible. I know women who have survived that kind of caner. I could decide that the risks and the pain were worth the possibility of a longer life.
But for most other kinds of cancer, I agree with Ginach. The older you are the less sense it makes to trade relative comfort now for uncertain benefits in the future. Reading "Being Mortal" confirmed that belief for me.
I might have the tests, but first I'd ask if having a firm diagnosis would change the treatment plan if I refused chemo, radiation, and surgery. Could they keep me more comfortable if they knew what was causing my symptoms? Or are they going to use generic measures no matter what? Then let's skip the tests.
One case discussed in "Being Mortal" is that of a person trying to decide whether to have the treatment the oncologist was urging. The author asked the question, if no cancer treatment is given, what is the best-case life expectancy? The answer (after the usual disclaimers for uncertainty) was "about 3 years." And if the chemo/radiation/surgery is accepted, what is the best-case life expectancy? The oncologist answered that it was just over 3 years. Hmmm.
Carla, how old is your mother? I think in her situation I would prefer to get support from a spouse or a sibling or a friend near my age instead of from any of my children. Age really and truly makes a difference in one's perspective.
I think it is part of my need to have all my ducks in a row that makes me tend to want a diagnosis, but after reading so may answers I've altered my opinion a bit. Someone pointed out that all or nothing isn't the only response available, the docs should be able to figure out how this can be managed without the biopsy, focusing on symptom control and improving QOL.
I am almost 84, my DH is 86 with Alzheimer's. We both feel the same way. Someone the other day was talking about changing his diet so he would be healthier. I asked "Why"? He has had Esophageal cancer, every time he eats he hurts, he has diarrhea all the time because of the surgeries he has had. We eat a well balanced diet, why would I make him do without food he loves just to keep him suffering longer? A couple of good hearted people wanted me to not "let" him do his hobbies because he might "cut" himself. I told them what kind of life would this active, talented, man have if he had to sit in the chair because he "might" hurt himself? With the Alzheimer's that will come soon enough.
Sorry to be so lengthy but I'd like to present another perspective.
I don't see why your mom couldn't be signed up with hospice with the diagnoses she has...anemia, congestive heart failure (especially if she needs fluid drawn off every so often), then chronic nausea and immobility. The doctor should be able to state that she has less than 6 months to live (even if it's longer).
Your mom doesn't want any more "bad news" and not having the tests is one sure way to not have any bad results. That is her perogative. Yes, it makes it more difficult for everyone involved to "anticipate" her next need but, if her mind is made up, as long as she's not demented, that's her right.
As a nurse, I've seen so many old, sick and tired folks submit to painful and tiring procedures just so their family would be satisfied. They didn't want the procedure or surgery but the family put on the pressure then pressured for the treatment too. To the family, it was worth 'anything' to keep their loved one alive. However, THEY are not the ones going through the procedures and treatments.
The family isn't looking at it the same way the patient is. Often times patients are ready to die. But, in this culture, we don't let "natural" decline and death happen anymore. They are poked, proded, injected, X-Ray'd, scanned, scoped and assaulted in many other ways. We literally fight to the death to not let them die.
I have a 90 year old friend, Jane, who had an 88 year old friend, Maggie.
Maggie had many chronic health conditions and she took LOTS of medications. Those meds kept Maggie alive and mostly well.
Maggie was told by her ophthalmologist that she had macular degeneration and, unfortunately, would be blind in about a year. This was Maggie's last straw. She would not accept going blind. She gave it a good deal of thought then announced that she would no longer take her medications. They argued that she wouldn't "make it" if she did that. "Precisely", she said. Maggie died 7 months later, still being able to see.
Maggie orchestrated her own death because she refused to live with blindness in her future.
Maybe your mom is driving her own future also by letting things "BE".
She has that right. You don't have to be happy about it but you must accept it.
In my thoughts, God's gift to us is our life. What we do with that life is our gift to God. Whether we fight to keep it as long as possible at any cost or we surrender to "whatever will be, will be", we all return to Him when it's our time.
Maybe your mom is ready to face the unknown but the rest of you aren't.
Such a hard situation with no perfect answer. 😢 It's hard to let go.
God bless you all.