Wednesday, March 8, 2017

How many times have I lectured those who cared for patients at the end of life that a refusal of food is natural. It requires a lot of energy to chew, digest, and eliminate food and the process can result in great discomfort. Sometimes people eat to placate their caregivers. Certainly I saw this in my dogs many times. But when the energy or desire for eating is gone, nothing can be done.

Today, the nurse visited mom to re-certify her for hospice. She noted that mom’s heart was strong, her lungs were clear, and she still had bowel sounds. But we could not get a reading of mom’s oxygen saturation, because her extremities are cold and her circulation is poor. The nurse also noted that mom’s mid-upper arm circumference has greatly diminished. All in all, mom is in “good” condition, apart from the fact that she is wearing out. But what about that mid-upper arm!

Inspector Clouseau: The obvious conclusion?

Me: I am starving my mother!

Inspector Clouseau: No, you idiot!

I worried all night that I was not feeding mom enough. When the nurse asked how many hours mom sleeps during the day, I replied, “Nearly all the time.” Mom is awake only when she needs to use the potty. Immediately afterwards, she falls into a deep sleep and cannot be disturbed. So do I wake her? Do I suggest or insist that she have something, anything to eat? Do I try to re-establish her former meal pattern?

No. Mom is setting the pattern now. The best part is that she is clean and comfortable and not in any pain. She is losing weight rapidly, but I will ask her when she is awake whether she would like to eat. If she says no, I will honor her wishes, however difficult it is for me. One’s natural inclination toward someone you love is to nurture them—back to health, if possible. The if possible is the operative phrase here.