This may be it - Round 2
Things are going from bad to worse with my mom.
She's out of it again, having been insufficiently scrupulous about taking all of the drug (lactulose) that's been keeping her head clear. This morning, she had the safe, minimally-invasive diagnostic done to pinpoint the source of the GI bleed. It worked. The source of the bleeding is the cancerous mass in her bowel. Basically, there's nothing that can be done to stop the bleed. The docs offered us some options, but more for the sake of offering options than because they're any good or likely to be of use.
My brother P. and I tried for about 45 minutes this afternoon to get Mom to take a dose of lactulose. We got about a third of a dose into her. I spoke with Mom's and my friend J., who's a nurse, on the phone during that. She told me Mom needed the kick of getting an entire dose into her all at once to help clear her head. The hospital staff wanted to intubate her - we were trying to get her to swallow the stuff without making her go through intubation again. They had intubated her in the ER, and she was fighting it, and begging them not to. I left the room in tears, but my brother stayed with her through it. We were trying to avoid that happening again.
While trying to get her to swallow the lactulose, we also tried to get her to tell us what she wanted (in terms of treatment). The only clear thing she was able to tell us was "I don't know!" We decided to leave and let her try to get some sleep for a few hours, in the hope that perhaps some rest might help to clear her head. (We also realized the additional buildup of toxins might leave her more muzzy-headed, and clearly unable to decide for herself.)
When we got back to the hospital this evening, she was at roughly the same level of lucidity as before we left. Perhaps a litttle clearer-headed, but still extremely groggy and mostly unable to speak clearly, despite trying. My brother, who's her health-care proxy, tried hard to get her to say what she wanted. He agreed with me, though, that if she was unable to communicate clearly, there was no way we could be sure that she was lucid enough to make a decision.
He really didn't want to have to be the one to give permission to go ahead and intubate her again; he described it as torturing her. But he agreed that it was the right thing to do; give Mom the option of deciding for herself what she wants with a clear head. We found the nurse and told her they had our permission to intubate Mom, since that was the only way to get the lactulose into her.
She told us that when she came on that evening, the previous nurse told her that Mom had taken her entire 5:00 PM dose of lactulose. (One of the ways we'd gotten her to swallow the stuff earlier had been by asking her if she wanted her head to be clearer; she'd said yes.)
We left the hospital with the understanding that they'd keep offering Mom the lactulose on the usual schedule; if she takes it, great. If not, they have our permission to intubate her in order to get it in her, but not to use the NG tube to prep her for a colonoscopy. (One of the procedures offered as.. a thing to be offered.)
At this point, my hopes are that my mom will regain enough lucidity to say goodbye. Unfortunately, I don't think she's ready to die. She said a few days ago that she didn't want to give up. Her body has other ideas. I'm not looking forward to being there with her when she's told that there are essentially no more useful options. But I will.