My mother in law has been put on a feeding tube through her nose. She hasn't been able to communicate with us for a few months now, and I'm not sure this is the best course to follow. She has been asleep since they installed the feeding tube and I feel she sleeps with her eyes open when she finally opens them. They have tied her hands and she feebly fights the restraints whe she is conscious.
My brother had a feeding tube while he was recovering from throat cancer. He was expected to improve and not need the tube anymore. He did improve and he no longer uses the tube. That seems to me a very valid use of a feeding tube.
But if recovery is not expected, that is an altogether situation, in my mind. Restraints? OMG!! That poor woman. Where are you? In US?
If you or your husband are in the hospital yourselves, perhaps you could ask discreetly whether it might be possible to get an independent review of this lady's case done? They might have an ethics committee, or patients' advocacy service, or something like that offering support and advice.
I'm sure your BIL is doing his very best but these are extremely difficult decisions and it can be hard to "admit defeat."
Your post is an exact duplicate of my second patient as a new nurse in 1979. Her name was Annie and I will never forget how horrible I thought the whole situation was. I was 23 years old and she was 90, in end stage Alzheimer's, bedridden, unable to move on her own, unable to eat, incontinent, unable to speak.
She had round, hard, flat "mittens" tied around her wrists so she couldn't grab and pull out the NG tube we used to feed her. We would have to turn her every 2hours and give her the tube feeding every 4. The poor thing fought us every time we bothered her.
I thought it was cruel then and I think it's cruel now. At the VERY least, they should switch the Nasogastric tube to a gastrostomy tube. The doctor makes a tiny hole in the upper abdomen and pokes the feeding tube right into the stomach. It's held in place with a little balloon at the tip. It is not a painful procedure and a local anesthetic is given. With this location of the tube, there's no irritation of the nostrils or gagging feeling in the throat like she has now. Tell your brother to have her tube changed to this more humane way of feeding. It can be tapped to her tummy and an abdominal
binder can be loosely placed over it so she won't have access to it. Then TAKE OFF THE RESTRAINTS! The poor dear is just doing what any of us would do if we had an irritation and wanted to remove it.
First educate yourself about hospice. Talk to the hospital-I'm sure they're connected with one or have their own. Arrange a meeting so the team can inform you of what they do. Then, talk to your BIL about hospice then invite him to the informational meeting. Hospice will make sure her last days are comfortable and not restless and in pain like she is now. With hospice there won't be any more feedings but they can explain how the body starts shutting down as we prepare to die and to force it to "stay alive" because of the nutrients makes life even more difficult and painful for the patient. If she was out in nature, she would die naturally because her body is shutting down and she can no longer eat. Animals go through this as they prepare to die.
This woman needs her son to be better informed and someone to stand in as her advocate. You could also talk to the hospital social worker, if not specifically about HER case, (due to patient confidentiality-HIPPA), then about this type of situation in general. At this point we need to treat our elders humanely and not let them suffer until they are worn out and finally pass away. Death SHOULD be with dignity.
This hospice nurse will get off her soapbox now.
Artificially feeding someone with end stage dementia is something akin to torture in my opinion, as the body can no longer process food.
Removing the feeding tube would NOT be starving her; it would be allowing nature to take its course.
That poor woman!
My inclination would be to remove it,take off the restraints and send her home with a recommendation for Hospice care. She deserves that.
I realize her son does not want to loose his mother and feels he needs to do everything possible to help her survive. What he is doing though is prolonging her suffering and preventing the inevitable.
To answer the actual question . "Yes she will die" but that is probably what is happening anyway and her body should be allowed to continue on it's natural path and give her peace for the time she has left.
she is 90 yrs. old
I think this poor lady has more going on than has been conveyed to you. You might want to ask for a heart-to-heart talk with her son and get the frank update on her situation. Or perhaps your husband can talk with him, as I assume this is his mother and it's his brother who is proxy for medical decisions?
But the issue of the restraints troubles me even more. I think my heart skipped a few beats when I read this in your original post. If you haven't discussed this with your BIL, or your husband if he knows, I would definitely raise the issue.
To me, this is literally torture, to have the uncomfortable NG tube but to be restrained is to me very cruel, especially to someone who's apparently unable to communicate.
If you don't get any answers, you could try to get information from a charge nurse, who probably couldn't tell you anything because (I'm assuming) you aren't listed in any HIPAA documents. But just the fact that you raise an issue of concern and potential cruelty might get staff in an oversight capacity involved to provide some answers. The hospital I'm sure wouldn't want this to be shared publicly, whether or not the treatment is within acceptable limits.
The basic questions you want answered are (a) the purpose of the NG tube, beyond administration of nutrients (b) whether she's in a terminal state and if so, (c) why haven't they suggested hospice?
BTW, are you in the US or another country? Your profile doesn't provide any information, and for some reason I see this situation more likely to occur in a small rural hospital than in one in a major city.
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