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I've been following the list for few months now but have not to date provided any background on myself. I am approaching 69 and my wife was diagnosed with PD in 1963. I myself have a wild and wacky medical history culminating in a Kidney transplant in 1990. Since May of last year my wife has had two serious falls which have culminated in her being totally dependent on others for alll the aspects of daily living and is presently confined to an extended care facility and probably will until she passes on to be with the Lord. My major problem now centres around making decisions about what will happen if certain events occur. I have signed a "do not resusitate order" in the event of breathing or heart failure and I can accept that. The problem that is now rearing it's head is that of "aspiration pneumonia". Do I:

(a) tell the Doctors to withhold anti-biotics in the event this occurs or

(b) is my decision really based on ending my wife's suffering or because it makes things easier for me.

I really cannot come to terms with this, my life style is deteriorating in spite of help from my church friends. It is getting more difficult to communicate with my wife because she has difficulty speaking although she is completely aware of everything going on around her but we have now resorted to an alphabet board for her to convey her thoughts. I guess my question is how do I make choices for my wife of 47 years who has been so forgiving of me at times when I didn't deserve it and has loved me unconditionally always. Can someone help.

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My response to you is as follows. You said your wife is totally aware of everything going on around her. With this in mind! Ask her what she would want in the event of aspiration pnuemonia. Have you discussed any of these scenarios prior to her being in this frail condition? Did the 2 of you have this type of discussion prior to your kidney transplant?

It would seem to me if you had this type of discussion you should have an inkling of what her wishes would be. I realize it is always a difficult choice to make. However, you may never have to make this decision.

The good Lord just may do it for you.

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Every time I have tried to initiate this conversation she bursts into tears and then there is little hope of a meaningful conversation, I guess I just want to know what the Lord's will is in this and I know I will have to wait for that.

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Do you have any children and do they have any input (how do they feel about this)? I know I would want to have some say if this was my mother.

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I am rather new to the care list but will tell you what happened to my mother who was confined to a care center after having broken her hip. She caught pneumonia and I will never forget the look of terror on her face as she gasped for breath and they wheeled her out to an ambulance. In the hospital she almost died but over my objections, gave her a very potent dose of antibiotic. She gradually got over the illness but never recovered her strength enough to get out of bed. She spent six more month of a very low quality life. Finally she decided on her own that she had had enough and started to refuse food and her medication. She died peacefully in her sleep.

I wish I had been more knowledgeable about how to stand up to the doctors. My mother had a living will and I know she would not have wanted to go on at that point. I think we sometimes forget or wish to not be reminded that we are really mortal and have to die sometime. In the old days they used to say that pneumonia was an old man's best friend.

I can understand your pain. But in my experience, the pain of seeing my mother go on for months suffering was even more painful. That's just my humble opinion.

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As many of you know, I have had to deal with much of the same things as you are dealing with now. If your wife really does understand what is going on around her, now is the time to discuss what she wants with her even if it does involve a letter board. If she cannot tell you her wants, what do you know of them from previous discussions? Also, what really is her quality of life? Since October, Hospice people have been coming here and helping me with these kinds of decisions. They have a lot of literature that can be helpful as well as counselors and Chaplains to discuss it with. I am sure you can talk with them even if you do not decide to turn your wife's care over to them.

My husband's quality of life really sucks. His only pleasure that if left is eating, and if he gets Aspiration Pneumonia again, I will follow the suggestions of Hospice as to treatment or not. As you may know, my husband is prone to Urinary Tract infections and has been taking preventive antibiotics for years in between aggressive treatment when the infections got bad. He is never completely free of a UTI. The last time he had a bad one, we decided with Hospice help not to treat it with antibiotics. We had had to discontinue them earlier because he was getting so many yeast infections. He became extremely ill, and the nurse told me and the office staff that he would probably go that night. The next day, his fever receded, and he is still here! I know he is happier knowing that Hospice is coming and that nothing heroic will be done to keep him alive, and I believe he has decided that he is not quite ready yet to leave.

You are dealing with some very difficult issues, but for me, I have found that putting it in God's hands is the most helpful. May God help you with your choices.

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