The Eldercare Monologues

From The Beginning of the End

From The Beginning of the End


This is a transcription of an “ELDERSCOLD” (my tease),  that I lovingly laid on Marilou during her most recent chest congestion / cough period in mid-November 2019, when she indicated that she was tired of coughing and went into a funk. She told the social worker, during her intake interview upon being admitted to hospice treatment by the Doctor/Nurse team with Caremore, the Medicare Advantage provider outfit that visits senior living communities, that she was “tired of coughing, and tired of eating (which exacerbated her coughing, since she normally aspirates a certain amount of what she eats or drinks, even when she doesn’t have a cold)  and wanted her life to end soon.” (Bear in mind, Marilou’s career was an Administrator for the Retired Senior Volunteer Program in Fort Wayne, IN, our home town for 12 years, an Activities Director at a skilled nursing facility before that, and a Clinical Gerontological Social Worker for a large Senior Living Community in Florida after retirement (She got her Masters in Social Work at Age 60 in Wisconsin as my Dad was approaching his early retirement — she is very mature about what she’s facing at age 93 and knew who she was talking to, and that it was being written down, and she has many times reassured me that she is more than ready for “this phase of my life to be over.”).

I spoke to her after the social worker left, thru the Google App “live transcribe”):

“Mom, If you do stop eating and make the Sovereign decision to end your own life by refusing nutrition, then this whole hospice team will make you comfortable as you weaken.  If you choose to sit and eat with me, though, even a little bit, even with difficulty, then that’s your choice. And that nurse said “if she’ll eat a little, even through her difficulty, she could easily live 18 months… two years… or much more,  unless she takes a fall.”   And she has seen a lot of old people. That was her expert opinion. It’s all about if you aspirate food and cough, or if you get bad mucus deposits, like a pre – pneumonia, or any bad congestion, you might weaken anyway and die.  But you might “tough it out” and the mucous may back off and you’ll be okay again.   The coughing and mucous are the things that make you want to stop eating, but if you’re in a weakened state from a bad cough, well, that’s the worst time to stop eating. Because you need to build some strength to give your body a chance to bounce back one more time.

So it’s about being strong enough to want to “pretend to want to eat” (because you probably aren’t going to really want to eat , because you don’t feel hunger anymore). But it’s a life necessity, and it’s either you accept it, and use the time to extend your life by eating – even if it’s unpleasant to you, well, that’s one choice that would extend your time with us.

And If you stop eating and start coughing, and don’t stop coughing unless we give you, you know, medication to calm you, but you don’t eat anymore, it will be a very slippery slope and won’t take long…… four days, which you know.

If you stop eating, if you won’t get out of bed and go and eat, we can sit you up and offer you nutrition, ensure shakes, and if you sip at them in bed (because your body is actually hungry, and you will probably drink it), you may find yourself bouncing back, and then being back at this table eating again in a couple of months, because you’ll realize, it’s a hell of a lot easier to eat and not feel miserable than it is to pretend to think that this “not eating” will be a quick-and-not-miserable experience……….

It is actually kind of a slow and miserable experience. So people in your spot will generally start eating again.

So you can just accept what I’m telling you is true, and eat now, a little, even while you’re just starting to regain strength, but still coughing a lot, and trust that you’re probably around for a while.

It’s really more a matter of attitude than anything else. So it’s fine for you to make the dramatic announcement to the social worker that you hope this doesn’t take much more time but until the end of the month…….. and it’s fine for you to tell me that you’re like Mort – ready to go….  but it’s,  it’s a different thing to pull it off.

So I’m going to keep offering you food and shakes, and trying to cajole you into taking nourishment, and you can tell me “no stop doing that. I don’t want to eat anymore,” and it’ll all get written down in a binder over here.”

She smiled while reading all of the above.

(She was admitted into hospice treatment the day before we had this conversation — started 3x daily nebulizer breathing treatments, an oxygen machine for continuous oxygen, day and night, her cold went away, she kept eating, and as of this writing in January 2020, is a cheerful, if frail, tough and self-described “lucky old lady” who eats (and drinks my protein smoothie) every day and is happy to be hugged by her friends…….and me.