My Grandma is 84. She was diagnosed with breast cancer in 1999. Went under surgery and treatment only the find that on 2001 it traveled and become bone cancer in her pelvis. Since then , she has had a pacemaker put in (2004), had a knee replacement, suffers on and off aging severe bouts of vertigo, which leads to falls. Most recently Nov 26th, she suffered a horrible fall resulting in 2 broken cervical spines in her neck, and multiple fractures through the back. She is in a C spine collar and back brace currently still. She was hospitalized for a few weeks, including 10 days of intensive rehab. Became well enough to be discharged to go home. She was to go home Monday December 26th. On Friday December 23rd, we received a call from the home that they found her unresponsive and slurring words and we're calling a ambulance (original thought was a stroke). Came to be that she had a UTI. For 3 days she was delusional. We watched and waited. Christmas day, we were told to consider hospice, which was a shock since we were told by drs that it was just a infection and she should.come around in a few days. We came to find out that her Advanced Directive had no antibiotics or IV fluids on it. We were already 2 days into treatment at that time, and decided to continue forward. She is slowly coming around, but we have .outlying put her back at square one as far as rehab goes and I feel horrible. We were aware she had a AD, but unaware of such detail to it. My uncle insist that she wasn't aware either, my aunt says yes she was. I live near my grandmother and am very close with her. I KNOW that she has been ready to "let go", and now I feel that we went against her wishes. She is still not well enough to have the discussion with, and I fear it's going to happen again, sooner rather then later. My uncle says if it does we will treat again, I say no let her go. The wOman has suffered enough through her life and I know she's ready. My question is mainly, in a case such as this:
1. Should the hospital have even treated her in the first place? Her AD was on file there and we also gave then another copy again that night
2. Is a UTI severe enough means for a AD to come into play?
My uncle says no...we're all "dying", it's a infection that can easily be treated. I say yes, if it requires her to be hospitalized for treatment and rehab her AD should come into comsideration. He is the POA, so ultimately I have no "say" although we are a close family and try to make decisions as one. If and when she gets well enough to discuss this matter with a clear head, I honestly have no doubt that she would have not wanted us to do anything. I fear that he will talk.her out of it. He lives a state away and is not here to be the one taking care of her and talking to her like I do. Anyone else ever faced a issue such as this?
That's the first issue; if you could clarify it would help others provide answers to the other dilemmas you raise.
In your place, I think I would report my concerns to her attending physician and ask them to explain the hospital's AD protocol to your POA uncle. Note, the hospital will not be able to discuss your grandmother's care with you; but that doesn't mean you can't give them information and expect them to take it seriously.
When you say "we watched and waited" who's the we? Is one of your parents involved?
Hers is VERY detailed, IV's ONLY if she needs antibiotics and the chances of her surviving "whatever" (likely a UTI or pneumonia)..and that's a sticky part for me. I'm glad I am not her MPOA. Hospitals "have to" accede to the stated AD. I'm hoping it won't be an issue.
W/o knowing the specific details of the AD, I would say generally that if an infection would be cured, it would be treated. If it was uncurable, that might be a stronger indication for hospice.
However, there's another issue. You wrote in the first part of your thread introduction that in 2001 the breast cancer was discovered to have metastasized to the bones. I am frankly totally amazed that she's survived so long with that kind of metastasis.
I would ask the doctors if any further metastasis has occurred, and if that was considered in the decision to recommend hospice. I suspect it was. And that's probably a stronger indication for hospice than a potential recurrence of the UTI. In fact the cancer may already have compromised other organs and made it more difficult to recover from the UTI.
You wrote that she's "ready to go." I would let that also be my guide; it is her life and if she's exhausted from the battle, it's time for her to find peace.
You might want to, or have a doctor, explain to your uncle the nature of metastatic cancer and how it can eventually compromise multiple systems.
The nasty fall she experienced recently makes me wonder if her entire spine has been compromised by the cancer metastasis.
I would insist that her AD be honored. It doesn't matter what others think. It is her call and she made it with her AD. If you explore the AD document, it may have language that says, "If my HCPOA says anything different from my AD, then my AD overrides my HCPOA." I'd check on that and insist it be upheld.
POA grants authorization to handle finances and legal matters, not health issues. If Gramma chose you as her healthcare proxy, then you have the responsibility to make medical decisions when she cannot. It sounds like you know her best and will act in her best interests. If your uncle tries to interfere, tell him to ask an attorney. Your role is not an easy one, especially if your uncle disagrees with you, but it is you that Gramma trusted with this responsibility.
Are you bringing in hospice for an evaluation?