@Chumom, if your husband feels comfortable doing so, he could try talking to his sister and father about what kind of end-of-life process they’d prefer for MIL, taking into account both her needs and their own. Some issues to consider:
Would they prefer that she die at home? Dying at home might be more likely if she doesn’t have surgery.
Assuming there is surgery and MIL is well enough to be released, who will take care of MIL after the surgery? If FIL is already overwhelmed, it seems likely he wouldn’t cope well with having to provide post-surgical at-home care.
Is there a hospice provider in the area? Can they provide in-home care, care in a facility, or both? FIL might prefer hospice services to surgery but not want the hospice care to be in his home. (This happened with my next-door neighbors; the wife was at home receiving great care from hospice but she and her husband eventually decided that they preferred that she be in the hospice facility.)
Are family members prepared for the possibility that surgery could hasten MIL’s death rather than postpone it?
Are the family members able to cede preferences and decision-making for the good of the family unit? When my dad was dying, I had mixed feelings about the large amount of narcotics he was on, but I knew that was what my mom preferred, and I decided it wasn’t worth making her feel worse by expressing my concerns.
A little guilt might be normal but please don’t feel that a big dark cloud of guilt is necessary or expected.
The gun?
Chumom, it’s possible your SIL doesn’t have medical POA. I’ve been in several sitiations where health folks took us at our word. It may be Dad.
Your husband may be able to speak with the doc ahead of the meeting and express concerns that she not be put through further pain. Some of the surgery decision depends on where she lives. But where I am, ime, they are frank and can be hesitant to promote surgery, when it will not improve quality of life.
I agree to look into hospice.
Yeah, I’d want to SEE the POA. SIL may be a designated POA, but perhaps only in the event of a spouse being unable to make decisions for the other. Sounds like MIL’s DH is still competent. My sister is POA for my dad, but it doesn’t kick in until certain conditions are met.
I would be surprised if the docs recommend surgery for someone with aggressive cancer, who already has several other illnesses that significantly impair QOL. Aggressive treatment in a dementia patient is only going to further disorient her. I’d be asking, “what does Mom get out of this?” The decisions are difficult, but don’t spend energy on guilt. Let her be comfortable and able to enjoy the time she has.
I agree with the above sentiments, it may be kinder not to do “everything”
Surgery at 80+ is no small thing, if she has terminal cancer, what is really gained buy the surgery?
We don’t know the degree of dementia your MIL has, but being in the hospital and then anesthesia are both likely to make it even worse.
My sister was shocked a few years ago when DH & I advised her FIL not have a “lifesaving” cardiac surgery. He had it, because the family took the “lifesaving” comment to mean they would be killing him if they elected for him not to have the surgery. It has been a nightmare, He is unable to comply with any of the doctor’s instructions, the dementia is incredibly worse since the surgery and is wife is at wit’s end. They are finally paying someone to bathe him, but nothing about the situation is going well 
This is something @chumom and at the level of my parents, for which I am grateful. But as with @somemom, I doubt this is where she will be after surgery. In addition to finding out is SIL really has POA, does she have a living will? It really doesn’t mean much legally, but it would tell you that your MIL at least desired a natural death while she was still cognitively intact. I’ve been asking my dad’s doctor if we can stop the statin and aspirin. He felt better about doing this once I produced the Living Will, DNR (both made when he had cognitive impairment, but not dementia) and MPOA papers. I carry around my folder of such.
@psychmomma. Yes, I agree, if they are unsafe at 2p they are unsafe at 2a. 4 hours is probably temporary and mom’s doctor wants 24. I asked for 4 hours as a transition to give some companionship during daylight hours, help mom with lunch (they go to the dining hall at dinner), and have someone checking on them daily. What would your mom have said about more medical care while not demented? I asked my parents, pre dementia, if your only option was nursing home care (which seems to be where your mom is at the moment) would you want to be kept alive? They both said “no.” Have you read Being Mortal? Also a documentary. I struggle less with end of life issues than the bringing in caregivers. I think “do not hospitalize” is a reasonable decision.
Ha, the gun (loaded) is a long story, something that my dad, unknown to me, brought with him when they moved to the CCRC. Did you know it’s hard to surrender a firearm to the police here in North Carolina? They won’t take it! At least they disarmed it for me.
@chumom, here’s a link to the film “Being Mortal.” It’s really worth an hour of your time, and if you can convince the other siblings to watch, it may expand their perspectives.
http://www.pbs.org/wgbh/frontline/film/being-mortal/
I am so sorry. My dad died three years ago and a year later, I was able to look back at his final year or two of life and see the progression. It’s so hard to have any perspective when you’re in the middle of it.
[[[[[hugs]]]]], we’re here for you.
I ditto oldmom4896.
((((@chumom)))) and also (((phycohmomma))) These are tough times.
@Chumom, sending hugs. Will you or your husband be at the meeting? Your FIL should have the final say. @rosered55 gave a good synopsis. Personally, I would never subject a family member who is 89, diabetic and suffers from dementia to surgery. The risks of death, infection, post op complications, pain, anesthesia affecting dementia, and very low long term survival changes far outweigh any benefits that I can see. I think it would be very cruel. Of course, surgeons will suggest surgery. Is there any paperwork suggesting an advance directive that was ever filled out by your MIL? Is the review board a tumor board? Will MIL’s PMD be there or have sent in a prepared statement? I would suggest, if you are able to call the PMD with your FIL, ask what their opinion is and see if they will participate in the process. Will there be a social worker or patient advocate at the meeting? Don’t be afraid to voice your concerns.
Our area has a number of hospice agencies. I would check out which one would be ‘best’ for your situation. Comfort/palliative care. If the mom/MIL for @chumom is within 6 months of death, hospice can be arranged. Others had great comments of things to think about. The lady has dementia, and it would be kindest to have her discomfort minimized - the doctors can best determine with her situation. Certainly her H would have the most to decide at this point, and should not be swayed by one who says they have POA - do they REALLY or just want to have more say? Sounds like everyone is thinking, and thinking in the best interest - but also need to have all the facts and process all the facts.
With my breast cancer, the cancer itself was not painful.
Could coming at it from another point of view help? Another way to think of it, when talking to SILs, is would you subject your child to that surgery if they were guaranteed terminal?
The 6 month terminal illness rule for hospice has been relaxed. I was able to put my aunt put onto hospice at age 90 with no diagnoses other than hypertension. The next year, I decided to have a pacemaker put in because she was fainting and passing out and I was afraid she’d hurt herself. Although I was told that would not impact her hospice care, once she got it placed, they kicked her off. I had to move her to assisted living after that because it was cheaper than 24 hour care in an apartment. She lasted one year there and then she developed vascular dementia. She died within 3 months, before I was able to get her back onto hospice. I moved her out of the assisted living and into MIL’s spare room. I paid MIL $2K a month for the use of the room and hired 24 hour care for that period of time. I am not sure if the pacemaker helped or hurt her. I know that in general I don’t favor surgery for the elderly who are ill or have dementia. My aunt was terrified of having cancer - she never did but I had to promise her 4 times a week not to send her for a colonoscopy. I didn’t send her - what would be the point? OTOH, we did have my MIL’s hip replacement revised when she was about 89. She is almost 93 now and has all her wits about her.
My mom had sepsis at the end, and the surgeons advised against surgery. She had been totally bedridden for ten years due to a catastrophic femur break that never healed, CHF, diabetes, lymphadema and an antibiotic-resistant infection that shut down her kidneys in 36 hours. She and my dad had discussed options many times over the years she was incapacitated, so when the docs said surgery would not improve her situation, Dad agreed to morphine to keep her comfortable. She was 73.
SIL may want to give MIL a chance (or alleviate guilt over making a decision not to treat), but sometimes it’s more of a gift to let a loved one pass in as much peace and dignity as possible. The cost-benefit analysis for surgery feels problematic.
Mother was borderline for a pacemaker but had dementia - why have the body last longer than the brain? It turns out she was able to have a peaceful death, dying in her home with a few days of hospice - which is exactly what she wanted. She died with a smile on her face.
I was talking to someone a couple of days ago about my parents and dementia. He said, “at least they’re still alive.” But they aren’t! I don’t understand why loving children would want to keep a parent alive when they really aren’t there! I feel I lost my parents several years ago.
The day my mother went into the nursing home my brother and I had to make some decisions about several things. One of them was what happens if her heart stops. Now, she was 88 at the time with dementia. I immediately said do nothing. My brother had a fit and claimed I just wanted her to die. I calmly said to him that “she is better today than she will be on any day for the rest of her life”. He angrily said do whatever I wanted. About an hour later, my wonderful cousin who is a nurse stopped by. I told her what transpired, and she went to talk to him. She told him that CPR on an 88 year old wasn’t pretty (like on tv shows). A rib would probably break and pierce her lung or something else. He calmed down about it.
After she died 3 years later, he said that he remembered what I said on that first day and realized I was right after watching her decline. He said “I never knew it would be like this”.
My wise MIL told me more than once that there were worse things than death. She was so right.
In “The Conversation: A Revolutionary Plan for End-of-Life Care,” the author, a physician, talked about a video that shows real people receiving end-of-life care (including CPR, I think). He said it was not pretty and it helped some viewers make the decision to not request extraordinary measures to keep them alive.
Chumom, if there is to be a family meeting to discuss surgery, attempt to get another with hospice or palliative so the options are fully presented to all. Palliative as an option can feel better than surgery or what is perceived as nothing, in the absence of a voice to speak for that point of view. My sympathizes on being at this difficult point. Hard family dynamics make the process even more painful.
@Chumom - I wonder what your SIL is thinking an alternative outcome could be? It’s one thing if a person in their 40s has a disease and people disagree on how aggressive to treat it. But when you are talking someone close to 90 - do they think their parent is going to live forever? Are they in denial? No need to answer, these are rhetorical questions and ones I saw with my own in laws.
I believe I have one more trip left to clean out my parent’s old (as in 15 months of residence) apartment. My husband and son and I took yet ANOTHER day off work to do this. I am so steamed about the circumstances but there really isn’t anyone at fault. I am not mad at my folks for having health crises. I realize they had to move. I am just sick to death of looking at stuff and having to decide: keep, donate, toss. I guess I am a little upset that they kept so much stuff and didn’t organize it, but really I’m frustrated with the universe. Still cognizant of the fact that they are here on this earth though…
If you have a number of Hospice agency choices, go to several well run facilities in your area and ask which Hospice they recommend. We have a resident who has been on Hospice from some agency that just isn’t taking care of business - the family chose the Hospice, so we have to sit at the sidelines and wait for them to do things/approve things/get things into place like the liquid narcotic pain medication…
DD has seen first hand as a RN a code gone bad, where the lady would have benefited from DNR (do not resuscitate).
Some people and families handle emotions differently.
Thank you to everyone for your insightful suggestions and mostly just for caring. The meeting was held and unfortunately my MIL’s cancer has progressed to the point where it is not treatable by any means. The dr says she has months to live. Monday Hospice is coming to their house to get thinks rolling. Both my SIL’s want to care for their mom in her final journey. We all just want her final days to be peaceful and pain free. Again thank you all so much