Uncle managed to choke on a bit of his dinner and is in some distress. He can breathe and talk a little but it's triggered an all out bout of hatred towards all those around him. He's convinced that if we let him lie flat on his back he'll be ok, and if we try to sit him right up and lean him forward to smack him on the back to clear his windpipe he grabs the handrails on the bed with his whole strength and goes into full scale fight mode and swears at me to go away with every ounce of strengh he has as he thinks I'm trying to kill him.

I've wound the bed down a little just to make him relax and as most of the vehemance is aimed at me I've got my husband and son on standby to invervene as necessary, but how can I handle it? I think I'll give him a heart attack if I insist on pulling him forward or attempting to sit him on the edge of the bed, but if he doesn't improve soon I'm going to have to do something.

From experience, an ambulance would take at least an hour to arrive, and they'd have to sedate him to treat him in any case.

My other half thinks that it will sort iteself out eventually if we just monitor him, but I'm dubious. Any advice gratefully received.

quote:

Uncle has slept virtually all day today, and although he ate a good breakfast, he's hardly touched anything since.

Please call the doctor and have him examined. It sounds like he could be developing aspiration pneumonia.

I hope you will receive some kind of medical help with this - there ARE techniques and tricks to help reduce the liklihood of his aspirating. Trust me when I say that death by aspiration is not an easy one for either the patient (although it's usually real quick) or the caregiver...

Lighting a candle for both of you... {{{HUGS}}}

The part of Portugal we live in is very rural and traditional, and there seems to be a very strong tradition of caring for old folk at home and totally respecting their wishes. I'm not sure what the legalities are as the Portuguese routinely ignore such things, but the elderly are almost revered and it is expected that they will be looked after at home if at all possible. There are homes that elderly can go to, but it seems that anyone who doesn't look after their parents and sends them to a home unnecessarily is looked down on, and on the other hand anyone who looks after them at home is almost revered while they are doing so. I have certainly been treated differently by people in my village for the last couple of months and everyone speaks quietly and respectfully to me and constantly wishes me 'all the best' and urges me to have 'patience, patience'. No-one has tried to force us to do anything, but they do very gently ask me stuff and make suggestions and they seem to totally respect our wishes.

Uncle has slept virtually all day today, and although he ate a good breakfast, he's hardly touched anything since. He's been at sea most of his life, and he's always treated his time ashore as a time to rest while awaiting his next ship. I've a feeling his next ship won't be too long arriving, but I'm going to let him rest till it gets here. I've lit another candle for him, and I'm off to try and get some sleep myself.

Thanks for all your support - it's truly appreciated.

http://www.gratefulness.org/ca...les.cfm?l=eng&gi=ECO

Feel at home to light one for your uncle and yourself. For anyone at all.

Olivia, My heart goes out to you because I know how difficult it is when you have to decide between what you KNOW to be your loved ones wishes about end of life matters and if this is an end of life matter.

I know that my mother does not want to go to the hospital ever again because she is afraid she won't make it home to die. Her decline is obvious to everyone who knows her BUT not to medical persons. Even though we have hospice here, last week she was turned down for acceptance to the program. I was advised drag her to the doctors more often and call 911 for all the normal reasons.

So in order to get end of life comfort care for her, I must make her as uncomfortable as she can endure. She will also refuse to go to the hospital if she is conscious and can speak or signal her denial of consent.

In Portugal, is there a legal document similar to our Advance Directive, where a person can spell out their wishes about end of life matters and name another person to be responsible to follow the wishes? At least I do have that.

(((Hugs))) This is a very difficult time for you. We have a candle thread. I will light one for your family.

Thanks TORP - I feel like I need one right now.

No, it doesn't seem harsh. That's why I suggested about calling the nurse if he's on hospice. (I didn't realize you were in another country.) Over here, typically the hospice nurse would visit but they don't necessarily offer hospitalization for pneumonia if the individual is comfort care only.

That point where you are having to make these types of decisions for them is the hardest, and one we all hope never to reach. I've offered a prayer for your family.

As long as I've known him uncle has been prone to choking, though it's only happened two or three times in the four years he's been with us as I've been careful to feed him soft, sloppy foods as much as possible. We're not even completely certain that it was his dinner that he choked on this time as it was at least half an hour after he'd officially 'finished' that he started to salivate and become distressed and say he was choking.

The angle of the bed is a cause of some concern as he has developed a bit of a thing about it, though he's not consistent. He's determined to eat at an angle far lower than I'd like, and it takes a bit of deviousness on my part to get the bed up as far as I'd like. I usually wind him in two stages so that he gets used to one position and the next one doesn't seem so extreme. If I over-do it, he kicks up the most enormous fuss so it's a bit of a balancing act. Distressed, angry uncles are probably more prone to choking than comfortable ones.

I've discovered that there are a couple of versions of the Heimlich manoever that I can use on him if he chokes, one involving lying him on his back and one on his side, but unless he was in imminent danger of death or losing consciousness I think he would still fight me and accuse me of assaulting him. Attempting to persuade him to sit right up and lean forward was a disaster as he's convinced the cure is to lie flat on your back and the more I tried the more stubborn and angry he got.

Choice of food is tricky. He has porridge every morning, which is brilliant as I can make it as sloppy as he likes and it's nice and nutritious. Soups are considered a punishment food however and cause huge problems if I try to feed him them. If his appetite is bad we sometimes do thick shakes or maybe home-made icecream based on milk and fruit. Meat is almost always cooked in a slow cooker (crockpot) for him as he loves meat but needs it to be really soft. Stews and soft curries are about his favourite, with really well cooked squishy vegetables, though he'll always try to eat the meat and leave the veg if possible.

He's definately deteriorated since the choking session though. He's much weaker, and paler, and he's lost most of his sense of what time of day it is. He's sleeping more than normal and when he talks he's making far less sense than normal. His appetite is poor, though if I get him agree to try he might eat everything I give him, or he might not. I really feel that he's fading now.

I know I might seem harsh to some people for not calling the ambulance, but I honestly feel that the stress would have killed him. I want him to end his days here, where he feels safe and loved, not somewhere he's always hated and has made quite clear that he never wants to go.

Olivia what exactly are you feeding him?
If this is a problem that is reoccurring and this is a "normal" diet your feeding him ie meat veggies (what you ar I would eat everyday) then you might consider feeding him a mechanically soft diet, things that are blended or mashed, thick soups etc.
There comes a point with some folks when they cant swallow properly anymore.
Also sit him upright not at a 30-45 degree angle if hes eating in bed it helps with swallowing it also allows the lungs to expand.

I'm afraid bobcat is right - no point calling an ambulance if he's still able to refuse treatment. I retreated after he started shouting at me to give him a chance to calm down and gradually my other half managed to persuade him to sit up and try to cough up whatever was blocking his throat and it seemed to sort out. He calmed down fine and after an hour or so he appeared to forget all the swearing and accepted me back again with no problem. But several hours later the stress seemed to have taken it's toll and he just seemed to shut down. He went cold and trembly and we had to warm him up and reassure him loads and for the first time since he's been here he actually turned the television off and instead of ranting at everything he started to say his prayers, which is something I don't think anyone who knows him has ever heard of before. He's still adamant that he doesn't want to see a doctor, and at this point I'm not going to argue with him. I've been up all night sitting in the next room and he does seem to have recovered to some extent. He's sleeping peacefully at the moment and the trembling and praying has stopped. I've no idea what tomorrow will bring though.

There is no at-home hospice in Portugal, and he has made me promise not to send him to hospital here, and it's a promise I intend to keep if at all possible. I just hope I have the strength to see it through.

Ditto what TORP said, Olivia! Please keep us posted... Good luck.

Olivia, I don't have a clue how such things are handled in Portugal, but TORP is correct that this could lead to pneumonia. Here, a person who can speak for themselves can refuse treatment and it sounds like he would do that. That is a long way for an ambulance to come if that's what he can and will do.

Smacking them on the back would probably NOT help and may hurt. It may just be an irritation caused by the food, but if it went in his lung, it can be very serious.

I hope that you have called the ambulance. This will NOT sort itself out, and can lead to aspiration pneumonia. Very dangerous situation!

He is on hospice? If so, call the nurse. If not, call the ambulance.