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My dad died three weeks ago from Alzheimer's complications, though I still don't know which complication and it does not matter I guess. Late at night the NH nurse called to say he had begun to go downhill around seven, and I thought her next words were going to be "so maybe you should come here" Instead she said, he passed away twenty minutes ago. I wondered why she didn't call me earlier in the evening when she determined he was going downhill. I am mad about that. But I would have wanted to be there to see him during his last hours. Maybe I wouldn't, I don't know. But would be nice knowing how he died. It wasn't due to lack of food, as he had been eating some. He did throw up food at lunch earlier in the day though. So don't know if that meant aspiration. I feel I have this need to know what actually killed him. We have not seen death certificates yet. What were his last hours and moments like? Was he suffering or unaware?

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Karsten, I am so sorry to hear about your dad. I had a similar situation when my dad passed. He didn't have Alzheimers but was in the skilled nursing area in his facility, with lung cancer. The nurse called me one evening and said my dad was just put on oxygen for the first time. I said, "Should I come?" She said, "No, he's not actively dying, I just wanted to let you know." I lived 10 minutes away. My mom had seen him that afternoon and he was ok. Over the past month, he had gotten quieter and had been eating less and withdrawing more, so I thought we were probably coming to the end. I planned to see him the next day. The nurse called me 90 minutes later and told me I should come. When I got there, he had passed away and was alone in his room. I went in by myself and sat with him for a while. I knew when they called he had passed, even though they didn't tell me that.

My initial reaction was to be annoyed with the staff that they didn't call me when dad starting having issues. I felt terribly guilty that I wasn't with him when he died. But I also knew he had passed very quickly from when he started experiencing problems breathing and I had no way of knowing his time had come. Over time, I came accept that I was there when it counted in the previous 9+ years and my dad passed when it was his time. I hope you can accept that over time as well. You'll never know exactly what killed your dad - it was probably a variety of things. But he went quickly and you did the best you could, that's what counts. {{{Hugs}}}
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Karsten, if he was suffering do you think the staff would tell you?

As to being unaware, there are only certain levels of observation that staff can make when someone is dying, but I would also ask the same question. Do you think your father would want to be aware he was dying, and do you think the staff would tell you that they suspected he knew he was?

Nurses have told me that people often wait until their loved ones are gone so that family aren't there for the exact moment of death. I think, actually, I'm positive, that my father did that. I got the call at exactly the time it took me to arrive home.

Based on the many posts you've written about your father's death, it was clear that he was inching slowly toward the end. At that point, multiple organs can become involved in the eventual end of life. A medical person could elaborate, but from my understanding, it's literally a given at that point.

Would it really make a difference to you? Could you, or would you, have done anything differently?

I understand that you're still troubled by this, and probably still in a lot of turmoil. But would answers to these questions really make a difference? You did the best you could, and from what I remember of your earlier posts, was quite a lot - you really supported him, tried to work with the staff to get the best care … which is what most of us do, under the circumstances. Please don't plague yourself with issues that you couldn't have controlled.

Your posts and tribute to your father testify to your good character, and your loving relationship with him. Be proud of that. Many people don't have those kinds of bonds.

You wrote: " I wondered why she didn't call me earlier in the evening when she determined he was going downhill. I am mad about that." I suspect that he wasn't being monitored every single minute, and the nurse may have felt that to tell you he was close to dying might have put you in a situation of driving rapidly to be there, possibly injuring yourself in an accident b/c of preoccupation with arriving before he passed.

Nurses who have worked with dying patients are very insightful, and can often "read" us better than we can ourselves. Honestly, I think they were probably trying to treat you as kindly and gently as they could.

As to the Death Certificate, I wouldn't put much stock in the cause of death. My father's first factor was probably right, but the second was clearly wrong. Is there any merit for me to pursue this? No, he's gone, and is relieved from suffering, which is the important fact.

My mother's death certificate was similarly somewhat inaccurate. But, as with Dad, and with my sister, they were gone, and were suffering no longer. That was the important point.

Unless an autopsy is done, I think doctors do the best they can to approximate the cause of death (nurses here, please correct me if I'm wrong). If your father died suddenly, that would be a different situation.

Give yourself a break, be good to yourself and don't torture yourself any more.
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It's a perfectly reasonable question.

It may at the same time be a question without as specific an answer as you would like.

Wouldn't it be best to wait for the certification, ask for your father's records, and if it still isn't clear what happened then take these to the facility's doctor and ask him or her to go through them with you.

All you're asking for is clarity and closure, as far as one can ever achieve these. There is nothing unhealthy about that.
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Karsten, so sorry you are going through this. It is possible that maybe your Dad had Aspiration Pneumonia. My Dad passed having that. What happens is that any food and water doesn't go to the stomach but instead finds its way to the lungs.

My Dad [in his 90's] also went downhill quickly and he passed rather suddenly. I knew he was heart broken from my Mom [also in her 90's] passing a year prior and that he wanted to be with her. Thus, they were together again. Dad had a peaceful passing, so did my Mom as both were on Hospice that gave them comfort care.

Please note some elders prefer not to have family members around them when they pass on. I know my Dad waited until I had left the building and passed a couple hours later in the wee hours of the morning. Those that pass that way do so so not to panic their love ones.

It will be interesting to see what is listed on the death certificate.
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I’m in much the same boat as you on this. My mom was in a NH due to a stroke, or maybe strokes. After a time, years actually, she became withdrawn and suddenly non responsive to us. Then she couldn’t tolerate food any longer and we were told the end was coming. She died a little over 2 weeks later. She was alone when she died, as it was such a long process no one could predict when the end would come. It’s been a long time now and I’m mostly at peace with it, but I’ve told family that I regretted that we don’t really know if there were more strokes, or what else may have happened, or really how she died or what caused it. I well know none of that would change a thing, she was very ready to go, it’s just the same thing you said, knowing how she died. I’ve thought of it less and less over time, and I hope we both can one day move past it, but I do get it
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GardenArtist is right and so is everyone else. Would it really help your grief to know exactly why your father passed? Seriously? Or is that just one more thing to torment yourself with? You need to bring peace to your mind by realizing you were a good son to him. Knowing why, when or how he died will not bring you this peace. His facility did exactly what my mom’s and both my in-laws did. We were called and told we needed to come to the facility but nothing more. By the time we arrived, they were gone. These staff members deal with this on a daily basis. They are angels and should be treated and respected as such. They just know how to handle things. Trust them.

Realize you are in your own grieving process and recognize it will take time. Some of this pain will never go away. If you find yourself unable to deal, seek help from your church or your doctor.
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Wow, how lucky you are to have had a warm, loving relationship with your dad. To be loved, guided and taught by him. You got to look up at him with such pride and admiration, knowing he always had your back, would never steer you wrong and would gladly lay down his life for you.

You are a part of him and him you, hell, half of your genes are from him! You will NEVER really be apart.

Look back with joy and gratitude....You were and will always remain blessed....because of who YOUR DAD was. 💞

I would have loved to have had that.
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Pepsee, you offer a different but heartwarming perspective.
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Most likely the death certificate is going to say "Respiratory failure due to dementia" or something similar. I don't think they do an autopsy on an elderly person who has a myriad of health issues unless it is a suspicious death.
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Thank you GardenArtist 😊
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There are times when knowing what was the cause of death to see if there is a pattern in a family tree. On my Dad's side of the family, majority of the blood relatives, going back four generations, it was heart related. Thus, I have a Cardiologist.


My own Mom's death certificate didn't really mention the root cause of her passing.  The certificate said Dementia, but Mom only had that for 3 months.  The root cause was complications from a head trauma from a fall which spiraled her to go into memory loss.
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