How honest are nurses at the end?

[Henrietta]

When someone is appearing to be near end of life, with multiple complex health issues and on IV drip for infection how honest are nurses regarding prognosis?
Will they always offer a cheery optimistic reply or would they tell you if they thought the prognosis was not good?

[bowlingbun]

It depends on the nurse I'm afraid, and also whether they feel it is their place to tell you. The Matron at mum's nursing home was lovely to me, she knew I wanted an honest answer. The GP wasn't so good.
I've mentioned a few times before that when mum was clearly nearing the end, I googled "Signs of Dying". As well as the explanations about how the body knows how much food and drink it can cope with, it also mentioned that about 2 weeks before death, patients often appear to be picking at imaginary crumbs from the bed clothes. I thought this was really odd...until I saw mum doing exactly this. I went home to the family, just a few days before Christmas, and said "It won't be long now". Mum just lasted into January.

[Elaine]

I don't think she can be honest. It's not a nurses place or her job to tell you anything the doctor hasn't said she may. Mainly because she doesn't really know. She could make a guess based on previous experience or even medical notes or conversations but she can't possibly know for sure and she cannot advise relatives on that basis. It must be hard to be in that position and reverting to optimistic platitudes is probably the only response available to her. You have to read between the lines and get as much as you can out of the doctor.
KR
E.

[Greta]

Our GP was quite honest about it a couple of months before. I wouldn't expect a nurse to say that, as Elaine says. I already wrote about my brother eating less. I had read here about signs of dying in the last couple of weeks, but looking back I think the eating less for months earlier was a sign too that the body could not take in enough sustenance. I hope you are managing OK, Henrietta.

[Henrietta]

Thank you all.
I have googled as you suggested BB and a lot of the earlier signs are present sadly and as you say Greta the dwindling appetite for the past few weeks.
Dad is on an IV drip fighting infection but part of me is thinking- what if he partly recovers? he has had no quality of life for weeks so when do Drs decide to intervene and why try to prolongue this if it is end stage- but perhaps it is not. I suppose I've answered my own question with those last few words.

[bowlingbun]

Sadly, time to ask to see the doctor and ask whether it is appropriate to continue active treatment? Ask whether palliative care, keeping dad comfortable and pain free, and letting nature take it's course, is in the patient's best interests?
My mum told me that sometimes she woke up, and thought "Oh no, not another day like this", which was helpful to me when I spoke to mum's doctor.
You know your dad better than anyone else. What would he want? What does your conscience say to you?
It's a dreadful time, either way. My thoughts are with you today.

[jenny lucas]

I think they 'cannot' prognose accurately - because they simply don't know. In Cancerworld there's a saying 'No doctor or medic has your time-of-death certificate in their pocket'.....and I would suspect that is true in a way of all of us. Some people 'hold off death' for much longer than 'generally expected, others succumb faster. It may be a combination of physical state AND 'character' (for want of a better world). When my husband was in late end stage I also asked that question, and was told 'it could be a few days, it could be a few weeks'.....

However, I agree that you do need to tell them 'I want an honest answer' as otherwise they may, indeed, 'soft-soap' you, in an effort to be kind. But I don't think, myself, it's kind, because it can backfire if the person dies faster than we are led to expect. When my father had an operation in his 80s no one 'warned me' he might not come through it, so when he didn't, I was truly shocked and appalled - I had absolutely no expectation that he might die in theatre, but he did! In my case, I think it was a case of 'crossed expectations' - the medics knew perfectly well that a sick man in his 80s might very well not survive surgery, but I, being naïve, had no such expectation. Medics can 'assume' you know things that you don't.


Whatever the situation is now for your poor father, I do hope that the end, if it is now the end, when it does come, comes gently and easily.......for both him, and yourself.

Kindest wishes at such a painful time, Jenny