Friday, April 21st, 2017 dad took mom to the Emergency room . This would be the 4th time in almost a year, each of the preceding times due to aspiration pneumonia which is a not uncommon side effect of those suffering for MS with dysphagia. We would find out that this was the cause for this ER visit as well. While in the ER, mom stopped breathing and ultimately was intubated and placed on a ventilator to do the breathing for her. Once she was stabilized, she was moved to the ICU.
Saturday she remained stable and alert when she was not sleeping. A Spirometry test (a test to assess volume of exhales and inhales) was done with weak results. The doctor expressed concern with her ability to breathe on her own once the ventilator would be removed, but planned to do more tests in the future. They "stepped down" the ventilator so that it was still providing support, but would allow another way for the doctor's to assess her condition. She was able to handle that change, so the plan was to do another step down later on. During the course of Saturday night to Sunday morning, the fluid in her lungs increased, so a second Spirometry test was cancelled as the results could be predicted to be poor and she remains on the ventilator.
Sunday afternoon, Dad, Cheryl, and Mark had a meeting with the respitory doctor (Pulmonologist?), A palliative care RN and her day nurse for the preceding 2 days. Concerns were reiterated about her ability to breathe on her own and treatment options were laid out. Essentially, if she can not breath on her own, a tracheostomy (a tube is inserted into the windpipe to enable breathing) is the only option. Given that the procedure itself has associated risks, the additional care that would be needed to take care of a trach and the increased risk for infections, etc..., the family agreed this option would only decrease mom's (and Dad's) quality of life and we denied this as a treatment option.
That leaves us with the only option of hospice. Tuesday afternoon, the plan is to remove mom from the ventilator. If she can breathe on her own, she will remain in the hospital until the pneumonia is resolved. At that point, she will return home and hospice care will begin as it is a certainty that she will continue to be affected with complications of aspiration. If she struggles with breathing after being removed from the ventilator, she will not be put back on the ventilator, but rather, be made comfortable and hospice will begin in the hospital.