Expert: Mary Gordon - 2/24/2010

Question
My father is 70 he was diagnosed with Karzakoffs disease,3 years ago.he almost died then. 6 weeks ago he kept sleeping all the time and was admitted to hospital with pneumonia. He returned to his care home after 2 weeks.In this time he has went through times of sleeping for 2 days at a time with no response, almost coma like. He then wakens and eats some pureed food and drinks  some thickened liquids. He appears to be talking to people who are not there in his waking times. 3 days ago his breathing was laboured and his feet and hands were very cold, he appeared as if he was stopping breathing for a few seconds and then starting again. We really thought this was coming to the end, but he woke and had some juice and soup.He has again been sleeping and having bright moments. I can't understand what is going on, he has also lost a lot of weight, he is frightenly thin and sweats a lot even though he has no temperature. Can you please help me understand what is happening.

Answer
Hi Beverly I would say he came extremely  very close to death - and while he may have apparently rallied a bit, I would think the odds of him surviving this are not great. I could be wrong - the frail elderly can sometimes be surprising - equal parts tough as steel and fragile as glass.
He really has no reserves left to fight with at this point, so it won't take much to tip the balance.

Here are the typical signs of the end being close - and I know you will realize that you have seen almost all of them with your dad in recent weeks.

http://dying.about.com/od/thedyingprocess/a/process.htm

I hope you have some good supports - have you had a frank discussion with his doctor and caregivers? Do they have hospice services ? Have they ventured any thoughts about prognosis? Have you discussed next steps - i.e. if he had another crisis, would you want him rescusitated, taken to hospital, given tubes and treatments, or are you prepared to let nature take its course and just keep him comfortable.

I know the watching and waiting - and not knowing - is very emotionally wearing. If I were you, I would take this time to sit by his bed and talk to him. Let him know you are there and tell him whatever you have in your heart to say to him. I don't think you will regret it, even if you don't think he can understand. He will know you are there.

Hope this helps. Hang in there. I very strongly suspect peace is coming for him soon.

Mary