Is it a bad idea for my terminally ill grandmother to go to the USA for 48hrs?
August 22, 2011 8:47 PM Subscribe
My dad and I are thinking of taking my 85yr old grandmother on a road trip. She was diagnosed with small cell lung cancer last Thursday and decided on Friday that she doesn't want to go through treatment. She does, however, want to see her sister, sister's kids and grandkids one last time. However, they live 1,300KM away in a mid-sized Mid-West city in the States while we're in Toronto. We'd like to make this visit happen for grandma, recognize all the risks inherent in trying to do so, and would like to hear the stories/experiences of anyone who has done anything similar. Relevant details below the fold. Thank you.
Trip parameters: We'd like to do it earlier vs. later while she's still doing okay. She came home from the hospital today. My dad wants to 'observe' her for a couple days to see how she is before deciding on whether to go ahead with the trip. The challenges are that there are no direct non-stop flights between us and them, neither from Toronto nor from Buffalo. This means either approx 6hrs of fly time with stop-overs or else 12hrs of drive time. If we fly (which is the lead option) will airlines ask her for medical clearance? Will US immigration or border services? She doesn't look sick...well not right now...she looks 85. Her doctor said that there isn't any issue with her flying but advised against it because of her lack of insurance in the States in case things do turn.
Healthwise: Like I said above, Grandma is in pretty good shape right now, not a lot of pain but we don't really know how far the cancer has spread and from what the doctor told us, this is an aggressive kind of cancer and deterioration can come quickly. Doctor said that by averages, we're talking weeks until she's gone. Also, while grandma is pretty sharp mentally and clear-headed when she's at home she exhibits signs of senility when she's in unfamiliar surroundings (at the hospital she became alternately aggressive - words only - and confused at times...both to staff and to my dad and me.) I'm afraid that she gets like this at the gate, at customs, on the plane.
Insurance: Obviously she has no medical coverage in the States, which scares the crap out of us. If we do this trip, we would be out of Canada for less than 48hrs - give her one full day with family with a travel day on either side, but still is this too long to be out of the country (even if she has all her meds with her?)
I know there were other aspects to this question I wanted to ask about, other details I wanted to give but right now I'm tired and my brain is fried. Please ask for clarification and I'll try to provide more background in the morning too. Oh yeah, the reason it's us doing the travelling is that there's only the three of us in Canada, there's about a dozen relatives all in the states.
Is this really a bad bad bad bad idea? Or workable? Have you done anything similar?
Thank you.
Trip parameters: We'd like to do it earlier vs. later while she's still doing okay. She came home from the hospital today. My dad wants to 'observe' her for a couple days to see how she is before deciding on whether to go ahead with the trip. The challenges are that there are no direct non-stop flights between us and them, neither from Toronto nor from Buffalo. This means either approx 6hrs of fly time with stop-overs or else 12hrs of drive time. If we fly (which is the lead option) will airlines ask her for medical clearance? Will US immigration or border services? She doesn't look sick...well not right now...she looks 85. Her doctor said that there isn't any issue with her flying but advised against it because of her lack of insurance in the States in case things do turn.
Healthwise: Like I said above, Grandma is in pretty good shape right now, not a lot of pain but we don't really know how far the cancer has spread and from what the doctor told us, this is an aggressive kind of cancer and deterioration can come quickly. Doctor said that by averages, we're talking weeks until she's gone. Also, while grandma is pretty sharp mentally and clear-headed when she's at home she exhibits signs of senility when she's in unfamiliar surroundings (at the hospital she became alternately aggressive - words only - and confused at times...both to staff and to my dad and me.) I'm afraid that she gets like this at the gate, at customs, on the plane.
Insurance: Obviously she has no medical coverage in the States, which scares the crap out of us. If we do this trip, we would be out of Canada for less than 48hrs - give her one full day with family with a travel day on either side, but still is this too long to be out of the country (even if she has all her meds with her?)
I know there were other aspects to this question I wanted to ask about, other details I wanted to give but right now I'm tired and my brain is fried. Please ask for clarification and I'll try to provide more background in the morning too. Oh yeah, the reason it's us doing the travelling is that there's only the three of us in Canada, there's about a dozen relatives all in the states.
Is this really a bad bad bad bad idea? Or workable? Have you done anything similar?
Thank you.
I haven't done anything similar, but I say do it! Yes, there are things to consider, but just the freedom in going on a road trip is so good for the soul. If it for any reason had a negative impact on her health, I bet she'd still feel like a spring chicken on the inside for being so adventurous.
posted by healthyliving at 9:11 PM on August 22, 2011
posted by healthyliving at 9:11 PM on August 22, 2011
Is/was she the adventurous kind? If so, then I can't think of a better farewell. If not, it is a judgment call. Some people would hate this at age 55 in perfect health. Can she sit comfortably in the car you have? Knees? Does she enjoy diners and other roadside stuff?
NOW is the right time, as soon as you can get the tickets, because you just don't know.
Is her sister a pretty cool head if your grandmother starts to decline noticeably while there? What if, God forbid, that was it, at her sister's house? Is her sister older and/or sicker?
If you move the front seat all the way back, it might be pretty comfortable.
My grandfather came to my college graduation even though public transportation was involved (non-Northeasterners can understand the sacrifice and drama). Although he turned out to live about another year, at the time we all (I think including him) thought that it was more like the situation you describe. While not particularly adventurous (or particularly close to me), he was known far and wide as a party animal. We all I think had imagined a nice lunch out, but there was torrential rain that made it impossible even for a healthy person to walk. We (Grandma, Grandpa, both in their 80s, and two aunts) went to the very watering hole a block away where I had gotten loaded numerous times. We got two pizzas and two pitchers of beer. He could not see hardly at all, and I will never forget--remember, this is not even a person I was close to--him holding the money all the way down by his stomach so he could see to count it and pay. I was worried about him the whole time--it was scary to see how he was--but to all reports he talked about this excursion literally for all the time he had left.
So, yes, do it, unless (no disrespect to her) she's the type who would have hated it even when younger.
posted by skbw at 9:21 PM on August 22, 2011 [2 favorites]
NOW is the right time, as soon as you can get the tickets, because you just don't know.
Is her sister a pretty cool head if your grandmother starts to decline noticeably while there? What if, God forbid, that was it, at her sister's house? Is her sister older and/or sicker?
If you move the front seat all the way back, it might be pretty comfortable.
My grandfather came to my college graduation even though public transportation was involved (non-Northeasterners can understand the sacrifice and drama). Although he turned out to live about another year, at the time we all (I think including him) thought that it was more like the situation you describe. While not particularly adventurous (or particularly close to me), he was known far and wide as a party animal. We all I think had imagined a nice lunch out, but there was torrential rain that made it impossible even for a healthy person to walk. We (Grandma, Grandpa, both in their 80s, and two aunts) went to the very watering hole a block away where I had gotten loaded numerous times. We got two pizzas and two pitchers of beer. He could not see hardly at all, and I will never forget--remember, this is not even a person I was close to--him holding the money all the way down by his stomach so he could see to count it and pay. I was worried about him the whole time--it was scary to see how he was--but to all reports he talked about this excursion literally for all the time he had left.
So, yes, do it, unless (no disrespect to her) she's the type who would have hated it even when younger.
posted by skbw at 9:21 PM on August 22, 2011 [2 favorites]
I agree it would be better if family can come up and visit you in Canada, and you could help offset the costs if needed.
Otherwise ... could you rent a Motor Home, even a small one, for a few days to make the trip? This would make it more comfortable for Grandma, esp. in the even of a decline, and also would make crossing the border easier than say, on airlines. There is a chance she would never be required to leave the vehicle ... but these things cannot be predicted.
My experience has been that U.S. customs does not ask about medical insurance, but I have not traveled with a very elderly person.
Memail me for more suggestions i.e. crossing border, if this is route you choose to take.
posted by batikrose at 9:21 PM on August 22, 2011
Otherwise ... could you rent a Motor Home, even a small one, for a few days to make the trip? This would make it more comfortable for Grandma, esp. in the even of a decline, and also would make crossing the border easier than say, on airlines. There is a chance she would never be required to leave the vehicle ... but these things cannot be predicted.
My experience has been that U.S. customs does not ask about medical insurance, but I have not traveled with a very elderly person.
Memail me for more suggestions i.e. crossing border, if this is route you choose to take.
posted by batikrose at 9:21 PM on August 22, 2011
I'm from the States, so I'm not sure if this is accurate, but isn't it possible to buy travel health insurance when leaving Canada?
posted by XerxesQados at 9:21 PM on August 22, 2011 [1 favorite]
posted by XerxesQados at 9:21 PM on August 22, 2011 [1 favorite]
If you can somehow finagle the travel health insurance, stay longer than 48 hrs. THAT part is a disaster even for a healthy person.
posted by skbw at 9:24 PM on August 22, 2011 [1 favorite]
posted by skbw at 9:24 PM on August 22, 2011 [1 favorite]
This honestly isn't intended as a derail (and, for the sake of the OP, please don't make it one), but does the US honestly not cover medical costs if a foreigner has a medical problem while traveling here? I sprained my ankle pretty badly traveling in the UK about 15 years ago and I was patched up and given a crutch for absolutely nothing, period. We don't do something like that?
A sprained ankle is obviously different from cancer treatment, but I'm kind of hoping someone will chime in and say that you don't have to be so worried about this.
(hope this is an OK response to leave on AskMiFi)
posted by pkingdesign at 9:44 PM on August 22, 2011
A sprained ankle is obviously different from cancer treatment, but I'm kind of hoping someone will chime in and say that you don't have to be so worried about this.
(hope this is an OK response to leave on AskMiFi)
posted by pkingdesign at 9:44 PM on August 22, 2011
pkingdesign ... Mr. B, a Canadian, suffered a massive cardiac event in the U.S. and while the travel insurance through the company he worked at covered most of it, we were on the hook ourselves for the remainder, several thousand dollars. Getting ill or injured in the U.S. will cost you, whether resident or visitor.
XerxesQados ... a person with serious pre-existing conditions would have a difficult time getting travel insurance, and "if" they could get it, it would be an exorbitant cost ... Mr. B is not able to procure travel insurance for the reasons above.
posted by batikrose at 9:55 PM on August 22, 2011
XerxesQados ... a person with serious pre-existing conditions would have a difficult time getting travel insurance, and "if" they could get it, it would be an exorbitant cost ... Mr. B is not able to procure travel insurance for the reasons above.
posted by batikrose at 9:55 PM on August 22, 2011
I was originally going to come in to say you should just do it, and I still more or less think that you should do it. If you fly, have a wheelchair from literally your car to the check-in desk to the gate and down the gangway onto the plane. NO walking. NONE.
The ONLY reason I would hesitate is this:
Also, while grandma is pretty sharp mentally and clear-headed when she's at home she exhibits signs of senility when she's in unfamiliar surroundings (at the hospital she became alternately aggressive - words only - and confused at times...both to staff and to my dad and me.) I'm afraid that she gets like this at the gate, at customs, on the plane.
It might be that your grandmother will not have enough time to recover from the stress of travel and orient herself to her family's home for the trip to be enjoyable for her, especially if the extended family's homes aren't ones she has visited many times or recently. I might consider making the trip LONGER, which would give her time to visit with more people one on one instead of having to do everyone in one day. I know if I were about to see my sister for the last time, no matter which one of us was ill, I would want AT LEAST a long afternoon with just the two of us, and maybe one or two other family members.
The other thing is- has she thought about where she would like to spend her time before passing? If it is very important to her that she remain in her home- not just "not in the hospital" but in HER OWN home- for the remainder of her life, then you should take that into consideration. I think it's also worth considering if, as skbw says, her sister will be emotionally able to have her beloved sister complete her journey in her home during this trip.
I would ask the doctor what things are likely to be necessary to keep your grandmother comfortable during the coming weeks (will she need oxygen? What about an IV to more effectively aid her pain?) and see if there are any ways to plan for that in case you need to implement it in the US.
I would not worry about her having a long hospital stay in the US. Think of it this way: she has already declined aggressive treatment. Your goal now is for her to be comfortable, out of pain, and with her family and friends, enjoying herself and gathering wonderful memories of you and her family. If, for whatever reason, she does have to go to the hospital, I would say something like this to every medical professional you encounter, "Our goal is take Grandmother home today. What can we do to make that happen?"
As far as the insurance goes, yes, see if she qualifies for travel health insurance, but honestly, if I were in your position with my grandmother (who is 90 and in poor though not currently declining health), I would get her whatever health care she needed and figure out the bill later. What are they going to do- garnish her wages? I am not a lawyer or health care expert, but it is my understanding that her estate will be responsible for her bills, not her family. It might mean that there is less or nothing to inherit, but...who cares? (I hope I don't sound callous when I say that, obviously there might be a financial consideration that someone really needed money from the estate or whatever in which case...grandma should give it them now. then travel. um. that is not legal advice, but. it's a thought.)
I hope you do not feel overwhelmed by this discussion, or by the prospect of thinking about settling your grandmother's affairs. This is a tough time, and I commend you and your dad for wanting to make your grandmother's life wonderful, comforting, and happy. You are doing a big thing, a thing that shows you what kind of person you are, and you are doing everything right, you are coming out on the side of the angels. Please take care of yourself during this tough time, too, and just try to make the best decisions you can and remind everyone often that you are doing everything for love, which is the best reason we can do anything, and hopefully things will fall into place.
posted by Snarl Furillo at 9:55 PM on August 22, 2011 [1 favorite]
The ONLY reason I would hesitate is this:
Also, while grandma is pretty sharp mentally and clear-headed when she's at home she exhibits signs of senility when she's in unfamiliar surroundings (at the hospital she became alternately aggressive - words only - and confused at times...both to staff and to my dad and me.) I'm afraid that she gets like this at the gate, at customs, on the plane.
It might be that your grandmother will not have enough time to recover from the stress of travel and orient herself to her family's home for the trip to be enjoyable for her, especially if the extended family's homes aren't ones she has visited many times or recently. I might consider making the trip LONGER, which would give her time to visit with more people one on one instead of having to do everyone in one day. I know if I were about to see my sister for the last time, no matter which one of us was ill, I would want AT LEAST a long afternoon with just the two of us, and maybe one or two other family members.
The other thing is- has she thought about where she would like to spend her time before passing? If it is very important to her that she remain in her home- not just "not in the hospital" but in HER OWN home- for the remainder of her life, then you should take that into consideration. I think it's also worth considering if, as skbw says, her sister will be emotionally able to have her beloved sister complete her journey in her home during this trip.
I would ask the doctor what things are likely to be necessary to keep your grandmother comfortable during the coming weeks (will she need oxygen? What about an IV to more effectively aid her pain?) and see if there are any ways to plan for that in case you need to implement it in the US.
I would not worry about her having a long hospital stay in the US. Think of it this way: she has already declined aggressive treatment. Your goal now is for her to be comfortable, out of pain, and with her family and friends, enjoying herself and gathering wonderful memories of you and her family. If, for whatever reason, she does have to go to the hospital, I would say something like this to every medical professional you encounter, "Our goal is take Grandmother home today. What can we do to make that happen?"
As far as the insurance goes, yes, see if she qualifies for travel health insurance, but honestly, if I were in your position with my grandmother (who is 90 and in poor though not currently declining health), I would get her whatever health care she needed and figure out the bill later. What are they going to do- garnish her wages? I am not a lawyer or health care expert, but it is my understanding that her estate will be responsible for her bills, not her family. It might mean that there is less or nothing to inherit, but...who cares? (I hope I don't sound callous when I say that, obviously there might be a financial consideration that someone really needed money from the estate or whatever in which case...grandma should give it them now. then travel. um. that is not legal advice, but. it's a thought.)
I hope you do not feel overwhelmed by this discussion, or by the prospect of thinking about settling your grandmother's affairs. This is a tough time, and I commend you and your dad for wanting to make your grandmother's life wonderful, comforting, and happy. You are doing a big thing, a thing that shows you what kind of person you are, and you are doing everything right, you are coming out on the side of the angels. Please take care of yourself during this tough time, too, and just try to make the best decisions you can and remind everyone often that you are doing everything for love, which is the best reason we can do anything, and hopefully things will fall into place.
posted by Snarl Furillo at 9:55 PM on August 22, 2011 [1 favorite]
I can't really speak to logistics, but if she wants to do it, make it happen. Chances are she'll enjoy the trip so much she won't go downhill until she gets home (if even then). It's amazing what the happy brain chemicals can do to keep a person going. As long as you trust her to let you know if she doesn't feel right, and she trusts you to take care of her if she gets confused, do what you can to make the trip happen.
Look into travel insurance for sure....at least see what it would cost to have her transported home (or if the insurance would cover that) in an ambulance if needed. Get a note from her doc that says she can travel via airplane (and he might be able to mention she gets confused, but you can take care of her and make decisions if needed) without mentioning the cancer if at all possible. I doubt you would need the letter unless something happens and you have to prove her doc is aware though. Plenty of elderly fly all the time and it goes smoothly. If she does kick up a fuss at the gate or whatever, you have the letter from the doc to show you aren't harassing her. A power of attorney document (or the equivalent in Canada) would be helpful to have if you have to make medical decisions.
Talk to her about what she really wants. If a road trip makes her feel like a kid again, try that. It night be fine. The plane might be good too, especially if you can figure out how to pack light and get toiletries when you arrive. You might want to consider longer than 48 hours though...that's a pretty quick turnaround time for anyone.
Another option might be to meet halfway in a great cabin getaway somewhere. Or a fabulous hotel. YMMV based on location.
Whatever happens, I wish you the best and hope you have a great time with as many wonderful memories as you can handle. I lost my grandfather almost 4 years ago and I still think of all the great things he taught me. I'm sorry to hear of your grandmothers health, and I pray for a wonderful trip and an easy, peaceful passing for her and for her loved ones whenever the time comes.
posted by MultiFaceted at 10:05 PM on August 22, 2011
Look into travel insurance for sure....at least see what it would cost to have her transported home (or if the insurance would cover that) in an ambulance if needed. Get a note from her doc that says she can travel via airplane (and he might be able to mention she gets confused, but you can take care of her and make decisions if needed) without mentioning the cancer if at all possible. I doubt you would need the letter unless something happens and you have to prove her doc is aware though. Plenty of elderly fly all the time and it goes smoothly. If she does kick up a fuss at the gate or whatever, you have the letter from the doc to show you aren't harassing her. A power of attorney document (or the equivalent in Canada) would be helpful to have if you have to make medical decisions.
Talk to her about what she really wants. If a road trip makes her feel like a kid again, try that. It night be fine. The plane might be good too, especially if you can figure out how to pack light and get toiletries when you arrive. You might want to consider longer than 48 hours though...that's a pretty quick turnaround time for anyone.
Another option might be to meet halfway in a great cabin getaway somewhere. Or a fabulous hotel. YMMV based on location.
Whatever happens, I wish you the best and hope you have a great time with as many wonderful memories as you can handle. I lost my grandfather almost 4 years ago and I still think of all the great things he taught me. I'm sorry to hear of your grandmothers health, and I pray for a wonderful trip and an easy, peaceful passing for her and for her loved ones whenever the time comes.
posted by MultiFaceted at 10:05 PM on August 22, 2011
Best answer: As a doctor I have had a lot of experiences with elderly patients at the end of life. I would offer the following thoughts on your situation:
- I would second the idea of the family coming to her, rather than her going to the family. From what you've said here, she just wants to see them, she doesn't care about making the trip or having the adventure. This would solve all the problems you cited with her traveling. It would be so much easier for her. Even though there are a dozen of them, I think that it will be worth it for her comfort and ease for them to come and visit her for a last time.
- If you travel away from home, your grandmother will likely continue to have problems with sundowning/dementia, or may even have delirium related to issues with her terminal illness. You have to be the judge of this, but do you really think she will be able to enjoy/understand the trip if this is going on? If she cannot enjoy it/understand it, or worse, if it causes her suffering (even in the name of doing something she wants to do) is it really worth doing?
- If you decide you are going to bring her into the USA, ensure that you have several legal documents. A document designating a healthcare proxy is the most important, and that basically means a document that designates who is her healthcare decisionmaker if she does not have the capacity to make decisions on her own. This should be a person who knows best what she would want in a given medical situation. The second thing is to obtain a DNR/DNI ("Do Not Resuscitate/Do Not Intubate") order. This would specify to any EMS or medical personnel that if your grandmother, god forbid, was to become so ill that she had a cardiac arrest or stopped breathing, that she would not want chest compressions, electric shocks, or a breathing tube and being put on a ventilator. Keep copies of these documents with her at all times and if you must, be aggressive about ensuring that these things are not done to her against her will. Then, if any other medical issue should arise, you should make sure that you make it abundantly clear to the medical staff that she is terminally ill with cancer and her life expectancy is in weeks, and you want to maximize her comfort and quality of life. This has been stated but just to reiterate - this should help you avoid ludicrously expensive medical bills, although as you may be aware, even 'small things' like an ambulance ride or an emergency department visit can easily cost you $1000 or more in the USA.
- If you decide to take her on a road trip, be sure to have her wear compression stockings and have her get out to walk every hour or two. As an elderly person with active cancer on a long car trip, she is a setup for a blood clot in her leg, which could turn into a fatal pulmonary embolism in the worst case scenario.
best of luck and hope your grandmother gets her wish.
@pkingdesign: afraid not... providing free medical care is socialism! (wink wink)
posted by treehorn+bunny at 10:47 PM on August 22, 2011 [4 favorites]
- I would second the idea of the family coming to her, rather than her going to the family. From what you've said here, she just wants to see them, she doesn't care about making the trip or having the adventure. This would solve all the problems you cited with her traveling. It would be so much easier for her. Even though there are a dozen of them, I think that it will be worth it for her comfort and ease for them to come and visit her for a last time.
- If you travel away from home, your grandmother will likely continue to have problems with sundowning/dementia, or may even have delirium related to issues with her terminal illness. You have to be the judge of this, but do you really think she will be able to enjoy/understand the trip if this is going on? If she cannot enjoy it/understand it, or worse, if it causes her suffering (even in the name of doing something she wants to do) is it really worth doing?
- If you decide you are going to bring her into the USA, ensure that you have several legal documents. A document designating a healthcare proxy is the most important, and that basically means a document that designates who is her healthcare decisionmaker if she does not have the capacity to make decisions on her own. This should be a person who knows best what she would want in a given medical situation. The second thing is to obtain a DNR/DNI ("Do Not Resuscitate/Do Not Intubate") order. This would specify to any EMS or medical personnel that if your grandmother, god forbid, was to become so ill that she had a cardiac arrest or stopped breathing, that she would not want chest compressions, electric shocks, or a breathing tube and being put on a ventilator. Keep copies of these documents with her at all times and if you must, be aggressive about ensuring that these things are not done to her against her will. Then, if any other medical issue should arise, you should make sure that you make it abundantly clear to the medical staff that she is terminally ill with cancer and her life expectancy is in weeks, and you want to maximize her comfort and quality of life. This has been stated but just to reiterate - this should help you avoid ludicrously expensive medical bills, although as you may be aware, even 'small things' like an ambulance ride or an emergency department visit can easily cost you $1000 or more in the USA.
- If you decide to take her on a road trip, be sure to have her wear compression stockings and have her get out to walk every hour or two. As an elderly person with active cancer on a long car trip, she is a setup for a blood clot in her leg, which could turn into a fatal pulmonary embolism in the worst case scenario.
best of luck and hope your grandmother gets her wish.
@pkingdesign: afraid not... providing free medical care is socialism! (wink wink)
posted by treehorn+bunny at 10:47 PM on August 22, 2011 [4 favorites]
Best answer: Yes, I have done this, if not across borders. When my mother was dying, all she wanted to do was travel -- various places, to see something, or as she put it, "to feel lousy somewhere else." The one place she wanted to go that we kiboshed was... China, and I now feel we were wrong.
The way you and I think about feeling rotten -- not to put too fine a point on it, but say: vomiting, fainting, being too weak to walk, soiling one's pants -- is that it's something we would definitely prefer to do in the privacy of our homes. But the unspoken second part of that is ... and when I am all better, then I'll... do whatever it is. But when you're never going to get better, when you know that you will only feel worse and worse and then die, you have a different perspective on today's lousy -- you know it is better than tomorrow's. So you go to the Monterey Aquarium with your grandkids, you accept that maybe you'll ride in a wheelchair, and you bring extra pants.
My mother also was belligerent -- sometimes because she was confused, sometimes because Life was just on her last nerve. It didn't matter. A few whispered words will make everything clear to people -- sometimes they figure it out without that -- and they will be very kind and accommodating. Even at the rentacar. Even the TSA. Even in line.
It is very hard to get one's head around the idea that someone you love is not going to feel better, and that these precious days and hours will be including some suffering. But we have to get there, so we can make this time everything the dying person wants it to be. Money, health insurance, logistics -- all these things can be worked out.
posted by pH Indicating Socks at 10:53 PM on August 22, 2011 [5 favorites]
The way you and I think about feeling rotten -- not to put too fine a point on it, but say: vomiting, fainting, being too weak to walk, soiling one's pants -- is that it's something we would definitely prefer to do in the privacy of our homes. But the unspoken second part of that is ... and when I am all better, then I'll... do whatever it is. But when you're never going to get better, when you know that you will only feel worse and worse and then die, you have a different perspective on today's lousy -- you know it is better than tomorrow's. So you go to the Monterey Aquarium with your grandkids, you accept that maybe you'll ride in a wheelchair, and you bring extra pants.
My mother also was belligerent -- sometimes because she was confused, sometimes because Life was just on her last nerve. It didn't matter. A few whispered words will make everything clear to people -- sometimes they figure it out without that -- and they will be very kind and accommodating. Even at the rentacar. Even the TSA. Even in line.
It is very hard to get one's head around the idea that someone you love is not going to feel better, and that these precious days and hours will be including some suffering. But we have to get there, so we can make this time everything the dying person wants it to be. Money, health insurance, logistics -- all these things can be worked out.
posted by pH Indicating Socks at 10:53 PM on August 22, 2011 [5 favorites]
Might be helpful to know the name of the city, just to know how quickly you can get back to Canada and to identify a local hospice, if necessary. This is totally doable. Don't over think it. Just get the basics together (passport, medication, power of attorney) and go. I have been on a plane sitting across from someone in full-blown dementia. It's painful to watch but doable. Go or you'll spend the rest of your (and her) life, wondering what if...
posted by Xurando at 10:54 PM on August 22, 2011
posted by Xurando at 10:54 PM on August 22, 2011
Have you thought of renting a RV or camper for the roadtrip? It would allow for resting, lying down and a few more amenities than simply a car?
posted by infini at 1:51 AM on August 23, 2011
posted by infini at 1:51 AM on August 23, 2011
My sister escorted my nearly 87 year old grandmother to Oklahoma to see her family last year. This was my grandmother's last trip out there.
We live in the Northeast, US. It's a long trip on a plane. But they went. We did have a medical emergency and much of the family was pissed that my grandmother went and that people "let" her go. But you know what, when is she ever going again? She's not.
So, yes this trip is important. And if your grandmother is up for it, you should take her so long as you and she are aware of all possible consequences of doing so. But I think it is a terrible idea to try to drive that much (the 1300 km? That's one way? So you're really talking about 4000 miles roundtrip? 2600 km total???) in less than 72 hours with her. If you make this trip, it needs to be for an actual period of time so your grandmother has a chance to rest with all the other activity around her. I wouldn't make such a trip for less than two weeks. And I'd recommend flying, provided your grandmother's doctor approves of air travel. My own grandmother was supposed to be in Oklahoma for two weeks, but it turned into three when she ended up in the hospital.
As for the insurance portion, you'll have to figure out what is best for you. The US has laws that in an emergency anyone and everyone has to be treated despite the ability to pay, so there's fear in your grandmother NOT being treated if she needs to be. And many hospitals will work with patients on lowering the cost of the bill if they are unable to pay the amount in full, so there is that to consider. But you probably would have to pay something at some point.
So for me, this question isn't so much about whether you should or shouldn't go and is more about the planning aspects if you go. And I do think you need to give that a lot more thought before making any decisions. Driving just isn't reasonable.
posted by zizzle at 3:44 AM on August 23, 2011 [1 favorite]
We live in the Northeast, US. It's a long trip on a plane. But they went. We did have a medical emergency and much of the family was pissed that my grandmother went and that people "let" her go. But you know what, when is she ever going again? She's not.
So, yes this trip is important. And if your grandmother is up for it, you should take her so long as you and she are aware of all possible consequences of doing so. But I think it is a terrible idea to try to drive that much (the 1300 km? That's one way? So you're really talking about 4000 miles roundtrip? 2600 km total???) in less than 72 hours with her. If you make this trip, it needs to be for an actual period of time so your grandmother has a chance to rest with all the other activity around her. I wouldn't make such a trip for less than two weeks. And I'd recommend flying, provided your grandmother's doctor approves of air travel. My own grandmother was supposed to be in Oklahoma for two weeks, but it turned into three when she ended up in the hospital.
As for the insurance portion, you'll have to figure out what is best for you. The US has laws that in an emergency anyone and everyone has to be treated despite the ability to pay, so there's fear in your grandmother NOT being treated if she needs to be. And many hospitals will work with patients on lowering the cost of the bill if they are unable to pay the amount in full, so there is that to consider. But you probably would have to pay something at some point.
So for me, this question isn't so much about whether you should or shouldn't go and is more about the planning aspects if you go. And I do think you need to give that a lot more thought before making any decisions. Driving just isn't reasonable.
posted by zizzle at 3:44 AM on August 23, 2011 [1 favorite]
My grandfather had the same type of cancer and about 2 years before he died, he went with me and my cousins on a road trip to see my cousins soccer tournament, last vegas to Albuquerque, nm, not as long, but still a good haul. It was a great time, but just be prepared to stop ALOT. we had to stop for him to use the bathroom, and other stuff almost every 2 hrs or less. I don't think it's a huge problem, as long as you give them the times to stops...
posted by fozzie33 at 4:12 AM on August 23, 2011
posted by fozzie33 at 4:12 AM on August 23, 2011
Best answer: Earlier this year, I took my 86-year-old grandfather to visit his brother in a small town on the other side of the continent. My grandfather doesn't have cancer, and is in very good physical health for his age, but he does have dementia which is getting worse. Our trip involved: me picking him up from his place, 2 hours away from the city where I live - him staying overnight at our apartment - a five hour flight - a 400km (220 mile) drive in a rental car. (And, of course, the reverse on the way back). The flight and the 400km drive we did in one day, which made it a very long day.
Not that long ago my grandfather was quite an adventurous traveler, and he has made the trip to visit his brother on many occasions, but he was confused a lot of the time while we were in transit. Luckily, he was willing to trust me so he mostly wasn't too anxious. The long drive after the flight was actually rather lovely, because my grandfather grew up on that side of the continent, and had lots of intact early memories about the history of some of the places we passed - he reminisced about riding his bicycle around the area of the airport (before there was an airport, apparently it had been a golf course) and we had lunch in a town where his family had holidayed in his childhood. He was still confused, and periodically forgot why we were there, but in fact returning to places of his distant past drew on the memories that were still strongest for him.
I had thought that medical clearance was going to be an issue, but when I rang the airline it turned out he didn't even need a letter from his doctor. (Of course, different country, and different medical conditions, so YMMV.) So my advice on that score would be to check out the airline's website and/or ring them and find out what is needed.
I have to agree with the people above who are saying that going all that way for such a short time seems like it would maximise the disruption and discomfort to your grandmother, for the least possible gain. I doubt she will be herself the day after she gets there, and I think it would be a great disappointment to all concerned if that was the only time there was. I'm not sure if the ultra-short trip is in deference to your concerns about your grandmother's health deteriorating while far from (affordable) help, or if there are external factors e.g. time off work. Would it help to talk to your grandmother's doctor and get some hints about early warning signs that things are going south? If it's a matter of getting time off work - I would say ask, people can be very understanding.
One final thing - make sure your grandmother and those she'll be visiting have thought through what it means to have a last visit. It's very hard to say goodbye, knowing you will never see someone again, and while it can be healing, it doesn't always bring out the best in people. Perhaps coincidentally (but perhaps not), my grandfather ended up having a nasty fight with his sister-in-law the morning we left, and it really soured his memory of what was otherwise a really lovely time with his brother. I still think it was worth it.
posted by Cheese Monster at 4:29 AM on August 23, 2011
Not that long ago my grandfather was quite an adventurous traveler, and he has made the trip to visit his brother on many occasions, but he was confused a lot of the time while we were in transit. Luckily, he was willing to trust me so he mostly wasn't too anxious. The long drive after the flight was actually rather lovely, because my grandfather grew up on that side of the continent, and had lots of intact early memories about the history of some of the places we passed - he reminisced about riding his bicycle around the area of the airport (before there was an airport, apparently it had been a golf course) and we had lunch in a town where his family had holidayed in his childhood. He was still confused, and periodically forgot why we were there, but in fact returning to places of his distant past drew on the memories that were still strongest for him.
I had thought that medical clearance was going to be an issue, but when I rang the airline it turned out he didn't even need a letter from his doctor. (Of course, different country, and different medical conditions, so YMMV.) So my advice on that score would be to check out the airline's website and/or ring them and find out what is needed.
I have to agree with the people above who are saying that going all that way for such a short time seems like it would maximise the disruption and discomfort to your grandmother, for the least possible gain. I doubt she will be herself the day after she gets there, and I think it would be a great disappointment to all concerned if that was the only time there was. I'm not sure if the ultra-short trip is in deference to your concerns about your grandmother's health deteriorating while far from (affordable) help, or if there are external factors e.g. time off work. Would it help to talk to your grandmother's doctor and get some hints about early warning signs that things are going south? If it's a matter of getting time off work - I would say ask, people can be very understanding.
One final thing - make sure your grandmother and those she'll be visiting have thought through what it means to have a last visit. It's very hard to say goodbye, knowing you will never see someone again, and while it can be healing, it doesn't always bring out the best in people. Perhaps coincidentally (but perhaps not), my grandfather ended up having a nasty fight with his sister-in-law the morning we left, and it really soured his memory of what was otherwise a really lovely time with his brother. I still think it was worth it.
posted by Cheese Monster at 4:29 AM on August 23, 2011
I would agree with those suggesting that the family visit her and grandma stays put. Extreme humidity and heat are very difficult to withstand for someone at her age and physical condition. The few folks in my life who were diagnosed with terminal illness or advanced age had a desire to travel; it's a common mental state for people who are approaching the end of life. My grandfather was in mental decline for about five years before he died and he was very preoccupied with "going home" when he was already in his home.
posted by effluvia at 6:03 AM on August 23, 2011
posted by effluvia at 6:03 AM on August 23, 2011
Best answer: My mother was diagnosed last month with lung cancer, and in 3 short weeks died. We never expected it to be so quick, and the deterioration so fast. She was much younger than your grandmother, and mentally fine. The two times we took her from her home out of town to doctors 3 hours away were really, really hard on her.
We ended up taking her back to familiar surroundings and allowing anyone to come visit her. Even short visits were more taxing than we expected. In your situation, I would do whatever possible to stay put and have people come to her. I know it is expensive and challenging, but you need to do what is best for her, both physically and mentally. Also know that all of this will be draining for you and your father, and the caregivers need to be thoughtful of what they can handle as well.
I am so sorry for you and your family. It is so rough, but you sound like wonderful caring people and will give her the support she needs.
posted by maxg94 at 6:32 AM on August 23, 2011
We ended up taking her back to familiar surroundings and allowing anyone to come visit her. Even short visits were more taxing than we expected. In your situation, I would do whatever possible to stay put and have people come to her. I know it is expensive and challenging, but you need to do what is best for her, both physically and mentally. Also know that all of this will be draining for you and your father, and the caregivers need to be thoughtful of what they can handle as well.
I am so sorry for you and your family. It is so rough, but you sound like wonderful caring people and will give her the support she needs.
posted by maxg94 at 6:32 AM on August 23, 2011
If your grandmother has been given a terminal diagnosis and has decided to stop treatment, she is an ideal candidate for hospice. Hospice is a service, not a place. Try to contact a local hospice and ask for their help. See if there is a hospice in or near the town(s) you want to visit. They do not provide treatment for the purposes of extending life, but do wonders for pain and discomfort due to the progression of the disease. They can counsel you and her about the issues of travel and help coordinate with the hospice at your destination city. I think you will find that they would believe this trip is a great idea.
posted by Old Geezer at 8:02 AM on August 23, 2011
posted by Old Geezer at 8:02 AM on August 23, 2011
Are you in a position to pay for your extended family to come to you? Given your concerns about her health and the related issues with insurance in the U.S. over Canada, it would make much more sense to bring her family to her instead of the other way around, even if it's expensive. The obvious advantage is that she's the most "herself" at home, with none of the stress of travel. I'm sure her family would like to see her happy and content.
Please give your local hospice a call. Even if she doesn't want hospice care, folks who work in hospice can help you figure out all of these logistics. You can get a case manager, social worker, etc., and they know how to arrange these end-of-life gatherings of families better than anyone.
posted by juniperesque at 8:03 AM on August 23, 2011
Please give your local hospice a call. Even if she doesn't want hospice care, folks who work in hospice can help you figure out all of these logistics. You can get a case manager, social worker, etc., and they know how to arrange these end-of-life gatherings of families better than anyone.
posted by juniperesque at 8:03 AM on August 23, 2011
Response by poster: Wow, I want to thank everyone for their responses. I've marked a few answers as "best" but many more have been helpful and given us much to think about. I wanted also to respond to some of the questions up-thread, provide some more context (now that I've gotten some sleep, grandma has been home for a day and we've all had a chance to consider things), and also what looks like what may happen.
Travel medical insurance for grandma is pretty much a no-go. In addition to her age, the cancer would be considered a pre-condition and would be excluded from any coverage we could get for her.
We were thinking of 48hrs out of country to minimize the risk of her condition taking a turn for the worse. The concern not only being the cost of treatment but more her being able to rest in bed at home or get quickly prescribed a stronger painkiller, etc.
Thank you all for the suggestions of hospice, we've actually got that covered thru the hospital. They were awesome and hooked us up with a social worker, home care, hospice and palliative care when the time comes. They were also very much advising against grandma traveling to the U.S. For the very same reasons above. I left that out of the original question because I didn't want it to influence answers as this is a trip we wanted to make happen for her for some late happiness and I could understand the hospital's position from a liability perspective of saying "yep, go travel" and then something happens to grandma out of the country.
My dad had a read-through of this thread and also contacted another doctor practicing palliative care for a second opinion on travel. Something we hadn't considered was grandma's inability to breathe in the less oxygen-y airplane cabin. We began turning away from the idea of grandma doing the traveling.
Money is an issue in terms of having everyone come here.
Long story short, here's the lead option what we are going to try for. We are going to see if grandma's sister can fly up here. Then we'll do a "party" with her here and the other relatives on Skype video which we'll project on our wall (did I mention that grandma is blindish?), have the kids open presents on the screen "from grandma". It isn't ideal, but I just got off the phone with my dad and it's safest and likely the right thing to do for her. Grandma isn't Internet aware at all, this may blow her mind. Thanks again everyone for your help.
posted by dismitree at 6:36 PM on August 23, 2011 [1 favorite]
Travel medical insurance for grandma is pretty much a no-go. In addition to her age, the cancer would be considered a pre-condition and would be excluded from any coverage we could get for her.
We were thinking of 48hrs out of country to minimize the risk of her condition taking a turn for the worse. The concern not only being the cost of treatment but more her being able to rest in bed at home or get quickly prescribed a stronger painkiller, etc.
Thank you all for the suggestions of hospice, we've actually got that covered thru the hospital. They were awesome and hooked us up with a social worker, home care, hospice and palliative care when the time comes. They were also very much advising against grandma traveling to the U.S. For the very same reasons above. I left that out of the original question because I didn't want it to influence answers as this is a trip we wanted to make happen for her for some late happiness and I could understand the hospital's position from a liability perspective of saying "yep, go travel" and then something happens to grandma out of the country.
My dad had a read-through of this thread and also contacted another doctor practicing palliative care for a second opinion on travel. Something we hadn't considered was grandma's inability to breathe in the less oxygen-y airplane cabin. We began turning away from the idea of grandma doing the traveling.
Money is an issue in terms of having everyone come here.
Long story short, here's the lead option what we are going to try for. We are going to see if grandma's sister can fly up here. Then we'll do a "party" with her here and the other relatives on Skype video which we'll project on our wall (did I mention that grandma is blindish?), have the kids open presents on the screen "from grandma". It isn't ideal, but I just got off the phone with my dad and it's safest and likely the right thing to do for her. Grandma isn't Internet aware at all, this may blow her mind. Thanks again everyone for your help.
posted by dismitree at 6:36 PM on August 23, 2011 [1 favorite]
This thread is closed to new comments.
posted by colin_l at 8:56 PM on August 22, 2011 [3 favorites]