View Full Version : End-stage illnesses and home care

09-22-2015, 06:58 PM
I have a character who for various reasons needs to be in the final stages of an illness where recovery is not possible. It's a minor character, but you know how these things matter--I couldn't forgive myself if I made up something that was absurdly wrong. So I'm looking for an illness or combination of illnesses/conditions that would allow the character to be:

living at home, possibly with a nurse or health aid to administer pain medication.
mostly ambulatory, at worst requiring a walker or some assistance, but not bedbound. He needs to travel as part of the story.
clear-minded and conscious despite medications.
able to converse, though difficulty in speaking/breathing is not a problem.

The idea I had in mind was someone who essentially is duplicating a hospice experience, but wants to be at home. So pain meds for comfort, but no other treatments because death is expected quite soon.If this is too idealistic and it needs to be adjusted for that reason, please tell me. I have not (thankfully) yet had to deal with this first-hand. Suggestions of complications that might make the depiction more realistic are also welcome, as right now the scene feels as if he's perfectly healthy, and that's not the image I'm looking for. This character is going to be convinced to sacrifice himself to save others, and so he has to be close enough to death that it feels like he's not giving up much. His age is flexible and not important to the story, but I was envisioning at least mid-sixties.


Katharine Tree
09-22-2015, 07:07 PM
I'm insufficiently caffeinated to come up with illnesses at the mo', but if your character has trouble breathing, then the care provider has probably brought in supplemental oxygen. Some people hold a mask and press it to their faces when they need it, others have a line beneath their noses to dispense a steady supply. One problem with trouble breathing is that it very quickly leads to trouble with any amount of physical exertion. A person who needs oxygen won't be walking far.

09-22-2015, 07:10 PM
It's called home hospice care. My grandmother had it for the last few months of her life. She was, almost to the end of her life, exactly as you describe. She had a walker to get around, and lifts installed on the stairs in her house, but she was mostly ambulatory. She was clear minded when she was wide awake. Now, that was only about half the day. She slept a lot, partially because of meds, and partially because of her deteriorating condition.

She still went to church every Wednesday and Sunday until the last couple of weeks when she finally became bed bound. She didn't drive, though. She was in no condition to operate heavy machinery. A home care nurse came to help her with medications and other things a few times a week. At first, she visited only 2-3 days, gradually increasing until she stopped by every morning.

She was basically just old. She had broken both her hips earlier in her life, then fell and broke one again, and simply never recovered from it. I don't know what condition would be suitable for a younger character to have that would result in the same lifestyle situation, but I did want to chime in that someone could, indeed, easily be as you describe.

09-22-2015, 07:43 PM
It's so variable, what do you want?

09-22-2015, 08:10 PM
You have to give parameters here.

The requisite or required story time-line between lack of mobility and death is relevant, as is the time-line between lack of understanding and/or loss of communication, and eventual death.

09-22-2015, 08:33 PM
Yeah, a few more details would be helpful. My mother had home care assistance for several years (dementia, COPD, stroke); my father had in-home hospice for cancer (a little over a year). There are innumerable illnesses/conditions/end-of-life situations for which in-home care assistance is available.

09-22-2015, 08:34 PM
Sure. The problem is that the things Bufty mentioned are not relevant just because they won't happen. The reader will never get to see them since the character will elect a voluntary death in the story's present. The character will only appear once. There will be no lengthy or time-spanning view of them, as they are minor in the grand scheme. Well, let me amend that--they are relevant, but they can be *anything* because they will never be described. Does that make any sense? The character will elect to sacrifice himself, thus removing any end-of-life description in the context of his illness.

I can see how working this out will quickly become longer than the actual scene :). I like the idea of supplemental oxygen--moving with difficulty is fine, but he will have to get up and go with other characters, but will have assistance doing so. An older character isn't quite what I want--though I appreciate the details--because he is set up as a former workmate of another character, so someone 20-30 years older would not have been in his circle.

The entire setup for this will be something along the lines of: "Charlie Mansour. Has end-stage metastasized lung cancer, and not doing well. He worked in my friendís office. They had a fund-raiser for his treatment last year."

09-22-2015, 08:47 PM
I don't see the point of the question in this case.

09-22-2015, 09:17 PM
One of my best friends had a form of bile-duct cancer for which there is no treatment, and died at age 50 (but she could have been any age). She decided to go to her end fully living. She did do chemo to extend things because her kids are young, but only at the very, very end (final week or two) did she become really restricted. She was never without her faculties. If she had been your character and you'd have told her to get up and go say...a month before she died, she would have done it.

09-22-2015, 11:13 PM
I think Stage III congestive heart failure will get you where want to go. It would typically require oxygen, assistance with ADLs, and the writing is on the wall.

09-22-2015, 11:37 PM
Thanks for this and all suggestions. And for making me look up ADL :).

09-23-2015, 01:26 AM
End stage cancer will get you where you want to be.

Siri Kirpal
09-23-2015, 03:19 AM
Sat Nam! (literally "Truth Name"--a Sikh greeting)

My mother is currently what you are describing. She had open heart surgery last year. At the time, she was living alone. She now lives with a caregiver, but is ambulatory with a walker or cane. Mostly mentally there, although she complains bitterly about her memory loss. Heart problems, just heart problems.


Siri Kirpal