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My mother is only 62 years old. She had a unexpected rapid decline over the last 4 months. She has moments where she talks and is herself, and then it is just like she fades away and is in an almost catatonic state. The last two days she has not eaten or had anything to drink. The hospital has run a ton of test, and everything has come back normal except that her liver is not working properly. They tell me there is no medical reason for it and this must be psychiatric. They asked me today to consider a feeding tube. A month ago my mother could talk and she told me she does not want it. She said "don’t let them do that". My family thinks I’m being selfish and I’m just going to let my mom die. The one thing she was always proud of was her mind. Should I go against her wishes and install it to keep her alive? She is aware of what is going on even if she can’t respond, and I fear if I do it she will be upset and decline faster. What makes all of this harder is we don’t have an answer as to the cause so I have no idea if this is something she can snap out of :( any advice or stories would help me tremendously.
thank you

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You say this might be psychiatric issue. Are you seeing a psychiatrist for a diagnosis. Does your mother have an advanced directive? Mine says that I am NEVER under any circumstances, to receive artificial nutrition through IV or tube. Has this been your mother's opinion, belief, expressed to you and are you POA? She is young. I think you should do psychiatric exams before you make a decision about this. Prior to all this was your mother a happy, well, functioning person without any mental problems or dementia? She may have early alzheimers, and what I would say is that I would have a DIAGNOSIS before I make any decisions. You mention liver functions. What followup are they doing about that. Could your Mom have hep C, or is there a history of alcoholism. This is going to be a difficult decision primarily because you mother is so young and no one seems to know what the diagnosis is. Do know that you can live a LONG time on minimal nutritional intake. You have time to make this decision, but it needs to be understood whether or not you have the documented Powers to do so.
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Undecidedkc Oct 2020
I do have poa for her... she did no do a directive but she has told me she doesn’t want one. They have “treated” her in a geriatric behavioral unit for two weeks and she came home worse than she left ... I had her home for two weeks with myself giving full time care and at the advice of the dr we went back to the hospital. She has since declined again not even able to take medications. We have been told that there is no way she is experiencing liver failure and since most of the tests have come back negative it can only be psychological.. I don’t believe it she was happy excited and her self prior to having multiple UTIs .. my mother rarely drank alcohol and she has tested negative for hep C. We are waiting on her results from a 24 hour urine collection to check her copper levels because the first test showed them elevated... but again we are told it is probably a fluke
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Unless you truly believe your mother was not in her right mind when she told you didn’t want a feeding tube, I would not go against her wishes. However have you sought a second opinion on the status of her health? Can you get her a psych evaluation? Because 62 is very young. Can you tell us what her health issues are? Did she have a stroke or something?
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Undecidedkc Oct 2020
A year ago my mother had sepsis from letting a infection go to long... she thought cellulitis was a bug bite. After that she was normal she started having UTIs in late March and started experiencing unexplained psychosis in early July that only got worse. The first time she was in the geriatric psych ward the dr was telling us it’s early onset dementia... my mom failed to get better and he change his diagnosis to major depression with psychosis..and now we are back at square one. In the hospital running tests and waiting to be transferred to another unit for psychiatric help. The issue is the dr is pushing for a feeding tube before they let her go because otherwise he said she is just going to come right back
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Who's ever heard of a liver failure problem being due to 'psychiatric problems'? I firmly believe that when the doctors have NO empirical medical evidence to point to specifically, they automatically say Oh It's Psychiatric. It's all in her MIND. Yet her liver isn't working right! Why is that? Was she a very heavy drinker? Drug user? If not, there's another unknown reason for why her liver is not functioning properly, the doctors are just unaware of it. Some reasons for abnormal liver tests would be:

Over-the-counter pain medications, particularly acetaminophen (Tylenol, others)
Certain prescription medications, including statin drugs used to control cholesterol.
Drinking alcohol.
Heart failure.
Hepatitis A.
Hepatitis B.
Hepatitis C.
Nonalcoholic fatty liver disease.

In any event, get her a psych evaluation before you make any further decisions. If she has a history of alcohol abuse, then she may be having alcoholic dementia symptoms or even Wernicke-Korsakoff syndrome which presents with confusion & loss of mental activity (but can be treated with IV Vitamin B/thiamine). Read up about it below:

https://www.google.com/search?sxsrf=ALeKk02q_QBHYOAhkEM_VijcraLLDlIiHw%3A1602186472867&ei=6Gx_X6O2NI-xtQb7uZbADQ&q=wernicke-korsakoff+syndrome&oq=wer&gs_lcp=CgZwc3ktYWIQARgDMgQIIxAnMgQIIxAnMgoIABCxAxDJAxBDMgcIABCxAxBDMgUIABCRAjIKCAAQsQMQgwEQQzIECAAQQzIHCAAQsQMQQzIECAAQQzIICC4QsQMQgwE6BAguEEM6CwguELEDEMcBEKMCOggIABCxAxCDAVDMnQhY_Z8IYOu6CGgAcAF4AYABuAOIAYoIkgEHMC4xLjQtMpgBAKABAaoBB2d3cy13aXrAAQE&sclient=psy-ab

A neurological evaluation may be in order if she has a history of alcohol abuse, or even drug abuse.

I don't think you can make a rational decision about anything until the process of elimination has been undertaken. If the psych evaluation and a neurological evaluation turn up nothing conclusive, THEN you'll have to decide about whether or not to install a feeding tube. If she's against it, then I'd decline to do that and respect her wishes.

I hope you can find an answer for her, I really do. I'm 63 myself and would hate to be in such a situation, or have my kids forced to make such decisions on my behalf. Wishing you the best of luck; here is a hug and a prayer for strength.
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I don’t think from what you’ve stated here that you have enough information to make a decision. There’s no way a bad liver links to being a psychiatric condition. Is there a history of liver disease or something that might cause it? My mother was given a feeding tube following a massive stroke. Our family chose to have it placed after all doctors involved assured us there was great hope of recovery. She was physically unable to do anything but mentally completely aware. Despite months of therapy the recovery never came and she lived a miserable life from then on. But we couldn’t stop feeding an aware person. It was simply horrible.
You need more information and to definitely know what’s going on to make an informed decision. Even after that, know you’ll be somewhat relying on your gut feeling, there are no absolutes. I’m sorry you’re in this place and wish you wisdom as you move through it
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Isthisrealyreal Oct 2020
Oh man, I am so sorry that your family had to go through this. Such an awful experience for everyone involved.
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It does not make any since at all to say that the liver is not functioning properly due to pyschiatric.

Have her seen by a GI specialist (to test her liver) and determine where you should go from there.
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How does your Moms medical POA read? My Moms read like a living will. What she wanted and what she didn't want.
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Sometimes, seizures can present the way you describe. Has she been seen by a neurologist?
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It sounds like a neurological evaluation with scans = needed. It's time to get in contact with the M.D. of the facility to get a referral to a Neurologist
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Have you tried to get Mayo clinic involved?

That's what I would do. Get her medical records and send them to them and beg for help.

She made her wishes clear, please do not let a doctor force you into a decision that goes against her wishes.

My prayers are with you for an answer and a healing for your mom.
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Do you think your mother didn't want a feeding tube because she didn't want to be kept alive indefinitely, or do you think she would be willing to have a feeding tube if there was hope of her recovering from whatever her problem is at the moment?

This "no feeding tube ever" thing isn't necessarily black and white. You aren't talking about letting a 90-year-old go who's had a good life -- this is a relatively young woman who was fine until recently.

If the feeding tube is what keeps her going until they figure out what's wrong, I'd go with it. If there's no hope of recovery, that's another thing.
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Are you in the U.S.?
Has she traveled outside the U.S.?

Any chance the alleged spider bite was a brown recluse spider?

I would ask for a PET scan of her liver etc. (By a neurologist?).

In this day and age, a diagnosis is possible. Do not give up.
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I don't think you should base your decision on what your mother said during a major depressive episode. Your mother was able to communicate a month ago, but at that time she was already seriously ill.

If her doctors are telling you that without artificial feeding your mother will die, I think you should take their advice. Inserting a feeding tube is reversible- so if there is no prospect of recovery for your mother you can later change this decision - but death is not. Your mother is only 62.
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