It does really suck and I am so very sorry for you and your dad..... Big hug and a blessing....xo

He started to respond a little to me later in the night, but I'm not sure he actually knew who I was. Mostly groaning. Hopefully tomorrow is better, but I know he's in pain. He kept asking for help

I'm so sorry about your dear father. At least you are there for him. That means more to him than you know.

It's just so hard seeing him like that. He looks at least 10 years older laying in that bed

I went through encephalopathy with my wife when her liver shut down. It's horrible to watch. It did go away and she knew me again before the end, but her mind never was quite the same. I feel for you. Hugs.

It's definitely not looking good. The Dr gave an executive order for both my mom and I to be there together tomorrow. We will discuss whether we can transport him to let him die at home. I hope that can happen so his dog can be with him again

I'm sorry to hear that. If it's the end, a hospice nurse can come into the home to help with his pain. I don't know his condition but if he's with it enough tomorrow to make a decision, the doctors should allow him to have a say. Just be there with him, no matter if he goes home or stays in icu. That's what is important.

He's not with it. But we will be there as long as they let us. Covid makes policy difficult

I didn't even think about how hard this must be with Covid limiting access. Yeah do what you can. Good luck tomorrow.

Hi Kaley, I am sorry to hear your Dad has stage 4 prostate cancer and with liver cirrhosis and metastasis to the liver (?). Stage 4 prostate cancer is still treatable and though not curable, treatment can extend your father's life and reduce the signs and symptoms of cancer. Does your family wishes to continue treatment or to palliate?

With the hepatic encephalopathy, due to liver failure, the liver cannot clear all of the portal vein ammonia to convert it into glutamine and urea, to prevent entry of ammonia into the systemic circulation. This leads to the build-up of ammonia and other toxins in the blood. which cause brain astrocytes to dysfunction and the brain to swell, creating an altered level of consciousness. To treat, doctors would prescribe lactulose by mouth, which will bind to the ammonia in the gut and excrete it via the bowel. As result to the reduction of blood ammonia and toxins, the cirrhotic person will regain consciousness.

Once your family has chosen palliation, all treatment will stop regardless whether your father's diseases are treatable or not. Perhaps your family can think about the options before making a decision.

He got the cancer diagnosis a month ago and wanted to fight it. But his liver was so far gone from cirrhosis already that we're pretty sure the meds they started him on made the liver go faster. They've given him a lot of lactulose, but he's not really coming around. Grunt responses here and there. They are keeping him on dilaudid though. They're going to talk to us about hospice today. They said his kidneys are shutting down now too. He's swelling. It's not looking good

The lactulose is not responding as the kidneys are also shutting down since there are too much toxins in the blood. So far your father has suffered organ failures in four organs: liver, kidneys, brain, prostate. If his life is to be saved, he would need gentle dialysis to filter the toxins from the blood in place of his kidneys.. as well as lactulose treatment. Here is the thing: once there is failure in more than three organs, the doctors tend to palliate if the patient is old, too fragile/weak, and/or if the treatment only extends life for a few months.

Dilaudid is a narcotic used to reduce pain, and is often given at low doses in end of life situation. Dilaudid will make your Dad drowsy, so he would not be able to respond to you if roused.

I really understand the desperation that you feel at the moment. I had faced the same desperation five years ago, when my father was dying from multiple organ failure. I am a health professional, and I have always pushed the doctors to try everything to save a life, especially if it is a member of my family. In my Dad's case, everything had been tried but nothing worked anymore, but that my intervention allowed Dad two extra days for my father to gain enough mental clarity to say goodbye.

If your father is bloated from water retention due to kidney failure, a dose of diuretics will enable him to excrete water soluble toxins through urination which may allow the lactulose to work, but this would predispose him to dehydration. Saving a life is trying to balance the demands from liver, kidneys and brain, but that maintaining brain function is paramount over all else.

Your family is making a very tough decision. As daughters of dying parents, I feel your frustration, your desperation and your pain. We want our parents to live forever, but all good things come to an end. Talk to your family as to what they want to do, what you want to be done, Talk to your family about the grief you are feeling now.

I pray that God will grant your father a miracle, and heal his body. God bless, Marie

We understand we're at the end. It's just hard, especially since it happened a lot faster than we expected. I've done enough research to know, but my mom isn't as informed. She's with him now and said he's more with it today, but not forming words. It would be amazing if we could talk to him one more time, but we are realistic about it.

Perhaps your Mom knows the end is near and she is not accepting the consequences but hoping for a miracle. Miracles do happen, our family has experienced it so often when it comes to my Dad's multiple recoveries before his eventual demise. Your Mom needs your support now more than ever. Hug your Dad tight and tell him that you love him. He can hear and understands everything even though it seems that he is sleeping. Hours/minutes before death, patients who are dying often regain a brief moment of consciousness to say goodbye. Your family will have a chance to talk to your Dad again.

We both got to be with him all day. We made the decision to stop treatment and just keep him comfortable. I played some of his favorite music and we had some people try to talk to him on speakerphone. There were definitely times when we knew he could hear us. We're hoping he holds on a bit longer because his best friend is flying in tomorrow night.