Mom with dementia now has metastatic breast cancer.

Ok, long story, and I will try to keep it short. Looking for advice.

My 82-year-old mom lives in a dementia home and lately has been losing weight, having trouble breathing, and feeling very tired. She also complained about pain in her chest. My husband and I thought it might be anemia; her doc thought it might be congestive heart failure. We were both wrong. Doc sent her for full exam and it turns out it’s metastatic breast cancer. She had a run-in with breast cancer in her 50s but was given a clean bill of health.

Now her oncologist wants to put her on chemo and tamoxifen. She hated it 30 years ago, and even though she probably doesn’t understand now what it is or what the side effects are, I am on the fence about putting her through all that again. SOMETHING will take her–either the cancer or the dementia, and right now I’m thinking that quality of life is more important than trying to squeeze out another year or so with her in such discomfort.

She also has a DNR. I’m DEFINITELY not going to try to tell her she has cancer, so that’s decided already. My husband and I talked about the tradeoffs between treatment and letting her live out her life with some small degree of joy. I feel like I’m going to hate myself no matter what we decide.

Treat the disease, treat the symptoms, or don’t treat at all?

When I have to face difficult decisions, I try to make calling the hard ones as easy as possible.

The right thing to do in your mom’s case depends a lot on what she would choose if she could decide on her own. As I see it, your choices boil down to trying to get the cancer to go away or trying to make your mom as comfortable as possible. If you opt for the cancer treatment, as you pointed out, she might live a little longer. But she’s also 82 and has dementia, so the cards aren’t exactly stacked in her favor. On the other hand, if you opt for palliative care, she may enjoy the quality of her days a little more.

What makes it hard to decide is that you don’t know how much longer Mom will live, and—if I’m reading this right—you feel like you’re sentencing her to an early death by not going after the cancer. But another truth is that for whatever reason, no one detected its return early enough to improve your mom’s odds of surviving after treatment.

I think it’s possible that there’s a middle ground. If your mom can tolerate the tamoxifen but not the chemo, give it a try. It might help. Also, if you can do things to help Mom breathe easier, have more stamina, or relieve pain, consider those as tools you can use to improve her quality of life.

I think part of the issue here is that you want to feel like you’re doing what you can, and what Mom would want, but not more than she’d want; and you worry that you’re not doing enough.

So here’s my advice. Since you can’t save her from the Big Bad Monster, make a reasonable effort to save her from the little, not-so-bad monsters like pain, worry, and fear. Take reasonable care of her and let God or fate or karma or whatever you believe is out there take its course.

After Mama died, my husband and I discussed our own wishes for eldercare. My husband put it succinctly when he said “I just don’t want to die of tooth decay.” What he meant was that if doing little things kept him alive, make the effort. But if it cost hundreds of thousands of dollars and only extended life another year or so, it wasn’t worth it. We all have to go some time, and maybe, he said, the answer is to live meaningfully while we can..

Ultimately, your call on the DNR will be some version of that. It’s a hard decision, and remember that sometimes doing your best means knowing when you cannot save the world.