In January 2017, my brother was shot in the stomach, liver, etc., had surgery and a colostomy bag was administered for a year. In December of 2017 doctors attempted to remove the bag, three holes were torn in his stomach. After 7 additional surgeries within 3 weeks, docs could not repair the 3 holes in his stomach and decided to do a skin graft (skin from his legs) to cover the incision which had remained open for 3 weeks. Because nothing works anymore (digestive system) he has had nothing by mouth since Christmas day 2017, only IV nourishment. Yesterday docs sent him to a skilled nursing home for long-term care (supposedly for 12 to 18 months). How long can he live this way?
TPN is administered through a tube inserted into a large vien in the chest and really is no worse than having an IV put in a vine.
If he is not already recieving TPN they have to follow what is called a refeeding protocol because his body has basically been starving just on fluids. They then gradually build up the dose till he is receiving sufficient callories etc for his size.
It does sound as though his prognosis is very poor at this stage and although the TPN will actually keep him alive he is now so weakened that he can easily die from something else.
If he is able to voice his desires it is important for someone to talk to him and then follow his wishes.
It has been a year since the shooting and he may prefer not to receive further treatment.
At this time long term care is really his only option in a skilled nursing facility as he needs so much care.
Personally I would not want TPN after a year but if it was in use would not arbitrarily stop it. he may have very strong reasons to want to live as long as possible. Do what he wants, what you think he would want or failing that what you feel is best for all concerned.
You did not mention his age or other family members so it is very difficult to see the big picture.
A 19 year old cannot reasonably be expected to be the primary caregiver of two other minor children. It ruins his life chances and is inadequate for their protection. Involve CPS, if they're not already on board.
These are an awful lot of misfortunes to be visited on one (even if quite a large) family, I'm very sorry for it. Do you get any support from your faith community?
I don't know the answer, but his doctor should.
I'm so sorry for your brother's situation. How did he get shot if I may ask?
I can only imagine how you feel about your brother's situation. So I don't mean to be dismissive when I ask how your *brother* feels about it.
Has he, for example - is he able to? - discussed advance directives with you, or anything along those lines? Have the doctors given him a long-term prognosis?