There's a saying and it goes something like....."You never know how strong you are until being strong is the only choice you have."
This is never more true than when dealing with someone you love having a chronic/terminal illness. You sound like a wonderful daughter(?) (sorry, I'm guessing!) and your Dad is very lucky to have you in his corner. He is overall very lucky to have the support he does, in your Mom and you and your sis - many don't.
You asked how you guys can help your Mom. Be there for her. I don't know how close you all live to each other, but take turns spending time with your Dad, running errands for her, even just lending an ear. It's really hard to say when she should take leave from her job. She'll just have to take it one day at a time. But someone does need to check in with Dad. No access to a car as long as he exhibits symptoms of H.E., no access to guns/large knives - H.E. really messes with the brain and can cause sufferers to do/say things they wouldn't normally do (as you've already seen).
One thing I wanted to mention. Is your Dad getting drained at the small hospital you talked about
- the one that doesn't have experience dealing with ESLD patients? I'm asking because that is a little worrisome. Are they giving him infusions of Albumin when they do the paracentesis? It is not usually needed if the amount drained is small - but with anything over 5 liters, an infusion of Albumin is needed.
I know what you mean about
comas. My fiance was in a coma for 11 days before he died this past Feb. 11th. It was heartbreaking. For 11 days, I talked his ear off - what I would've given to hear him tell me to "shut up, already!" The amazing thing was that although he was totally unresponsive to pain stimulus and commands (he did look at me a few times when I called his name though) - 6 separate times, he returned my kisses - I will treasure that forever!
Hope I answered your questions. Have a peaceful day.