Lucky died at around five o'clock yesterday afternoon in a secluded room within Midland Hospital. He had been admitted to the Intensive Care Unit two Saturdays ago. Initially given a very bleak prognosis, he seemed to rally for twenty-four hours. After Sunday, he embarked on a long slow deterioration.
He was given medication to support his blood pressure and heart rate. Daily blood tests painted a poor picture. As long as he remained on a drug regime that needed to be closely monitored, he remained in ICU. Faint hope for recovery gave way to the unpleasant inevitable; Lucky was falling into the 80% that were not going to survive this admission.
Ceasing the supporting infusions were delayed as Lucky rebelled against his fate. He was afraid and battling to understand what was happening to him. A day of verbal accusations and uncharacteristic behaviour illustrated his fear and frustration. I am ashamed to admit I took his assaults personally. I should have seen beyond the words to see an elderly man facing death.
The weaning process off the medications took two days. Lucky was eating very little, drinking not much more and becoming increasingly agitated at night. Whilst he remained in ICU, there were nurses available to tend to him and give comfort to his family. Sandra and Darryl had stayed overnight with him, but they had not been left on their own with Lucky for any extended period.
One of the consultants on ICU whom we liked and trusted talked a great deal about three words - comfort, dignity and family. She assured us that Lucky would be treated palliatively in an environment that would concentrate on keeping him comfortable and dignified.
Two days ago, he was transferred to an adjacent ward. Placed in a room accessed through an airlock, the staff received very little information and openly stated they were unsure how to nurse him. The first nurse we saw expressed his frustration with the lack of a plan. Michael and I had agreed to stay with Lucky overnight. There were other family members coming in and out during the day. One of the registrars remarked that this was the time to say goodbye.
We were informed that the staff would no longer be performing observations. Unless we rang the nurses' bell, there would be minimal nursing support. All his drip lines had been removed in ICU. By late afternoon, Lucky was finding drinking increasingly difficult. so swallowing was an impossibility. We realised that he would need a line inserted for pain medications. This was not a welcome thought.
As the evening wore on, Lucky became increasingly vocal and agitated. He was thrashing around in his bed, hitting his unprotected legs repeatedly into the bed rails. He also pushed his legs past the bed rails and needed one of us to place his legs back onto his bed as gently as possible. His purple fingers were curling inwards and clutching the rails like a terrified animal.
With the intervention of the ward co-ordinator, we had been provided with two recliner chairs but sleep was impossible for any of us. Lucky moaned and cried and tossed and turned. Around midnight, we requested drugs to help his obvious distress. A subcutaneous line was inserted into his abdomen. The last word we heard Lucky say was "ow". The staff expressed their concern about giving him too much morphine. We were incredulous.
We requested extra medication. After an hour, the nurses gave him a calmative as well as another half dose of morphine. We were berated for ringing the bell. One of the night nurses complained she had eight patients to look after and the other nurse had seven patients. We were asked - "Do you know it's only half an hour since you rang the bell?"
Lucky was soiling his pad frequently. We watched two of the night nurses changing him. They spoke forcefully to him to let go of the bed rails. They moved him backwards and forwards like a sack of potatoes. We struggled to recognise any decency in their treatment of him.
We then asked for an urgent review by the night doctor and an increase in Lucky's medication. This was refused. Finally, another dose of morphine started to sooth him. Or he was spent. Sometime between three and four o'clock in the morning, his cries became softer and subsided and his body ceased his frantic movements.
One of the night nurses was outstanding in her compassion. She listened empathetically to us in those grim small hours of the last night, offered us a cup of tea and coffee and obviously spoke to the other nurses about their lack of care. Around four thirty, one of the other nurses came into the room, washed Lucky's face and swabbed his mouth.
We both slept fitfully for a couple of hours. Morning shift began. Sandra arrived to be with Lucky. Michael was shattered. I was not much better. We grabbed tea and coffee in the cafe. Michael was so upset he could not return to Lucky's room. We decided to go home for a sleep. I collected our gear from Lucky's isolated outpost and we drove away, grieving not for Lucky's approaching death but for what had been the last night of his life.
Arriving home with relief, we slept soundly for three hours. Upon awakening, Michael could not face returning to the hospital that afternoon. He rang Sandra to explain his feelings. Lucky was quiet at last. Michael believed Lucky's spirit had left his body sometime during that awful dark night and relayed his belief to her as well.
Sandra rang us to let us know when Lucky died. We were incredibly sad. And we were so angry. Where had been the comfort and dignity for Lucky that we had been promised? After nine days in ICU, Lucky was taken and effectively dumped in a place that wasn't prepared to receive him and didn't know what to do with him. And his last night on earth was harrowing. Just as well the two of us were with him. With scant support from the nursing staff, we were continually challenged to prevent Lucky from hurting himself further in his high state of agitation.
This is our reality of Lucky's decline. Michael and I remain very concerned about some of the attitudes communicated to us. The staff's overwhelming desire seemed to be following drug protocols, rather than easing Lucky's suffering.
Midland Public Hospital is administered by St John of God, a Catholic organisation. We believe that their doctrine may dictate the care of patients. No abortions in this public hospital for starters. And what about easing the distress of palliative patients. We saw only resistance and excuses in our pleas for Lucky.
I will be writing to the new premier and the new health minister. The previous premier's name is proudly displayed in the foyer for the opening of this hospital. This public hospital's policies have been dictated by religious doctrines. This is not a hospital for all. The former premier compromised the health of Western Australians ( particularly the Wheatbelt catchment) in agreeing to the terms for the administration of this hospital.
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