For Lucky

To Whom This May Concern

My darling father in law died at five o'clock in the afternoon of 28 March. His death was not unexpected due to increasing frailty and the conditions of being elderly. What was unexpected was the traumatic nature of his personal path towards death.

He had been admitted to the Intensive Care Unit on 18 March via Midland Hospital’s Emergency Department. Initially given a very bleak prognosis, he seemed to rally for twenty-four hours. However, this rally could not be sustained and 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 – he was not going to survive this final admission.

Five days on, he became very anxious, battling to understand what was happening to him. A day of verbal accusations and uncharacteristic behaviour illustrated his fear and frustration. Here was a vulnerable elderly man facing death.

Weaning him off the supporting infusions took time. He 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.

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 he would be treated in a palliative environment that would concentrate on keeping him comfortable and dignified.

On March 27, he was transferred to an adjacent ward. Placed in a room accessed through an airlock, (an infectious setting?) the staff appeared to have received very little information and openly stated they were unsure how to nurse him. The first nurse we saw expressed outright frustration with the lack of a plan. We were quite astonished when we were questioned for his history by the ward’s registrars. Then, one of the registrars also remarked that this was the time to say goodbye.

My husband and I had agreed to stay with him overnight. There had been other family members coming in and out during the day. We were then informed that the nursing 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. This was unfortunate as he became increasing unable to swallow.

We realised that he would need a line inserted for pain medications. And so it began.

As that final evening wore on, he 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. We were concerned he might actually throw himself out of the bed.

With the intervention of the outstanding ward co-ordinator, we had been provided with two recliner chairs. But sleep was impossible for any of us.

He 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 him say was "ow".

Then the night nurses expressed their concern about giving him too much hydromorphone. We were incredulous.

We requested extra medication. After an hour, the nurses gave him a calmative as well as another half dose of hydromorphone. 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?"

When he needed his pad changed, two of the night nurses 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 his medication. This was refused. Finally, another dose of hydromorphone 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 his face and swabbed his mouth.

We both slept fitfully for a couple of hours. Morning shift began. My sister-in-law arrived. We were shattered. We grabbed tea and coffee in the cafe. My husband was so upset he could not return to his Dad’s room. We decided to go home for a sleep. I collected our gear from that isolated outpost and we drove away, grieving not for his approaching death but for what had been the last night of his life.

My sister-in-law rang us to let us know when he died. We were incredibly sad. And we were so angry. Where had been his comfort and dignity that we had been promised? After nine days in ICU, he was taken and effectively dumped in a place that wasn't prepared to receive him and didn't know what to do with him or us. And his last night on earth was harrowing for both him and us.

Here is a summary of our concerns –

·         Why was my father-in-law taken from ICU to a public ward that did not cater for terminally ill patients?

·         Why were all lines removed from his body in ICU when he needed another line inserted later? This procedure only added to his distress and discomfort.

·         Why was my father-in-law not transferred to the Private Hospital as was his request?

·         Where was the nursing support that we required to care for a dying man?

·         Why was there such reluctance to give him adequate medication to sooth his very obvious distress?

·         Midland Hospital (public and private) does not list palliative care as one of their services? If not, why not?

·         Why were there insufficient nurses on Ward 1B to cater to a dying man? We believe that there should be mandatory checking of the patient and family at least once at hour during this time.

·         Why did we have to beg for a medical review and additional medication? Why was this review and additional medication refused?

·         Why was my father-in-law reduced to terminal restlessness before his body finally relented and he fell into unconsciousness for his remaining hours?

Midland Public Hospital is administered by St John of God, a Catholic organisation. We are concerned that their religious dogma may dictate the care of patients. The dignity and comfort he had been offered was completely lacking. We saw only resistance and excuses.

Midland Hospital is not a hospital for all. The former premier, Mr Barnett, has compromised the health of Western Australians (particularly the Wheatbelt catchment) in agreeing to the terms for the administration of this hospital.