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.
