Saturday, November 22, 2014

not long

Ted is ninety-three. Five years ago he had a serious stroke that left him bed-bound, unable to speak, incontinent, swallowing problems and so on. The best he can do is intimate pain – everything else is subject to the attention and good offices of the nursing home staff. He’s padded and catheterised, spoon-fed pureed food. He takes a dozen meds including prophylactic antibiotics for urine and chest infections. Every morning after breakfast Ted is hoisted out of bed to a wheelchair, bolstered with cushions, then pushed through to the lounge where he sits with his back to the window, facing the TV. There is no DNAR.
The last couple of days Ted has stopped eating and drinking. There’s a suggestion that he may have had another stroke but of course it’s difficult to say. The doctor was informed over the phone. After reviewing the situation he arranged for Ted to be collected by ambulance and brought to hospital with a view to fitting him with a PEG – a tube that passes through the abdominal wall to the stomach.
He’ll be admitted via A&E, pending an available bed further up the chain.
Ted’s daughter Fiona arrives. We tell her how things stand at the hospital, the delays, the queues in the triage area. She’s quite stoical about it. She says she faced a similar ordeal a few months back when he was admitted with his breathing.
She rests a hand on his shoulder and leans in to shout in his ear. Don’t worry Dad. I’m coming with you.
He stares ahead, his mouth hanging open.
The nursing staff hoist him onto our trolley. We collect his notes, his medication, his personal effects. We head out of the lounge to the lift.
‘Going on a trip?’ says one of the nursing staff, holding the lift door for us. ‘Have a good one!’
We ride down, the bright down spots of the lift casting all our eyes in shadow.
Fiona pats Ted on the hand, fusses with his blankets.
We wheel the trolley through the lobby, passed a potted fern, a couple of soft focus canvases, four leather armchairs round a glass table displaying a circle of leaflets.
Fiona takes a call on her mobile, makes arrangements.
An assitant in the lobby keys a sequence into a pad and the doors slide open. The wind out in the car park hits us cold, blowing in from the sea across a swathe of dark, freshly-tilled earth.
‘Won’t be long now,’ says Fiona.
There’s no reaction.


md said...

Oh dear ... It sounds as if it has been far too long already and a PEG tube, if it does anything, is only going to prolong the process. End of life decisions are really difficult, especially if the person never made their wishes known, but there comes a point when I think that one has to say "enough is enough" and let nature take its course.

tpals said...

You know how to make a person think about choices. My gut reaction is that this is a life I don't want. I need to explain that to my son before it ever becomes an issue.

Spence Kennedy said...

MD - My thoughts exactly. I was very impressed with the high level of care the staff were providing, and the daughter was obviously loving & supportive, but the prospect of Ted being kept alive for a few more years with such a poor quality of life was actually quite appalling. Fitting a PEG seemed almost cruel - although ethically I don't suppose they had much room for manoeuvre.

At the risk of sounding overly dramatic, the whole thing reminded me of that quote from the end of King Lear, when Lear dies and an onlooker says: He hates him /
That would upon the rack of this tough world / Stretch him out longer.

tpals - Medicine has definitely outstripped ethics. It's a touchy subject, obviously. Government here has been tip-toeing round the whole assisted dying thing for years, without being able to make any progress. All other things aside, though, you'd think that common sense & simple human kindness would find leverage in the end of life debate. As things stand here, though, a Living Will or equivalent would have sorted the whole thing. A DNAR at the very least. Get it in writing!

Cheers for the comments! :)

martine said...

My mother recently had a Living Will drawn up, giving instructions for her care in the case of being unable to communicate her wishes. It does not feel morbid but rather reassuring.

Spence Kennedy said...

I admire your mum, Martine. I think she's absolutely doing the right thing. You just can't leave it to chance, or the hope that the medics in charge'll do the right thing when it comes to it. Whatever they might think personally, they have to work within the law, and the law at the moment is a surprisingly inflexible thing.

Anonymous said...

Thank god that when my 85 year old mother stopped eating, 9 months after having a stroke that half-paralysed her, she was just allowed to die. Incidentally she did not have any living will or advance directive.

I always enjoy your blog Spence.


Spence Kennedy said...

Sorry to hear about your mum, H. But it's good to know that everyone had the latitude to take that course, and nothing was done that might prolong her suffering.

Thanks for the comment, H - and for reading the blog. Very much appreciated.

jacksofbuxton said...

Sounds like Ted has made the decision to cross the night-ferry.

Spence Kennedy said...

I got that impression. It's just that no-one else seemed ready to let him go. :/