Friday, January 09, 2015


Harold looks less like a man and more like a cruelly animated cadaver. His skeletal frame is stretched out on the bed, the bony scoops and ridges of his skull as clearly defined as a mummy lain a thousand years in a cave. When I lift his pyjama top I can see his lungs still slugging it out behind the bars of his chest; his nose and lips and fingertips a dusty blue, his eyes glassy, his jaw bobbing up and down.
‘He’s still being treated for a chest infection,’ says Sandra, his daughter. ‘It’s set him back.’
Set him back?
‘You won’t be taking him to hospital, will you?’
I hardly know what to say. There’s no palliative care package in place, although it sounds as if it might be in process.
‘Don’t you want him to go to hospital, then?’
‘No! It’d kill him.’
We give him a neb, wire him up to the ECG, run through his obs, take the story. Ninety-two, a few things wrong, poor mobility, mind going, incontinent. Carers three times a day. In and out of hospital, but just this side of a failed discharge.
Miraculously, his SATS improve with the neb. He pinks up, looks a little less distressed.
‘Brilliant,’ says Sandra. ‘That’s done the trick.’
‘Does Harold have a DNAR?’
‘A what?’
‘A DNAR. Do not attempt resuscitation. It’s a form you sign if you don’t want us jumping up and down on Harold’s chest if his heart stops working.’
‘No. We haven’t done one of them.’
‘I don’t want to worry you, Sandra, but Harold was very poorly when we came in the door. Still is, obviously – although thankfully his breathing’s coming back. But his oxygen levels got so low he was in danger of arresting – you know, his heart stopping. And if it had, and you didn’t have the paperwork, we’d have to do something. CPR – pressing up and down on his chest...’
‘Oh, no.’
‘....sticking the pads on, needles in his arms, tube down his throat...’
‘Oh, no, no! He wouldn’t want that. I mean, look at him.’
‘I’m surprised no-one’s talked to you about this before.’
‘No-one’s mentioned it.’
‘I think it needs doing.’
She strokes her Dad’s hand, and he looks up at her over the plastic edge of the neb mask. She brushes the hair clear of his forehead, adjusts the mask on his nose, then holds his hand more positively.
‘You wouldn’t have done all that, though, would you?’ she says to me. ‘All that fuss. I mean – he wouldn’t want it.’
‘I don’t think he would. I don’t think I would.’
‘No. Me neither.’
I unclip the SATS probe from Harold’s finger.
‘We wouldn’t have had a choice, though, as things stand,’ I tell her. ‘When I talk to the out of hours doctor I’ll mention it.’
‘Could you? I think Dad just wants to be nice and comfortable here, at home, don’t you,? Hey?’
She squeezes his frail hand, and he turns his eyes on her again. And although his expression doesn’t change all that much, he returns the squeeze.


jacksofbuxton said...

Kindly handled Spence.

I guess Sandra has more than enough on her plate to worry about DNAR.

Hopefully (not a nice subject,but has to be done I suppose) it'll encourage Sandra to talk to her Dad about what procedure he'd like for his funeral,where the paperwork is and so on.

Mrs Jack (not her real name) and I have had the conversation and it is a weird one.However,we're now aware that as soon as I pass away,all my vinyl collection is going on e-bay.

Spence Kennedy said...

I think what struck me was that no-one had spoken to them about it, despite all the hospital stays and so on. He was in such a poor state, and it had obviously been a steady decline. I think those DNAR conversations are being had more often, but still they need to be a natural part of treatment interventions at a particular stage. It just clarifies the situation, and takes the heat off the ambulance service (and I'm all in favour of that).

Vinyl collection, eh? That should raise about four pounds fifty towards the cost of the wake. (Probably shows my ignorance. I bet you've got some pretty rare stuff in there worth thousands, though. Elvis' version of an Ed Sheeran number...)

Lynda Halliger Otvos (Lynda M O) said...

Your compassion shines thru, Spence, despite your humility. Thank you for this one. So many of us need to have that convo and get paperwork lined up. Otherwise it's CPR and all that carrying on. I don't want you hopping on me, so I have a DNR in place but many do not. I encourage those I know to do so.

Spence Kennedy said...

It's a sensitive subject, and one that a lot of people aren't comfortable talking about, let alone organising. I do think it needs to be part of the general health review people have with their GP, though. It's a simple, practical thing but it has such huge implications. Essentially, I think it gives people a chance at what many would hope for, which is an uncomplicated death at home.

Lynda Halliger Otvos (Lynda M O) said...

That's what I am hoping to have for myself and for my husband: uncomplicated death at home. We've promised each other that and done the paperwork.

I was so lucky to be present when a client with an intact DNR passed and the medics came. With the papers taped to the wall above her head, it went so smoothly--just as she had requested. No heroics, no CPR, not a whisper of any interventions. The medics called the doc who spoke her magic and no autopsy was needed. It was perfect.

Spence Kennedy said...

When everything's in place the focus shifts amazingly from the ER drama of it all to dignity, simple humanity even. Quite a relief sometimes, especially in those situations of great age & infirmity when you know the outcome isn't good (and even more especially when you get a return of circulation and take them in knowing full well they'll only end up dying in ITU away from their family).

Thanks for the comments, Lynda. Hope all's good with you today. x