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 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...’
‘....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.