Are people not allowed to just die anymore?(62 Posts)
My gran passed away last night, she was 92, not mobile and had been in a nursing home for the past two years. She has had a urine infection and been confused these past few days and tbh I feel this is a release for her. However, I am less than happy that her final moments were spent being pummelled on the chest by nursing home staff and paramedics.
Please please don't think for one moment I am upset with the people involved, I am not, they do a selfless and wonderful job. However, it seems that protocol now deems you cannot "just die" but efforts must be made to revive you. I am certain that those present were just doing their job but I so wish my Nan had been allowed to slip off without the heroics.
It IS a sudden death because despite the urine infection she had no other issues beyond the normal ones for her since her stroke. The Coroner has had to be informed etc and she had not seen a doctor for some time. I assumed she was on antibiotics but apparently not.
My Nan has wanted to die for a long time, she would not have wanted all the heart pummelling and I am relieved for her that it wasn't successful but so so wish she had just been put back into bed and had her hand held while they contacted the family. As a nurse years ago I don't recall us doing much else (circumstances depending), even for a sudden death when the patient had such underlying health issues as my Nan did.
I am probably being unreasonable but just wanted a more peaceful death for her.
It is really unfortunate that the nurse didn't check your nan's notes for a DNR, my mum had this written absolutely everywhere for her carers. I am sorry for your loss.
Sorry for your loss x
My Grandad is 93, he was informed when he moved in to the home that they would rescusitate if necessary.
He decided for himself (and went and filled the forms in himself - and didn't mention it to us until a few weeks later) that he wanted to pass peacefully, and he signed a DNR. All staff are aware of the DNR status.
He is doing well for a man of his age too (only has sight problems that make caring for himself difficult).
YANBU, it's a sorry state of affairs.
I am also a nurse who has worked in care homes, when I first started it was difficult to distinguish who was for resus and who had a dnar in place without trudging through the residents notes. Obviously in an emergency this is impossible.
We did implement a colour code system where a member of staff could identify at a glance if that resident was to be resuscitated.
I hope the home manager will look to improve things.
Also, yanbu, I am sorry this happened to your gran.
OP I'm really sorry for your loss. My lovely grandmar died six weeks ago in similar circumstances but thank goodness there was no resus. I actually don't know how this transpired as I'm not aware that she a DNR but am grateful.
I second what another poster said- she would certainly have been entirely unaware of what happened as her blood pressure would not have been sufficient to adequately maintain circulation to her brain at this point.
As a hospital doctor working with lots of elderly patients I think it's a release at that age- and spares any further loss of quality of life or dignity. Dying in hospital surrounded by strangers also not a nice option.
I also know that even at 32, losing your beloved Grandmar is sad. hope you have happy memories to treasure.
If you feel strongly about this or have elderly relatives who feel strongly about this then there are a few things you can do to help yourself/ them.
1) Talk about it as a family. Make sure everyone in the family knows
2) Raise the issue of DNAR upon admission to hospital or with primary care givers
Yes, the hcp should think about it but sometimes there is a lot of other stuff going on and it just doesn't get talked about.
Better to let them know early rather than an awkward conversation later.
Patients who are not for resuscitation get the same standard of basic care as everyone else. By saying you don't want to be resuscitated you are not saying you don't want to be treated.
I've just been a long drawn out hospital admission for a loved one. We had talked in advance about end of life (this person did not have cancer). I knew that they did not want to be resuscitated or to go to ITU if they were to deteriorate to that point (a stance I agreed with as I would not have wanted to admit them to my ITU). We discussed this with the treating medical team and the appropriate paper work was completed.
When the inevitable did happen it was reasonably calm and controlled and no heroics were attempted. It was as good an experience as death can be.
V sorry about this and of course your feelings are more than reasonable. A friends 91 yo grandmother had her third massive stroke last week and is totally unresponsive.. She is being fed through a tube into her stomach...
Apparently all this has got worse since Shipman. It's a sad state of affairs and in no one's interest. I hope you reach some peace with your nan's death.
I am sorry for your loss.
I understand how you feel. I would have been horrified if that had happened to my mum, and so would she. She got a Do Not Resuscitate thing attached to her notes and told everyone who was involved in her care (she lived with us, and died in her own bed).
I think that is the only way to avoid the situation you describe. Medical staff have to do what they can otherwise. The more people who know about it, the better.
YADNBU. I'm a student nurse and have just had a placement in A&E. My Grandad died on boxing day and had he still been alive i would have insisted he had a DNAR in place (he had heart failure so he was near the end of his life anyway). Luckily he died in his sleep at home so i'm grateful that he had a peaceful death.
Rescusitation, while an immensely necessary part of primary care, is incredibly invasive and brutal and if you've seen a resuscitation attempt then you will realise you would not actually want your loved ones to go through it. It doesn't often have the desired outcome and for an elderly patient can cause a lot of injuries in the process.
With regards to DNAR's, yes they should have checked the notes but sometimes that isn't always done unfortunately. As was in your Gran's case. When someone goes into cardiac arrest, the focus is understandably on dealing with the patient, not looking through the notes to check DNAR status.
We had a patient come in by ambulance in respiratory arrest being given CPR who was from a care home. As soon as he arrived at the hospital it was decided to cease resuscitation and it wasn't until about half an hour later that we found out that he had a DNAR.
An elderly friend of mine had a hard time when his mum died. She was over 100, and had a DNR order in place, but even so, as she just slipped away in her sleep it was deemed 'suspicious' in some way and needing investigation! She had insisted on remaining in her own home, and she had fallen and hurt herself a bit (bruising) and been kept in hospital overnight for observation.
Her family all felt it was her time, and didn't hold the hospital staff responsible in any way, but my friend had to be interviewed over and over by the coroner, police and so on when he just wanted to be left in peace to grieve.
So sad that at such a difficult time they had to go through all that as well. It was something to do with safeguarding after the Harold Shipman murders, apparently.
I know exactly what you mean and I agree with you. I am very sorry for your loss. I hope you have many happy memories and can allow yourself to get past the fact that she was not allowed to slip away as she would have wished.
pigletmania the family DOES NOT have any choice over whether a relative is DNR or not. If the lady in question had chosen that path for her care and end of days, then it would have been on her notes and the staff would have followed her wishes. As it clearly was not on her notes, we can safely assume that she absolutely did want to be resuscitated.
I am so sorry for your loss Jake. I am also sorry that your nan had to endure that during her last moments.
My mum and I are very open about this, we have discussed what will happen in the future should she become frail (she will hopefully come to live with me) and if she gets ill she wants a DNR - at her request.
We have both seen elderly people in work or personal circumstances which mean that being open is the best way to tackle this. Not talking about the wishes of the elderly with the NOK leads to people having to be resusitated when it's not what the family would want.
The NHS and care homes should also be more proactive in dealing with this with very elderly/ill residents.
this is sometimes because people well in advance say DNR if I become seriously ill terminally but if it is mot the termoinal illness that is killing them then the DNR might not apply
my friends father had cancer had about 12 months to live and had decided DNR once got to organ failure stage however someone did not quite understand the exact details and while having some treatment in hospital he started to choke on a fishbone or similar at lunch and someone decided the DNR applied to that so he died of choking when actually he was in reasonable health at time well enough to be going abroad to see his children and grandchildren the next week; so details have to be very very careful
however in OP's case it does seem a bit over zealous of the staff
LaGuardia in some circumstances the family does have choice over DNR or not. I know this because I have recently signed a DNR document (in consultation with family and carers) on behalf of my mother. She has early onset dementia.
OP I am very sorry for your loss.
When my DGMIL was 92 and failing I had a suspicion that she was hours away from dying on Christmas day (she had one of those rallying moments that cause me to go hmmmmmm). As I was a nurse I asked my MIL and SIL to tell me to go out for a walk if she actually died or I would have been obliged to resucitate her. I'm not qualified to allow her to die and she hadn't seen a doctor for a while so it would have been a coroner's moment which I wouldn't want my name anywhere near.
She collapsed the following day and died a couple of days later in hospital with a DNR in place. She had discussed with us that she felt ready to go so while we were sad, we were also glad that she'd had a great day with us all and then slipped away reasonably easily.
OP I'm sorry to hear about your gran, and that you feel her passing could have been easier.
Yes family do indeed have a say in DNAR's in some circumstances. Usually in diminished capacity/relative has power of attorney or in terminal illness where it would be distressing to discuss it with the patient. The doctor/medical team can make the decision to implement the DNAR but must discuss it with the family and the patient if appropriate.
A family however, when a person has full capacity is unable to sign the DNAR and the patient should make the decision with their medical team. I think one can also be implemented in an advanced care directive but i'm not 100%.
I don't understand why the notes can't be checked for a DNR in a nursing home where there are going to be several members of staff, and easily accessible notes. It would take seconds.
My disabled mum's notes had the DNR on the first page of everything, she'd made it formally in a healthcare power of attorney with two witnesses, and still it wasn't taken very seriously in trying to actually establish her wishes. Luckily she was still conscious then and I was there to speak for her by the time she couldn't speak.
DNR decisions ultimately lay with the senior clinician but ethically should be discussed with the patient or if inappropriate the patients family to gain a view of the patients prior thoughts.
I don't think this is a legal requirement but is best practice.
I agree OP sometimes it seems to be more appropriate to let some one die naturally at the end if their lives.
CPR is very often ineffective and distressing.
Am sure your DGM would have been unaware of anything other than falling asleep.
Wishing you peace
My mum had something stuck on the front of her notes. The outside. It was the first thing you saw.
The care home nurse should have been informed of the resus status of all patients she was responsible for; this is an issue that should be raised with the home. You could ask her GP to look into it if you don't feel up to it yourself. I am sorry for your loss
The care home needs to review it's shift handover, the resuscitation status of each person is flagged up at each and every hand over in the setting I work in.
I am sorry for your loss.
fuckwittery Yes there are several members of staff but in a rescusitation attempt everybody will be doing something and concentrating on the patient. The notes would probably not be near the patient and kept in an office for confidentiality reasons as otherwise they could be read by visitors etc. Secondly, looking at the notes would not necessarily take a few seconds, especially in the case of a 92 year old. Ideally a DNAR will be on the top of a patients notes so it is the first thing you see.
Also the PP is correct in that although this was a new nurse, she should have been made aware of all her patients DNAR statuses in handover.
Legally, if she did not have a DNR, DO NOT RECUSITATE, they are legally obliged to do all they can to make her stay alive!!
Sad but true and more what the Liverpool Care Pathway is about than people want to know. They want to think it is a hastening of the end, but it is not it is a not slowing the inevitable. Sorry for your loss.
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