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.
Unfortunately this situation occurs too frequently; I'm a paramedic and we find ourselves carrying out resuscitation on people who common sense says it's inappropriate. For us not to start a resus depends on strict criteria eg how long since the person was last seen, what is shown on the ecg etc. We are not allowed to look at the person individually, or even to use common sense as everything is timed and ecg printouts required if resuscitation is not started.
Also I think most people think having a conversation with famillies/care staff, or writing their own letter of intent re resuscitation will be ok -unfortunately for us not to start a resus on someone who technically we should do, there has to be an official DNR hard copy in place, on the premises, for us to see. Even DNR's active in hospitals are usually not active once the person is discharged home/care home, and not many people realise they need to get a new one sorted by their own GP.
I hope you have lots of happy memories of your gran and as others have said she wouldnt have been aware of a thing xx
I also found the book by the late Jennifer Worth very interesting reading. I didn't realise that life was preserved at almost any cost to the patient, even when the patient was highly likely to suffer a poor quality of life if resuscitation was successful, unless they had a DNR in place, which staff were aware of in an emergency where resuscitation was required.
The book had some truly heartbreaking stories in there of people whose quality of life was so poor after resuscitation, that even the family members who had originally begged for their loved one to be resuscitated, had realised it would have been kinder if the relative had slipped away.
I'm really sorry. My Granny died last night too. She was in hospital for a couple of weeks and there was a tremendous fuss last week when she was given all these interventions and hooked up to all sorts, and it turned out they had lost her DNR and left it at the other hospital.
Once that was found, things got better...but my parents were in a state trying to get what she needed and wanted - she wanted to die at home but ended up on a noisy ward instead.
It is a minefield and very hard to get it 'right' I think, because it's not the sort of thing you can get good at, it doesn't happen that often to many of us and we're unaware of the protocols and so on.
I do think things should be made less bureaucratic though for the sake of the people who are dying and those close to them.
Rest in peace, both of our lovely old ladies x
Your nan sounds like she was a great lady. I love her observation on her fellow resident.
I found Jennifer Worth's book of call the midwife fame very enlightening on just what you are saying. She argues,as others have here, that death has become too abstract for most of us and dnr is often the most appropriate course in very old age, but this is not applied in current medical care. I do so agree with you being so upset that this wasn't applied despite your nan's wishes.
I am so sorry for your loss.
Even if she is DNR medical staff DO make mistakes. One of my colleagues successfully resuscitated a guy who was DNR once only for him to arrest again 2 days later. Thankfully the second time a decent doctor was on duty and he got to pass away.
I think you should talk to the care home. It's good that you are able to accept it now but it shouldn't have happened if she had DNR on her notes.
I would calmly talk to them about reviewing their procedures so that it doesn't happen again. Someone mentioned a colour code system - perhaps over the door or somewhere discrete but obvious if you know where to look.
I used to work as a clinican and one of the main reasons I left the profession was the undignified preservation of life. I specialised in neurosurgery and neuro- critical care. I had to deal with a lot of young people with AIDS induced vasculitis, massive head injuries and devastating intra-cerebral haemorrhages. These people were left in comas and some were given the prognosis of LESS than 1% chance of a meaningful recovery. Were we allowed to switch off machines? Were we hell! They had not met the criteria for brain death. I now have a living will that if I am unfortunate enough to ever find myself in this predicament I am not to receive active treatment and just to have basic pain relief and a dignified death. Treating these poor souls left me with severe clinical depression which disappeared a few days after I quit the job.
Your nan sounds like a lovely lady with a real character.
I'm sure your Nan would have wanted the nurse to do her best for her in all the circumstances and it sounds like she was really lucky to be in a lovely place. Hopefully she didn't know or feel anything right at the end.
May she rest in peace, I hope you can enjoy sharing some memories about her with your family over the next few weeks.
Again I want to thank everyone for their kind words and their comments about this.
My Nan was asked several times over the curse of her stay in the nursing home about resuscitation, each time she clearly said she did not want this. The home is a busy one though and I cant quite clearly see that a nurse who is new might not know everyone well enough to know who is and is not for DNR.
As a family we know she had fantastic care in this nursing home, she was as sharp as a pin and didn't miss anything. She repeatedly told us about being happy there and the Carers and Nurses, she knew all their names and about all their families. She knew all the other residents and all their troubles, I will laugh forever about "the new lady who can't drink from the cups because she has a nose like Punch and can't get it in the cups so has to drink from the side".....my Nan all over that was
It makes perfect sense to me. We have families going to the media talking about the fact their "92 year old cancer-riddled/etc family member was placed on the pathway" - what did they expect?
We seem to have lost the ability to come to terms with death - I've witnessed sheer panic and terror at the viewing of a cadaver. Death comes to us all and I think we need a change in mass psyche. It's not uncheatable and I think we also perhaps need to look at the sensibilities of keeping people alive for the sake of it. Medical advancements are wonderful, but they don't need to be applied in each and every situation.
I would be horrified and furious if an ill and frail member of my family was "kept alive" despite DNR's.
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.
What???? It's not a hastening of the end but it's a not slowing the inevitable??
Firstly bringing the Liverpool care pathway into the debate is completely irrelevant when we are talking about DNAR's. Secondly your statement makes no sense whatsoever.
Sorry for your loss
My god she was old though, 92 years is an achievement!
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.
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.
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.
Message deleted by MNHQ. Here's a link to our Talk Guidelines.
My mum had something stuck on the front of her notes. The outside. It was the first thing you saw.
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
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.
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%.
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.
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.
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
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.
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.
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