Can't decide whether to have post mortem or not

[MarmaladeSunset]

I need to urgently decided on whether to request a post mortem from the hospital. My mum died in hospital last week, she was in a rehab hospital for a broken bone, was then admitted to hospital, took a week to die there.

During her time there she was diagnosed with delirium which is not a cause of death, it was obvious that nobody took her symptoms seriously, no effort was being made to find out what was wrong with her.

I've now been told cause of death is cerebro vascular disease - this to me sounds like their made up reason because they don't really know.

I was told by one dr that she was prescribed lorazapam and tramadol together at the previous hospital. Those two drugs together can cause respiratory depression and death (found this out using google, which says benzos and opioids together can cause this). I challenged hospital on this, medical officer has spoken to pharmacist who says he is confident that this isn't what has happened as the drugs would have been out of her system by the time of her death.

If I don't agree with their cause of death I can challenge it and presumably request a post-mortem to find out the actual cause. It's so difficult to decide what to do, I obviously don't have enough in-depth medical knowledge to know how long it takes to die of being given these two drugs together, the assumptions of the drs at the hospital may be correct.

Long shot but if anyone has any medical knowledge, or experience of this, or advice, I'd be keen to hear it.

What are you looking to achieve OP? What outcome are you looking for?

That will inform the answer.

This.

Personally if it would always play on my mind and I'd wish I'd had it done then I'd do it. If I can find acceptance of the circumstances of her death without it then I wouldn't.

How much do you want to know the cause of death? An autopsy is very invasive and reading one about a loved one is quite painful. They may still not find a single obvious cause of death. Sudden cause of death is usually a stroke or heart attack, they think it was a stroke and they are probably right.

I'm so sorry for your loss, OP.

Is it possible that your mother did die of cerebro-vascular disease? Why are you so sure that this was not the cause of her death?

Could you ask for toxicology instead of a full post-mortem? TBH lots of people are prescribed benzos and opioids when they're in hospital - it isn't unusual, and they're careful with the dosages given.

Do you suspect medical negligence?

Condolences for your loss, OP.
How old was your mum?

I'm sorry for your loss.

Also interested in how old your mum was and what you want to achieve from a post-mortum.

Agree. Think about what you want from the PM.

We decided against one for dd who went to hospital with a chest infection and died the next day. I wasn’t convinced about the cause of death and wanted to blame someone for a mistake somewhere- how on earth had it happened etc, but realised even a PM wouldn’t bring her back.

Is a coroner involved? Have they given a cause of death? Sorry if I have understood and I’m so sorry about your mum.

Sincere condolences on the loss of your mum. You obviously suspect medical negligence. It isn't unheard of. Tyring to put this delicately I think you are even more suspicious because of your mother's age. In other words, do they bother with older people so much given the chaos the NHS is in? I think you might regret it if you don't have a post mortem. You may feel you have let your mother down.

However, as others have said, a post mortem is invasive and they may find nothing.

I'm sorry for your loss. How old was she? PM won't necessarily pick up levels of lorazepam etc and pretty much everyone in their 80s has some evidence of cerebrovascular disease - basically means mini strokes. Is it possible that you were unrealistic about how frail whe was?

This is always very difficult as a non-medic is not really in a position to challenge the diagnosis/cause of death because of lack of knowledge - and google is not really a good source, as things tend to be a bit more subtle than that in practice. I am sure these two drugs do in conjunction have their problems, but the dosage is what matters.

I wonder if you could talk to the coroner's office locally and see whether they can give you some guidance about your decision?

Very often elderly people can have a whole raft of problems going on that interact and cause a decline, especially after the trauma of a breakage, or an infection. Sometimes it is not entirely clear what the final straw was.

I know that my OH (who had Parkinsons) was diagnosed with delirium after surgery for a broken hip and to be honest he never really recovered from it all - it was just more than his system could cope with and he declined over the next 9 months and died. The cause of death on the certificate was "pneumonia", but I am unconvinced to be honest - he had possibly had a cold, but I also think he had had a mild stroke (family felt that his smile was different) - I think he died of a whole combination of things. I did not request a post mortem, because I had no reason to think that anything had been done wrongly or that anything could have been done to alter the sad outcome, even though I felt the cause on the certificate was not wholly accurate. I was just pleased he was no longer suffering.

In the end, what is important is that you can feel at peace about her passing. I hope you can find this peace.

condolences op.
mortality rates in seniors after a fractured bone is 13-25% within one year.
mortality rates in seniors with delirium is 25-33%.
a seniors body is a balancing act that’s really difficult to manage fixing one issue causes a rebound effect and screws up multiple others.
some research suggests the brain deterioration often is the cause of the fall, and the rest a cascade of events.
its a sad event none the less and I understand the anger if you were caught unaware.

Thanks for all the replies, lots to think about with all that you've said.

I phoned back the hospital to ask the next steps if I want to challenge the cause of death. What would happen is the case would go to the coroner and he or she would review all the details and decide whether a post-mortem is needed, or whether they agree with the dr's stated cause of death.

She was 77, so not that young, but no signs of ill health. I spoke to her GP last week and she was as surprised by the death as we were and felt it had come out of nowhere. She said the case would automatically be referred to the coroner because she went in for a broken bone, but that wasn't the case, if I want the referral to the coroner I have to request it.

Some of you asked me what outcome I'd like - the ideal outcome would be a feeling of certainty that nobody did anything negligent that caused her death.

I'm leaning towards requesting the referral to the coroner.

In these circumstances I would ask for a post mortem .

Some of you asked me what outcome I'd like - the ideal outcome would be a feeling of certainty that nobody did anything negligent that caused her death.

Then you have to ask for a referral to the coroner.

Sorry for your loss 💐

I would also ask for the referral to the coroner. My Mum died last year and the coroner was involved and I found her help amazing.
Edited to add, I am so sorry for your loss, don't forget to take care of yourself.

I think that you should ask for referral to the coroner. The coroner is the expert on these things. With luck the coroner will agree with the doctors and you can say goodbye to your mother with the confidence that her death was unavoidable. If not then you will get the answers you need.

You need to be careful that you don’t go to the coroner wanting a post mortem and then feel let down if it doesn’t happen. You don’t - you are asking the coroner - the unbiased expert on these things - to rule in what happened. And hopefully they will be able to put your mind at rest.

Since updating the thread I spent time writing things down, the areas I have questions about and the concerns I have. I'm definitely going to refer to the coroner.

I'll be ok with it if they decide not to do a post mortem, I will probably be glad if that's the case, I think I just need someone to have completed a more thorough review.

Her 'care' in hospital was shocking, so I can't help feeling a lack of trust in the drs opinion on her cause of death.

have you spoken to her consultant to get their explanation of how they (or more likely their team member) came to the list of diagnoses they described on the death certificate? They might be able to reassure you that there was good evidence that supports what they've described or they might just say that they're also not sure it makes sense and agree with the idea of a post mortem. A lot will depend on the exact sequence of events leading up to her death. The hospital will have a bereavement office who can help organise that (or PALS should also be able to reach the right people).

OP, I think you are doing the right thing. In your shoes I think I would do the same.

I'm very sorry for your loss.

Sorry for your loss. I would support you to get an autopsy if that feels right. It may be that her condition took a sad turn for the worse as can sometimes happen unexpectedly, however at least you will know. If my mum, in otherwise reasonable health, went in for a broken bone and then sadly passed away, I would want to be reassured that it wasn't bad treatment that caused it.

I would also ask for a review. My dad didn’t get a pm and was put down as heart disease but it was best guess really (it was during lockdown). He also had been well until he died and I think I would have processed his death a bit more easily if there was a definite cause

Ask for the review. Definitely.

Really sorry for your loss OP.

Really sorry for your loss. You don't need to read the postmortem so although it's brutal you don't need the detail. Just the conclusions.

I wanted a second opinion after my mums inquest and what stopped me was 1) in my mums case she was found dead at home so no one did anything that could have prevented it ( but I felt they was clutching at straws for the cause) 2) my sibling was happy with unlike cause of death as a non scientific person. They could have said a full moon on Tuesday was the cause I think she'd accept it as most people don't challenge professionals.

So no advice really except once the opportunity has gone it's gone.

A post mortem doesn't always have to be invasive. can't they do it by scanning now in lots of cases ? I think if this could be done I would ask for it so you have answers. My own dm had a Post mortem before the scan ones were used and it is a horrible thought.

I’d say speak to the coroner!

To cut a long story short my Mum died quite suddenly and when she was admitted to intensive care (out of the blue) the first consultant we saw said “we’ll have to find out what caused the internal bleeding” things went down hill and the day we were asked to switch off her life support I asked (this time another consultant) how on earth we got here when she just had an infection and repeated what his colleague had said a few days previously and he shrugged it off!

My Dad didn’t want me to pursue it so I left it…… 5 years later and I still regret not asking more questions- not to sue or to pass blame but to understand what the hell happened but it’s too late now!

Sorry it’s a bit of an essay but ask all your questions now while you can!!