What treatment would King Charles get

[Notreadyforit]

Got a call a few hours ago from hospital. My dad was at friends for dinner this evening, tripped and fell on way to the car. The scan showed fractures and he has a brain bleed. I was told they’d probably need to operate at another hospital and they sent the scans to another hospital who said they don’t need to operate and monitor him where he is. I assume he probably left the house around 10. A and E is busy, with a 13 hour wait. Hospitals are at capacity. Dr Google says quick action and operation (I know, I know). He can’t speak, can barely move one side, has vomited and was trying to push something out of his mouth which ended up being a blood clot. I’m wondering if the treatment path is right for him - how will I know? What would they say if it was King Charles? My poor dad - I spoke to him earlier today and all was fine. They want to monitor him in resus for another five hours. There is no ventilation, no masks, just vulnerable patients and shitloads of viruses about.

Sorry for your loss. 💔

My condolences, @Notreadyforit. It’s good that you were able to be with him.

I’m so sorry for your loss, I hope he passed peacefully.

So sorry @Notreadyforit , whether you believe in the next life or not, he’ll always be with you. May his memory be a blessing.

So sorry. He was surrounded with love.

Very sorry for your loss OP. It can be difficult navigating the foreseeable alone. Do not be afraid to delegate tasks to people around you to help you even if it is blunt and direct. Make sure you give yourself space and grace, but don't isolate yourself, and be sure to eat and drink too even if you don't feel up to it.

I know if you were my friend going through this I'd be happy to come take a load off your shoulders, so make sure you reach out to people if you need it.

Sending you love, OP. I know how hard it is to lose both parents

I'm very sorry @Notreadyforit
but I'm glad you were with him at the end.

So sorry for your loss x

Told the kids this morning. My youngest (just turned 6) kept saying no and asking if I was sure it was true. I know how she feels. They’re looking forward to a sleepover tonight. The funeral is tomorrow, so there’s been no time to breathe.

I'm so sorry OP. I'm glad you were able to be with him at the end .

The last photo before my dad went into hospital was a jokey picture of him with a huge number six helium balloon pretending to my daughter that he was 6. The balloon is still going. He’s not. My daughter’s playing with it.

It might not feel like it but in a way that is really beautiful. He got to leave a memory of a fun time, and a souvenir that right now is bringing joy to your daughter.

It is of course also really normal to feel happy at the memories left and absolutely distraught and feel like you do not want to see any reminders right now. You are still processing what has happened.

Coroner has set a court hearing for February. Has anyone been through one in similar circumstances?

No but my dad died in similar circumstances, difference being that he had a stroke first, fell and banged his head resulting in bleeding on the brain

It can happen so fast I really am sorry. Will be thinkingof you and your dad🌹

I’m sorry for your loss. 💐

I’d been looking for this thread. We’ve had the inquest now. I don’t have the medical records yet. Neurology advice was to reverse the blood thinners. At hospital, they told me they’d done this. Turns out they didn’t. They had issues getting seizure meds. His terminal prognosis came following a Glasgow coma score taken near a seizure by a colorectal doctor. He wasn’t reassessed when he started talking and moving his right side.

Hi @Notreadyforit, I hope you’re doing ok. That sounds very bad, I’m sorry - what was the inquest conclusion?

Oh no @Notreadyforit it doesn't sound like the inquest gave you any positive answers. I'm sorry.

Dealing with funeral stuff at the moment; I can’t imagine the stress and sadness of having to wait for an inquest.

I’m so sorry you’re having to go through all this, @Notreadyforit.

AFAIK private hospitals don’t have A&E depts.

Warfarin is easily reversible with vitamin K but some of the more modern NOAC drugs that most people have these days either aren’t reversible or it’s a lot more difficult requiring restricted drugs that are very expensive and it carries a risk of thrombosis. They do wear off quickly anyway (2-3 days) if just not given don’t may not be necessary to try to reverse with drugs. Even if an attempt to reverse is made there is a higher mortality rate and a risk of further bleeding in people on blood thinners.

As I said on your other thread I would recommend you ask for some kind of debrief to understand the decisions made. It might need to better via making a complaint to PALS but that would provide a mechanism for another Dr to review the case and give you a written (or you could ask for oral) explanation

@TheApocalypticiansApprenticeI’m sorry for your loss.

I’d really value a review, but an honest one. This isn’t about survival at any cost, but ensuring that robust decisions were made. In my head, I thought the inquest would lay down a clear path, but it was just a high level statement from a doctor, portrayed as being unsurvivable from the start. I asked why he didn’t go straight to end of life pathway then or what would have constituted a meaningful change once on it, but didn’t get answers. The high level statement said blood thinner reversal was advised and I remember being told they had reversed them at the hospital when asking about his progress. It was also implied they were given in the high level statement, but was unclear when. The only reason I found out it wasn’t given was when I asked what time it was given. We were told at hospital that they can’t scan once a patient is on seizure meds. Guidance says not to base a prognosis on a GCS score near a seizure. I was told they were having difficulty controlling his seizures - not that they couldn’t access seizure meds. I’m left with a horrible taste in my mouth, trust eroded and more questions than answers.

The outcome I want is dad fell, there was nothing they could do and he died. That that is the best outcome is a headfuck in itself. The current situation seems to be dad fell, they could have done x/y/z, put him on EOL on a prognosis that goes against guidance and ignored him when he showed signs of recovery. The same doctor telling me ‘how long is a piece of string’ at hospital when talking about whether my dad might need some level of care when he came out and what that might look like, is now saying it was never survivable.

I think it is hard to get that level of detailed questions answered at an inquest which isn’t really designed for that purpose. It is just establishing the cause of death and whether it was natural causes and isn’t designed to look at any issues with the care provided.

I do think you will need to go via PALS and make a formal complaint to get the answers that you need. Just write a list of the questions that you have and need answers to and ask them to give a justification eg ‘please clarify whether my father was given a drug to reverse his blood thinners and if not please explain why?’ ‘Was my father given adequate anti seizure medication and if not please explain why? Did a lack of access to medication contribute to his death?’ ‘I am concerned that my father was put on a EoL care pathway prematurely based on a GCS score that was post ictal. Please explain why this was done?’

A complaint response should give you the kind of detailed reasoning you are looking for and will mean that another Dr reviews the case. If you remain unsatisfied after their response you would have the option of taking it to the healthcare ombudsman.