To think the hospital just let him die?

[sadaboutlife]

My uncle was 73.
He was taken into hospital last Thursday with severe stomach pains and vomiting.
They gave him a scan and found out he had a perforated stomach ulcer.
Now they said normal treatment would be a operation but they said they didn't think he would survive the operation so refused to do it.
They gave him antibiotics and fluids and 3 days later told us he was dying.
He died yesterday.
I'm angry.
Why wouldn't they just try the Op?
They knew he would die anyway so why not at least give him a chance to live.
I'm so upset.
This time last week he was watching tele happy and now his gone
I just don't understand

So sorry for your loss. When I was a nurse they always did operations on all kinds if hopeless cases if that was what the patient wanted.
Normally reasons for not operating would be if it would cause irreperable pain and suffering and the person would not survive anyway or if they had decided they didn't want any more treatment.
Could be your uncle didn't want to carry on and had already informed medical staff this was the case.
They don't not do operations to save money, it's nearly always the persons wishes.

‘No quality of life’ means just that - his life would’ve been painful and not worth living. Given the 95% likelihood of either death or no quality of life, it would have been very wrong for them to do the op, knowing that in all likelihood they would’ve made his situation much worse.

I’m sorry for your loss. The grief is so raw right now but the doctors’ decision will make sense with time.

Or did they mean a bowel perforation?

In this case the bowel develops a hole, and the contents of the bowel spill into the abdomen, casing severe infection. Antibiotics will not cure this - the bowel needs to be fixed. But the patient has to be fit enough to survive a big operation. If they arent there is a high chance they will die or have a very poor quality of life following the operation - pain, on a ventilator - and then die.

@PlasticPatty the trouble is that many people do not accept death as a natural part of life. There is this attitude that people should not be allowed to die when realistically there is either no hope of survival or if they do survive it would be an existence which is almost in humane.
Every single person is going to die. When operations and treatment are going to cause more harm than good it’s kinder and sensible to switch to palliative care to give people a comfortable, gentle and dignified ending. Anything else would not be providing good standards of care. I have been there myself with family members. And was very grateful that their last days were not spent undergoing futile treatments but spent comfortable and peaceful with family having precious time with them.

OP, my grandfather and FIL both died from perforated ulcers. Both in hospital. Both died relatively pain free with family around them.
My own father died in hospital from a blocked bowel. We knew that if he had been put through the trauma of surgery, he may well have been on life support for a long time, and not recovered. This was discussed with him, and he agreed that he didn't want the surgery. He died 5 days after being admitted, pain free and with us by his side.
He'd had a life saving op 3 years previous, which has only a 10% success rate, but obviously survived, spending 10 weeks in hospital and many more weeks recovering a time home. So the pp who said it's all about the money is talking absolute rubbish.
Another thing, unless you are his next of kin, the hospital or PALS will not discuss this with you.

Yes, it sounds like they just let him die - 73 is not that old.

Makes me laugh when people say the NHS is the envy of the world :(

Was he not very mobile, OP? I am sorry for your loss, as villamaria mentioned it does sound like he suffered from poor circulation which might have made the healing process much harder than usual, the ulcers on his feet were probably due to the poor circulation.

I'm so sorry that you have lost your much loved Uncle.

I'm another who thinks it would help you to come to terms with your loss if you talked to the hospital PALS.

It sounds as though your Uncle had very complex medical needs, and these would have been at the forefront of the Consultant's mind when he made the decision not to operate.

PALS will be able to explain things clearly to you, and help open the door to your grief.

When operations and treatment are going to cause more harm than good it’s kinder and sensible to switch to palliative care to give people a comfortable, gentle and dignified ending.

But surely the patient (or those closest to them, if they're not well enough) should be the one(s) to decide when to give up on active treatment, not the hospital?

Many people can't have the GA that would have been needed to operate without dying. Sadly it's not about letting them die but that the operation will kill them. Even my BIL, who is only in his early 50s, is a life-threatening risk because he has a defib and two stents/coronary artery disease. I hope you can find some peace from this. My FIL died this time last year due to superbug pneumonia. He had a number of serious health conditions that meant they could only do so much.

Similar happened to my Nan and she too died. She was a little older tho. I often thought what if we’d have insisted with the operation straight after. Now years later I can see it was the best option for her. Only time will really help you to understand.

My DM had a brain injury at the same time she had a heart condition. We were told that if they had to operate for the brain injury she would be unlikely to survive the operation because of her heart condition, and we would have to decide whether it would be fair to operate on her. Luckily she ended up not needing an operation, but we were weighing up what quality of life she would have if she had survived the operation.

I am so sorry for your loss OP.

I think it is possibly your grief making you angry that they didn't do anything. My DF died a couple of years ago from terminal cancer. In his last few weeks it did feel as if the doctors had abandoned him and I felt so angry towards them and also angry that I had not done more for him, but realistically there really wasn't much more they could have done, and it would most likely have resulted in DF in living only a few more weeks and being in much more pain, so no quality of life.

tttigress - 73 isn't old if you are in good health, but it sounds like the OP's uncle was in poor health with diabetes (ulcers on feet) and peripheral vascular disease (arteries in legs from smoking). These things take a toll on your body and reduce your life expectancy.

They didn't just 'let him die', I work in the NHS as a doctor, if anything we often keep going past the point where it is in the patients best interests to stop, for fear of a complaint/being sued.

But surely the patient (or those closest to them, if they're not well enough) should be the one(s) to decide when to give up on active treatment, not the hospital?

1. Only the patient has a right to consent to treatment, unless there is a nominated power of attorney for health.

1. No one has the right to demand treatment, only to consent to the treatments offered.

I’m sorry for your loss.

However, if he’d had the operation and likely died, you would be questioning why the hospital didn’t just make him comfortable, let you all say goodbye to him and let him go peacefully. You’ve lost someone suddenly and you’re going to question it but the hospital was in a lose-lose situation. Unfortunately, sometimes there is nothing that can be done.

Unfortunately from my experience, people also seem to perk up at the end, give you a false sense of hope and then they die very suddenly after that. It really knocks you because you start to think it’s going to be OK. It’s hard to get your head around for a long time.

@lludmilla. No. The wishes of the patient and family are always taken into account but healthcare professionals do not have to carry out unethical treatment that’s likely to be harmful to the patient. Families have no right to force doctors or nurses to cause harm to patients and rightly so as that’s essentially what they would be doing in cases like this.

But surely the patient (or those closest to them, if they're not well enough) should be the one(s) to decide when to give up on active treatment, not the hospital?

But surely you cannot compel HCPs to perform procedures that they know will do more harm to the patient than good? They have a duty to first do no harm, and putting someone through an operation that will kill them or give them a horrific death is doing just that.

maybe he was already septic on admission and they did not think he would survive surgery. Sorry for your loss.

Unfortunately Lludmilla people are not often thinking clearly when it's literally a life and death situation. I wanted my own dm to get the chemo that could only prolong and not improve her life. I wasn't ready for my dm to die, she was 64. If I was asked I would have said yes, chemo all the way. Looking back it would have been 100% the worst thing to do, her last months spent vomiting and pumped full of drugs. Instead she had a month only needing pain relief in the last few days.

Sorry for your loss!

As others have said, I suspect the decision was made based on the likelihood of him recovering. Surgery is painful and takes a lot to recover from, I think in someone so poorly it would add considerable amount of suffering on them to have similar outcome.

At the moment you are likely to still be in shock and you will go through so many emotions trying to get your head round it and question the what-if. This is all a normal reaction to have when people are suddenly gone.
I agree that you can contact the hospital and request a debrief as to why decisions were made in the way they were made. Nothing will bring your uncle back but it may help you understand why surgery wasn’t completed or viable in your uncles situation.

I'm so sorry for your loss - but sometimes making someone comfortable, and allowing them to die with dignity, and giving their family the opportunity to say "goodbye" really is the kindest thing.

Having worked with surgeons in theist, i really don't believe that money is the bottom line. What they look at is likelihood of survival, how likely the patient is to recover without severe distress, and the quality of life they are likely to have afterwards. (Also, I can tell you that having a patient die on the operating table when you are doing everything you can to save them is dreadful.)

It is very difficult when you love someone to accept that their time has come - we would do anything and everything to save them - but often the patient dies on the table, and there is nothing that can be done, or they survive the surgery, but never regain consciousness - or worse, they do regain consciousness, and have to be so heavily drugged for the pain that they don't recognise family, or slip back into a comatose state. Sometimes people can hang on for days and even weeks like this, and it is dreadfully stressful for the families - knowing there is no hope, hoping anyway, and having the process drawn out. Or sometimes they will recover, but their quality of life is so badly affected that it's not acceptable;e.

You are bound to be distressed, but I honestly and truly believe that even in this cash-strapped environment, the NHS puts the welfare of the patient above everything. And sometimes that means making them comfortable, and allowing them to die with our pain or distress.

My DH is the same age as your uncle. I don't think he's old enough to die either - it would break my heart if he had anything like this happen to him, and like you, I would fight tooth and nail to get any treatment whatever that would give him a chance. But it wouldn't necessarily be the right thing to do. Please trust that that doctors took the decision with your uncle's long-term comfort in mind.

But I do feel for you, and for all who loved him.

With the other health issues combined, it does genuinely sound as if they refused because your uncle would have died on the operating table or had no quality of life. I don’t believe it is to save money. My friend is on a waiting list to have heart surgery. He is in his mid 80’s. I asked him why he didn’t pay for it and he explained the valve would cost 20k.

Op I’m sorry for your loss. How lovely that you were close to your uncle.

I think it’s natural to seek out answers in situations like this. However I’m not sure any will make sense or be good enough, or help how you feel. The sadness is overwhelming, and the need to question and doubt may well be a manifestation of that awful feeling of helplessness (I’ve been there). But some situations are helpless and very difficult to get your head around. It sounds like your uncle was very poorly already and I don’t know how you shake off that feeling that something else could’ve been don’t but I think a small part is the shock, the strangeness, and the heartache and like someone else posted, I hope that soon some of the decisions made will make more sense

Studies into people who are unable to be operated on have shown some ulcers will self heal.

You mentioned a hospital admission 4 weeks earlier and his legs. It sounds like he was not a well man. His leg problems and smoking add up to him more than likely having severe heart failure. If that's the case his body would likely not have survived the anaesthetic. Plus the lengthy recovery would mean he would more than likely never walk again, the elderly lose a significant amount of muscle mass every day they're in hospital and struggle to gain any back.

Also a perforated ulcer wouldn't have been present on his admission 4 weeks earlier, it's an immediate thing, it's either there or not. At most they'd have seen a peptic ulcer if the popped a camera down but that's a very serious procedure as well. Most people with a perforated ulcer don't even know they have an ulcer until it perfs.

Did your cousin include you in decision making? A lot of this should have been discussed with him. I don't know how far you'll get complaining to Pals as you're not NOK. Also if your cousin is happy with the care received you may have to let this go, I think you need to know how he feels before you take anything further.

From what you've said, or not said as the case may be, I would be questioning why your uncle's previous admission four weeks before his death did not appear to have picked on the fact that he had an ulcer, or ulcers.

A perforated ulcer is not an age-related condition. Tara Palmer-Tomkinson died from a perforated ulcer which had caused peritonitis and blood poisoning. and it would seem that your uncle suffered the same fate.

Rightly or wrongly, it was decided that your uncle was too frail to survive an operation. At that point I would have sought a second opinion and I would have certainly queried why it was thought that he would 'have no "quality of life" if he did survive.

Many people make a complete recovery from this type of surgery, but early diagnosis is key.

As suggested by a pp, you and your family may benefit from a discussion with the team who treated your uncle and I would hope that monetary considerations played no part in their decision not to operate,