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

I'm sorry for your loss; my DH had ulcers and was admitted to hospital for surgery; the pre-op tests showed his white blood cell count was dangerously low so they didn't operate. Surgeon said he'd have died on the operating table if they'd proceeded. So they kept him on the ward for about a week until he was strong enough for surgery.

Sorry for your loss.

My dad died on the operating table. He'd been in a road accident a day before, he might have survived without the operation but more likely not, the operation was known to also carry a risk of death. I didn't see him before he died because I didn't live close to get there in time, if he hadn't had the operation I probably would have.

The doctors made the wrong call in my dad's case by operating, I don't blame them though, they don't have crystal balls, they can only make the best decisions they can with the information available.

I’m sorry for your loss
I think EverdeRose explains it well and I don’t think, given his blocked arteries in his legs, he would have survived an operation.
I’ve heard lung cancer patients say they have been refused an op due to their blocked leg arteries because their chance of survival is so low so they are told to just make the best of the time they have left.
I know this is a difficult time but putting his frail body through an op wouldn’t, in all likelihood, have changed the outcome but would have cause more distress all round.

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

People without many other attendant health problems which would complicate their surgery and recovery.

DonKeyshot - Ulcers would only be 'picked up' if they were causing a problem, i.e. bursting, bleeding or causing pain. Hospitals don't shove a camera down every patients throat (a significant and serious procedure) just in case they have an ulcer.

And many people do make a complete recovery from this type of surgery, but they are almost certainly people who have been deemed 'fit' to have the operation.

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.

Why would they without doing an endoscopy, especially if he had no symptoms of one? Even the tests for the bacteria are not conclusive. I had two of them, one breath and one blood. Both negative. Still had issues. Found the ulcers by endoscopy but even that can be risky in someone with certain health conditions.

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

IF they do not have any other health problems. A surprising number of people are serious health risk for GA and sometimes even prior treatment of certain disease (such as cancer) can cause unseen organ damage and failure that makes it risky.

Two tests, that is. Also had two ulcers, but those were only confirmed by endoscopy.

My DF had surgery in his early 80’s. He was a fit and healthy non-smoker but still ended up in HDU with pneumonia.

Pneumonia is a common complication of surgery for older patients and given your uncle’s health and history of smoking, it would be another risk they would have to take into account.

Sorry for your loss.

If it helps at all my grandmother died from the same thing in a country with privatised healthcare. There just wasn’t any point operating. I’m sorry for your loss

I’m so sorry that you lost your uncle . Sometimes it’s easier to deal with anger than grief. I work in a hospital and sometimes watch elderly people who have little chance of survival being put through all sorts of scans and tests on the request of the family. I understand that in the throws of possibly losing a loved one , families want to try everything possible to make them better, but this is really not in the best interest of the patient. I have seen patients pass away in the CT scanner , rather than passing peacefully in a bed with their family around them.

First of all I am so, so sorry for your loss.

I was in almost the same position with my mum back in the summer. She was very frail, aged 82, and diagnosed with a perforated ulcer in the duodenum and sepsis. I was with her when the consultant spoke with her (or tried to) and he gave me the same figures as your uncle but in reverse - he said that she had a 5% chance of surviving the operation, he felt it was unlikely to be a success but she had given her consent and he would operate.

For us there was a surprising happy ending - she made it through the op and is in better health than she has been for years.

But I really don't understand why two patients in different hospitals should be given what appears to be the same diagnosis/prognosis yet one receives an op and the other doesn't?

We were told that the situation was a dire as it could be - the consultant told me to stay with her until she left for surgery because it he did not think she would make it and I should make the most of my time with her.

He did say that he didn't know whereabouts the perforation was - higher up would be better than lower. Perhaps he also had sepsis and was in a worse condition than my mum? Perhaps the perforation was at a point where they could not repair it?

I am so sorry you are having to go through this.

We require consent to perform procedures but are only required to consult with the patient/family and friends to withdraw certain interventions or not carry out procedures.

As humans we are selfish, we don't want to say goodbye or lose people we love. Of course we'd say 'no keep my mum alive'. It would be cruel to make loved ones make that decision.

So sorry for your loss :(

'In terms of the hospital it likely boils down to money. Operations cost the NHS money. If they felt he wouldn't survive it they wouldn't want to waste it. '

Nope, not with that sort of operation.

Most likely the risks (95% chance of not making it through) of the operation outweighed the potential benefits.

They presumably hoped that the antibiotics etc would treat it, otherwise I imagine they'dve tried the op. When he deteriorated so quickly, they didn't have chance to do anything.

True that they could've picked it up earlier- that might've made a difference or it might not, IDK, depending on his general health and whether an operation then would've been any safer. The wait could be something your cousin could make a complaint about if they wished, if they felt different treatment at the time might've made a difference.

Hugs xxxxx

TPT had had to undergo treatment for a benign tumour (which is, well, often the same drugs used to treat malignant ones, they are powerful and can cause a lot of complications). She also had a blood disorder.

I am sorry for your loss @sadaboutlife.
Nobody can really tell you what factors were involved in the decision because even those here with professional knowledge don't know the details of your uncle's condition or his background.
I have over 25 years experience working in critical care and could probably make some educated guesses, having seen this type of situation many times in my career. But it would be conjecture. What you need to do is to talk to the staff who were actually involved in your uncle's care. But first you need to speak with your cousin, who I presume is next of kin?
What I will say though, is that this decision will not have been made lightly, and not by a single person. Your uncle's long term health, which sounds as though it was not good, will have been a big factor, as well as precisely how sick he was on admission. The other thing that it is important to understand is that it is rare for someone to die actually during an operation, even if they are frail and sick. More often in this type of situation the surgery is followed by a long stay in ICU having a lot of painful and unpleasant treatment. That is worth it of course if there is a reasonable likelihood of a good outcome, but not if death is inevitable.
But as I say, the only people who can really explain to you are the staff involved, and as others have suggested, PALS is the best way to do that.

But I really don't understand why two patients in different hospitals should be given what appears to be the same diagnosis/prognosis yet one receives an op and the other doesn't?

The OP's uncle had many other health problems, particularly regarding his circulatory system and his breathing, and that he was a smoker - smoking raises the risk of complications even for otherwise healthy people. It may be that your DM was in a less vulnerable state altogether.

As none of us have the medical records (and probably couldn't interpret them if we had) we can only speculate.

Ithinkisaw

Its cruel and unfair to say that. We're talking about two completely separate people. You have no way of comparing their comorbidities, size of perforation, current blood work, level of infection or about a thousand other things.

You might as well ask why her apple doesn't taste like your pear since they're both fruit so should be the same thing.

I'm so sorry for your loss. It's hard to lose someone unexpectedly and especially when you think there was something else the hospital could have tried.

I believe the NHS acted in the best interests of your uncle. A major surgery like that would mean a great deal of pain, his poor circulation indicates other problems. Operating and have him die in traumatic circumstances or dying in pain following a difficult circumstances would be much crueller than making him as comfortable as possible and allowing him to say his goodbyes.

I speak from experience. My uncle died on the table at 75. My mum died recently at 73 when the ICU said they had exhausted all possibilities and I watched her die. It was heartbreaking, but I know it was best for her to be comfortable and surrounded by people who loved her.

OP, I am sorry for your loss

Perhaps you might talk with your cousin. As NOK, they would have been the one talking with the doctors, and they will have given them the full information.

But it sounds as if your uncle was in poor health in addition to the ulcer, and if the doctors were saying he had a 95% chance of dying during the operation, that is just too high to risk. Far better he be given palliative care.

I lost mum last year, it's the first anniversary very soon. She had been ill for a while, so we had more warning than you. But it still hurt to agree with the doctors that she be labelled as DNR. Mum was too frail for any CPR, it would have killed her, and we didn't want her final moments to be full of pain and without us by her side.

Yes, there were other things that could have been done, your instinct is to keep trying. But looking back and being absolutely honest with myself, that instinct to keep trying can sometimes come from a place of selfishness. A part of me wanted the doctors to keep trying because I didn't want to lose mum, I was thinking about me, and not what was best for her. I had to give myself a shake and let mum go. That was best for her, she died peacefully. She was in her 70s too.

I think in time you will be able to see this more clearly, that sometimes the best thing to do is to let them go.

I posted before you mentioned that your uncle had a number of other health problems and, of course, it is not clear what his earlier admission was for and what was diagnosed.

Nevertheless, I stand by my post and as for your assertion that but then again I guess you can't argue with the doctor I must disagree and when it comes to geriatric care advocating and, if necessary, arguing on behalf of patients can alter the course of their treatment for the better.

I am sorry for your loss.

A perforated stomach ulcer would cause sepsis and blood loss. Given your uncle's other medical issues, infection and weakened state they took the view that he would not survive and were trying to improve his condition with the antibiotics.

My MIL (79) also died in similar but opposite circumstances. They decided to operate on her perforated ulcer but she died when she was put under anaesthetic - she was too weak and sick and her heart just stopped when they put her under. She died in the anaesthetic room and never even got into surgery.

Unless he was presenting with symptoms of an ulcer on his first admission why would they reasonably be expected to find it?

OP I hope that in time you will come to realise that the medics made this decision with your uncles best interests at heart and that by operating they saved him from an even earlier death which would have been alone, on an operating table or from more pain and an unbearable quality of life.

Doctors and nurses do not go to work with any other intention than to do their best for their patients. In your uncles case I hope you can understand that by not operating they really did do what what was best for him.
Palliative care is not giving up. It’s adjusting care goals appropriately and I honestly believe from all you have said that this was the kindest and most appropriate care for your Uncle. And the kindest care is what you would have wanted for him.

@redcupbluecup, saying In terms of the hospital it likely boils down to money. Operations cost the NHS money. If they felt he wouldn't survive it they wouldn't want to waste it.

What a load of rubbish. The surgeon said there was a 95% chance he wouldn’t survive the operation. That’s what would have made the decision, not funding. Please think before posting.

Op, I’m sorry for your loss. Perhaps speaking to PALS at the hospitals will give you some closure?

@sadaboutlife

No one here knows your uncles medical background. Some 70-80 year olds are very fit, some are not. The 95% figure they gave you is unite specific and sounds like the anaesthetist weighed up some particular health issues (heart, lung health as well as the condition of his GI system) to come up with that figure.

In those circumstances it is sometimes the choice of having someone die suddenly on the operating table without saying goodbye, “putting affairs in order” etc...or simply managing their discomfort and giving them a calmer few days until they pass, with the family having some warning and time (albeit brief) to come to terms with it. It’s a tough call. Many people say they would like to try everything, but it’s actually very difficult to come to terms with the sudden loss of someone dying during an operation.

So sorry for your loss.

@tttigress - 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

What a bonkers and unhelpful comment. Are you a surgeon? Do you know anything about perforated ulcers or the patient’s condition?

We are bloody lucky to have the nhs, Even with all its failings, and I don’t like seeing people criticising it without knowing what they’re talking about. He won’t have been ‘let to die’, fgs.