Doctors SHOULDN’T get to “play God” ... AIBU

[MissKittyBeaudelais]

My mum went into hospital as a planned admission, in autumn last year for:-
Medication review
Tests into breathlessness
Physio

Despite admission being arranged by GP, we were told she HAD to go through A&E. She was there around 6 hours and was then placed on a small ward. Whilst in A&E, the Doctor who admitted/examined her talked about end of life and resuscitation. This is standard practice. The Dr. went on and on about what MIGHT occur in the event of resuscitation ie, stroke, fractured bones, brain damage, damage to internal organs etc. My mum insisted that, knowing all this, SHE STILL WANTED TO BE RESUSCITATED. The Dr. continued to push her message and eventually, I asked the Dr. to cease as I felt she was trying to persuade my mum into agreeing to not being resuscitated.

My mum was 79, lived alone, was fully independent and still drove. Her home had two separate staircases and her bedroom was on the top floor. Two days before being admitted, she was shopping in John Lewis for a birthday gift for me and we joked that I hoped it was a suitably expensive and frivolous gift! Remember, she’d gone into hospital for tests. Arranged by her GP. She wasn’t expecting to die. She was put on a ward with MRSA and Norovirus. Ten days later she had got an infection, deteriorated and died.

We requested the medical/nursing care notes as we were not happy with her care. When they arrived, I was really shocked to read the A&E notes in which the admitting Dr stated that both Mrs X and her Next of Kin (daughter) agreed NOT TO RESUSCITATE. I’m fucking furious. I never said that/signed to that. My mother never said that/signed to that. Remember, she was in for tests and physio. She NEVER expected to die. Neither did the family.

AIBU here? Did this Doctor just decide to play God? I remember, when the examination was over, my mum jokingly said “remember Dr, I want anything and everything doing to keep me alive!”

Can a Dr just decide to do this? How does she sleep at night? Ought my Mum/I have been asked to SIGN something to say we agree/disagree?

What would YOU do?

@Bluetrews25... personally, after the experience of my dad with ca.lung and mets being resuscitated WITHOUT our consent (he knew he was dying; Macmillan nurses supporting him and my mum) I would not personally have wanted my mum putting through it. But...SHE was asked, SHE was of sound mind and SHE wanted it.

And not even listening to anyone on the thread

@Deathgrip - the OP said a DNR form was completed.

A DNR wasn’t completed, that’s half the point!

@MissKittyBeaudelais - it definitely sounds like the conversation about DNR was handles dreadfully.

@mindfulmam... I’M being offensive. How? The points I have made are true. They happened.

Before deciding what to do I again encourage you to ask fir copies of her notes and to see the correspondence to/from GP and the tests results etc.

Also were multiple pulmonary embolism ruled out as a cause of her breathlessness? Did she have a D Dimer or PET/CT scan of her chest.

You are bring offensive - medical practitioners are giving you the benefit of their professional experience and you are just insulting them.

Did the DNAR get completed in AE ? Because if not it seems it was just an introductory discussion and they left it until a further conversation was had.

@mindfulmam... I’ve said many times. Discussion AND DNAR went from A&E to MAU. So, discussion IN A&E and Dr completed form after she left the examination room. I have a copy of it. I have copies of the nursing and medical notes, all investigations, tests.

I appreciate the responses, all of them. Whether I agree with them, or not.

What was the diagnosis - sorry if I missed it along the way

@MissKittyBeaudelais

You are grieving. Please think about what outcome you want from this. Yes an error was made in recording that you & your DM wished a DNR to be in place. But as so many have told you, your mum did not pass away because of this. Also, the DNAR decision ultimately is medical. Not yours to make.

What could you receive? An apology? Would that be enough?

You say you agree with the DNAR, but in your OP you are saying that doctors are 'playing god' by putting one in your mums notes, asking how they sleep at night.

Which is it?

It doesn't sound like your mum realised how ill she was, but that doesn't mean a DNAR was inappropriate.

My goodness, you are very pleased with your medical qualifications, aren’t you? The scenario you gave of the death’s door fragile old lady... I do hope that wasn’t supposed to be my mother? If so, you have NOT READ THE PATIENT HISTORY FULLY AND OUGHT NOT TO BE MAKING LIFE AND DEATH DECISIONS.

As for this, I don't even know where to start. On another post you mentioned you a re worried your mum is on a ward with norovirus as she is so frail:
*Ward with KNOWN Norovirus AIBU?
My mum is 80 and was admitted to a ward at the weekend with a patient who has norovirus. Only found out when visiting because we had to gown up with gloves/aprons etc. She’s in heart failure and so when I found out about the norovirus I asked if she could be moved. I think if she catches it, it’ll see her off, she’s so weak.

Am I being unreasonable? My mums so frail.... a nasty bug could kill her on top of what she already has.*

So here you say your mum has heart failure and is so frail and weak norovirus might finish her off.

And yet you are saying that she was completely healthy, denying that she has heart failure of anything wrong with her at all, and me saying that she was frail and end of life treatment was inappropriate means I'm not fit to see patients?

I think you are twisting the facts to try and make it seem that doctors are the reason your mum died, and try and get people to agree with you and slag them and the nhs off. Probably because righteous anger feels easier, someone, that facing the enormity of your grief.
But it is really unfair on people who have limited experience of the NHS. It corrodes their confidence in the service, and means people avoid seeking treatment when they need it so the don't 'get murdered by doctors on a contagious ward.'

If you were a nurse, you must realise how damaging this sort of thing is, and how soul destroying it is when people complain about minor things that were done correctly because they cannot accept an elderly relative has reached the end of their life, and need to blame someone.

end of life treatment WAS appropriate.

Need to start proofreading!

@mindfulmam...that’s ok. We were told by the Dr looking after her on the day she died when we were called in that it was hypercapnia. It’s when oxygen is taken in and the patient is unable to exhale the carbon dioxide. Her symptoms were there for the week leading up to her death... all the things we complained about. Her confusion/agitation/shaking/muscle twitches/weakness/drowsy. So, the morning of the day she died, the dr explained that her organs were failing due to carbon dioxide retention. Dr told us she was in acute respiratory failure due to undiagnosed COPD. The birth certificate was signed by a trainee GP who had only met her fleetingly on MAU. They asked the A&E Dr to sign the death certificate but we were told “she’s busy looking after trauma patients” (and anyhow, she hadn’t seen Mum for 12 days. I thought it odd that the Dr who looked after her (and us, she was lovely) and who was there literally one minute before death, hadn’t signed it. It’s my assumption, she was not entirely happy to do so if they then went to the A&E Dr.

So many questions unanswered.

@AlexanderHalexander... please read the thread fully. I said she deteriorated very quickly. She became very breathless and if you read all of it, she wasn’t being fed because MAU can’t order food on a menu and get what’s basically left on the meal trolly. She lost over a stone in weight in her 10 days of admission. Frail, definitely, who wouldn’t be when there was no food on offer and she was developing hypercapnia.

Personally, as an ex nurse, I was shocked by what I saw. It was a total shambles, start to finish. And when I received my Mum’s notes, there were two other patients notes sent by mistake. Another elderly lady and a male patient! I’m not surprised, as they calling MY mum by the wrong name!

You’re very defensive. And not very understanding.

Quick thank you to all those who’ve thoughtfully suggested bereavement counselling. I am definitely in the K-R anger stage.

Excuse me if I'm wrong, but isn't a death certificate purely a certification of death? Any trained Dr can sign it if they have examined the patient?

I wouldn't rest too much on that.

It's possible the lovely doctor you would've preferred to sign the death certificate was just on leave when they wanted it signing, it varies who signs ours as they need to be done fairly quickly and we have nights, zero days and everything else that I'm sure you understand as a nurse. It's literally done by whoever is available in the hospital and has a spare minute, it doesn't mean anything in particular.

I'm so sorry for your loss. I can't comment on the situation as I obviously don't know the full story. I hope you can access some grief counselling to help you through this difficult time

It’s my assumption, she was not entirely happy to do so

What are you implying with this?

Ah ok. Type 2 respiratory failure. Do you feel she should have been sent up to intensive care for respiratory support?
I also wonder if the increasing confusion was then followed by friendliness and not eating fir that reason.
I'm sorry for your loss it sounds traumatic and that communication - from the GP onwards - might have been better.

Drowsiness

I think the MRSA and norovirus is a red herring and your narrative is a bit confused. Patients in England, Wales or Scotland with norovirus are not cared for on open wards, unless there is an outbreak when they are already admitted. In the event of an outbreak, the ward is closed to admissions. Hospitals are completely obsessive about the transmission between patients. I am not aware of any hospital where a single patient with norovirus would not be the highest priority for a single en-suite room with barrier provision.

Given the low incidence of attributable MRSA, it would be very unusual to have a ward with both. I’m also not sure how relatives would know about MRSA colonisation or infection in other patients.

Most wards restrict visitors to wards with norovirus. I’m surprised you were allowed in at all.

I suspect rather than complain, you might find speaking with PALS to arrange a discussion with the matron for the area or other senior member of staff to fully understand the decision making and reasons for admission. It’s perfectly possible your mother was aware how ill she was but wanted to protect you from knowing. She might well have told you one what she thought you wanted to hear.

It’s also possible the ED doctor was relatively junior and just made a one word error in the notes. Trust policy is usually that DNACPR decisions are reviewed and resigned by a consultant within 48 hours of them being written.

DNR isnt just something in notes. I wonder do you know if no attempt was made to resuscitate I.e. though the notes are wrong did it make any difference? Pals is the route to go x

I have to say that currently when there is one case of norovirus then usually that bay is barriered while waiting for side rooms to become available.