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?

If she was given diuretics to reduce heart failure symptoms, then a rapid weight loss would be expected and a good thing. More reason to understand fully - although as a nurse with the notes you’ll see a diuretic script on her MAR chart.
Hypercapn

Ah apologies I might have missed where it said a DNR form was completed

@NewMumAtLast... I was alone with her, when she died.

@CherryPavlova... it was MAU 8 bedded area with the norovirus. Some visiting times we were to gown up and wear gloves. Others not. One day, we were allowed in but then all visitors had to leave to gown up (?). All very inconsistent. We were told about both MRSA and norovirus on the ward. @CoffeeRunner... certification of death was made some hours later, so the body could be released from the ward. The Death Certificate for the Registrar took til Friday, from Sunday.

@mindfulmam... No, by the time she was out on the NIV (Non Invasive Ventilation) to literally blow the carbon dioxide out of her lungs, we could see it was too late for anything.

Yes I see. How sad. Intubation and ventilation as you probably know isn't usually advocated fir copd and T2resp failure unless there is a definite reversible cause as treatment would be unsuccessful.

Heart failure, copd, failed trial of niv. No way would resus have been appropriate. The doctors didn't play God. God did.
Go through PALS, get a health advocate to support you and get a meeting to help you come to terms with this. But don't chuck blame around where it doesn't belong.

@CherryPavlova... Yes, have seen MAR. Fluid balance sheets all very random. Long periods of not passing urine and then “PU” without amounts shown after 10/12 hrs. I accept weight loss expected on diuretics and yet by the time she died I could see every bone across her sternum and her legs still massively swollen so (and breathlessness +++) clearly not losing much fluid.

I don’t really know anymore. I’m worn out, thinking about it all. We will be making a complaint on a number of levels. We won’t get anywhere but, we just want to do it for her. We think overall, that care was not good, we want to state that. Not even expecting any apology. We just want our grievances on record.

And to those who suggest that as an ex nurse I am wrong to scaremonger about our amazing NHS, I was shocked by what I experienced. “We” are better qualified as nurses now....everyone has a degree... but basic kindness was lacking. For her and us. Other relatives felt the same. We weren’t alone. On the day she died, a nurse came to see me. She was not always on the ward and hadn’t seen mum since the day after her admission. She was flabbergasted it was the same woman. Genuinely. And said so.

Consider going on CQC website and completing a Share your Knowledge form. They have responsibility for oversight of deaths.
Ask trust from mortality review minutes/learning from death review to help understand their perspective.
If you complain, do so to the trust chair, in writing. You might get heard then and response might be swifter than via PALS directly.

On the day she died, a nurse came to see me. She was not always on the ward and hadn’t seen mum since the day after her admission. She was flabbergasted it was the same woman. Genuinely. And said so.

Do you think that was due to the nurses writing 'PU' on her chart, or due to her heart failure, type 2 respiratory failure, COPD and pneumonia?

I was shocked by what I experienced. “We” are better qualified as nurses now....everyone has a degree... but basic kindness was lacking. For her and us

If i could pick up on this.... anecdotally, when my Mum was in hospital after her stroke, a total of 6 weeks in 2 different hospitals, it was the EU staff nurses that provided by far the best care, talked to us and would be proactive, in contrast, the UK nurses were somewhat indifferent though more than competent
All the HCAs were great!
This improved in the community hospital, i guess less pressure and they tended to be older.

In regard to food, Derriford went out of their way to encourage us to feed mum, they just didn't have the HCAs to spend more than about 20mins per patient per mealtime and many do not have family, so we had a rota and made sure mum was feed, usually bringing in fav foods for her, as her illness progressed, so did her reluctance to eat increase, eventually fluids and then nothing at all.

I hope you get closure and some peace because in our case, i was very happy with the care my mum got, my sister far less so and it caused really stress as she couldn't accept Mums illness & death, always looking for fault and miracle cures.

@AlexanderHalexander...no. I think, she felt my Mum looked at death’s door. A far, far cry from the lady she’d seen and spoken to, ten days before. She didn’t need any medical info....she LOOKED awful. The nurses writing “PU” twice in a 22 hr period is NOT a good enough fluid balance chart as far as l’m concerned. For you @Alex, I think it’s just an “old lady...case closed” thing for you. I disagree. And she was MY much beloved mother.

@CherryPavlova...thank you for that info. It helps.

I agree fluid balance wasn't filled out properly by the NS. Sometimes however there can be a verbal discussion during the drs rounds too which may have taken place.
I think what Alex was trying to say is that from everything you've said it seems she deteriorated with respiratory failure and cor pulmonale or concomitant heart failure and that is the reason she looked very unwell.

@jasjas1973...thanks. That’s the thing, isn’t it? Yes, she was 79. She CLEARLY had undiagnosed underlying chronic health conditions which led to her hypercapnia, acute respiratory failure, organ failure and ultimately, her death. However, it’s THE MANNER IN WHICH ALL OF THIS HAPPENED.

And yes, I absolutely agree regarding the difference in attitudes between the EU nurses and our own homegrown nursing staff. It was like EVERYTHING was too much trouble. We also had experience of Phillipino nurses who were kindness itself and very helpful.

@mindfulmam... yes, I can see that. Are you a Doctor? You have a lovely attitude and calm manner. Thank you.

I suppose only a review could really say if poor clinical decisions were made and a review of nursing practice to see if they fell short in some way. It doesn't sound like anything specific went wrong but it sounds like you are unhappy and that may be to do with communication at that time and maybe circumstance for eg ward infections.
Good luck and peace with whatever you decide to do x

Ah sorry crossed posts x

I’d be approaching a solicitor about medical negligence if she was on that wards and you think she should not have died!

@Jimdandy... no point. But thank you, for the support.

It might be that she did only pass urine twice in 24hr but I would expect that to be escalated and a catheter inserted if a patient was that unwell and fluid balance is being monitored closely .
PU might also mean incontinence, so unable to measure -wouldnt be surprised in an elderly patient on diuretics.
Again I would expect a catheter to be considered for comfort and to enable fluid balance to be monitored .
When they sent you the copies of the charts/notes did they offer a meeting ?
I think that would be helpful to you .
Do you have any RL support OP ?

@QuickLittleNameChange... that’s the point I was making. Input was just over a litre (she was in 1 Litre restriction) in and ??? Out. It wasn’t flagged up. She was catheterised 2 hrs before she died.

Also, yes. Am very lucky with support, thanks for concern.

@AlexanderHalexander

"You are using very inflammatory language OP.
‘Contagion’ ‘fight for life’"

The OP is grieving for her mother, and understandably angry about some of the care she received in hospital. The last week of her mum's life sounds incredibly traumatic and distressing. Why are you are so heavily invested in picking away at her experience and misrepresenting pretty much every point she has made? Where's your empathy?

Hi OP
I don't feel I can really comment in detail on your mums case as obviously we don't know everything.
I just wanted to say that the most difficult cases are those of heart failure and renal failure especially if the patient can't drink very well and isn't for intensive care treatment.

@MaggieAndHopey...thank you for that comment. I think @AlexanderHalexander is possibly a very clever (presuming) male Doctor. Very competent and totally lacking in any “bedside manner” or skills to put the patient and family at ease. I may be wrong. However, over many years as a health care professional and as a “service user” I have come across people like this. We, the patients are human beings. Scared, frail, mentally weak in the face of illness, behaving inappropriately, defensive and utterly at the mercy of the Doctor and the care they advise.

Again @mindfulmam... thank you.

Misskitty - you are right about one thing, I am very clever

I''m a female, part time doctor, though not saying which speciality..

I have empathy. I, like everyone else, am allowed to give my opinion.

I find it so, so frustrating that the culture around death and dying in this country means that death is taboo, people are shocked, truly shocked, when elderly relatives die.

The OP was clearly being unreasonable with her 'AIBU to think that doctors play god' post, and misrepresented/withheld lots of things to make it appear that her completely fit mother was admitted to a ward, mistreated and died of a contagion that she caught through negligence.

No.

This is a grieving relative wanting to blame someone for the death of her mother, because she is struggling to cope with it. THe medical team are low hanging fruit, as they can't retaliate, and it's so easy to say 'they should have saved her' 'they gave up on her' and expect that they should have miraculously brought her back to life.

This is a normal grieving pattern to some extent (although the overseas aid comment feels a bit off). But what is maddening is the huns who jump on with comments like 'sue for all you've got' 'their obvious negligence' 'the doctor who lied in the notes should be struck off' etc, determined to whip OP up into a frenzy.

All that will happen is OP will complain, won't get very far with her complaint as the care was fine, and feel 'fobbed off' and hold a grudge for the NHS. Instead of grieving for her mother, who passed away aged 79 of heart failure and pneumonia, whose life was so much more than her short death. I hope OP can grieve, move on and remember the good times, instead of being encouraged by irresponsible ghouls to sue over 'PU'd' on a urine output chart

(If she was in heart failure and had sepsis she may have been passing little urine, the ward level treatment of this would be IV fluids, which make heart failure worse.

@AlexanderHalexander ... good grief. I really hope your part time job is something like feet... or wart removal ...or something that doesn’t involve emotion. You are one hard as nails lady.

Not once have I said that someone should have brought my mum “miraculously back to life”. I would not sue. Have not expressed anything other than my intention to be getting it off my chest, for my mum. For her. You weren’t there. I know what my experience was. We are not ghouls because we want better for our loved ones, in the care of the NHS. Standards are at an all time low. It’s in the news every day. People, patients and their families are EXPERIENCING falling standards every

All that will happen is OP will complain, won't get very far with her complaint as the care was fine, and feel 'fobbed off' and hold a grudge for the NHS. Instead of grieving for her mother, who passed away aged 79 of heart failure and pneumonia. And what would have happened at Mid Staffs NHS Foundation Trust, had Julie Bailey just said “ahh well, she WAS old, it doesn’t matter how my mum died and was treated!”?

I don’t want someone to blame. Sometimes, HOW WE TREAT PEOPLE despite the fact that they would’ve died anyway, is the point @ AlexanderHalexander. Does THAT occur to you in your “the Dr is ALWAYS RIGHT” mindset?