Should This Woman Be Put Down?

trip 075 This is my mother at Southampton airport on her way to celebrate her 97th birthday in Spain….the which she did…in style. Thank you, Maggie and Adrian.

She hasn’t changed a great deal since this photograph was taken a few weeks ago…….so does she look to you as though she should be put down?

When she had a hip replacement operation at 95 and a knee replacement at 96 her surgeon certainly did not think so…he told her she would be good for another ten years: but a more junior medic clearly did not agree.

Mother asked for a house call recently as she had a heavy chest cold and did not feel up to going to the surgery in the miserable weather to see whether or not it was an infection of some sort.
There was no problem with obtaining the house call – her G.P.’s surgery is well organised – but there certainly was with the result.

Mother and her friends have a mutual assistance agreement.
If they have a doctor calling one of them, another of their number is with the patient… not that they are expecting anything in the nature of a cross between Carry On Doctor and The News of The World – as they say, chance would be a fine thing at their age – but they think that two heads are better than one when remembering a doctor’s recommendations, so when the young female doctor arrived, mother’s friend Adolpha was in attendance.
Which is how I know what happened.

After the usual pleasantries, the doctor examined mother, looked at her notes and prescribed a diuretic which mother refused: there was some civilised discussion about mother’s blood pressure and then the doctor said that while she was there she would take the opportunity to update mother’s notes.
Just a routine matter, nothing to worry about.

‘In the event that you have to be taken to hospital in an emergency, would you like to indicate now if you would prefer not to be resuscitated?’

Silence in the room for a moment….then

‘If you want to kill me you’ll have to shoot me first.’

I first heard of this from Adolpha, full of rage and fury and was struck by something she said.

‘What did this young madam see; an old woman living on her own feeling miserable with a rotten cold and she has the cheek to even think that her life isn’t worth living.
I wouldn’t mind betting if she’d seen her in the villa in Spain, enjoying her holiday, the thought wouldn’t even have ocurred to her!’

I heard it from mother too. Her initial fury subsided, she was sad and downcast that the question had been posed.

‘I suppose she thinks that I’m on my own…you live the other side of the world…there’s no one here…they can do what they like.’

Then, angry again,
‘If they want to be rid of us let us have a dose of morphine to do it ourselves, not to be tortured to death without food or water!’

She and her friends, all people with their wits about them, hold the local general hospital in fear and loathing.

‘But you had both your ops there and nothing could have gone better…’

‘Yes, it’s all right if you go in for something like that….where they know it’s for a limited time and then you’re out into rehab……but you don’t want to be taken there helpless if you’re old…’

A gentleman living down the road from mother was taken ill and came to himself as he was being loaded into an ambulance. He fought his way out of it, terrified that he was being taken to die.

There is clearly something terribly wrong where such a lack of confidence exists and I don’t see much sign of the hospital concerned doing anything to allay the concerns of the elderly in its zone; especially those living alone who don’t have a family member close by.

Mother may not be able to get about as once she did…her eyesight is not what it was…but she enjoys her food, her music…and the sport on television.
If you want a re run of Krakatoa exloding just ring mother when the Hennessy Gold Cup is on the box….

She has cleared all her clutter – to save me doing it after her death; she has just what she needs and wants to stay independent and she very much resents anyone even asking the resuscitation question.

She doesn’t want to be kept alive if the obvious outcome is life as a vegetable…but she wants a doctor to assess the situation on the facts…not to use a consent to non resuscitation form to bump her off just because she is old.

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40 thoughts on “Should This Woman Be Put Down?”

  1. My grandmother would have been delighted to be offered a way of formalising a request not to be rescusitated. She had a heart disease that meant she was rescusitated 3 times in her 60s, much to her weary annoyance. She made it clear to the medical staff she did not wish to be rescusitated, but in those days (the 1970s) patients were not allowed to make the decision.

    1. I quite take your point.

      Ideally doctors would have enough guts to make their own decisions in the field….respecting, for example, your grandmother’s wishes.
      My mother wouldn’t want someone breaking her ribs to stimulate a 97 year old heart, I can assure you.

      But behind the doctors are the hospital trusts and their insurance companies…..and what my mother and her friends fear is being placed on the Liverpool Care Pathway which they firmly believe is the pathway to a hellish way to die….but which covers medical staff by being an approved procedure.

      She says she would prefer to be smothered with a pillow in the old geriatric hospital style than be deprived of water.

  2. Gracious me, I can only presume that you speak of those still wet behind the ears sycophants who continue to run-down the NHS at the highest levels until all that is left will be a tangle of scrapped hospital bed pans and a dog-eared copy of ‘teach yourself Indian’ translation guides. No wonder nosophobia is on the increase amongst our senior communities. The continuing hospital theory appears to be that it is easier to switch off a life than it is to spend money to prolong it. At what point do we determine that a seemingly healthy life is no longer of any importance, but accruing points on a national empty bed charter is?

  3. A sad but typical indictment of our times. “Please sign here to ensure the world that we take no responsibility at all should the worst happen to you while you are in our care.” That isn’t care. It is the exact opposite.

  4. Glad to hear you have a feisty mother, Helen. It’s not a question to ask someone when they’re ill – posed sensitively in a different setting, then it could help someone have their wishes respected when their life is in the balance. I think of my own parents and how different their situations are – and can only assume they’d make very different decisions.
    Hope the cold has now gone and the question doesn’t linger in your mother’s mind.
    Axxx

    1. It lingers all right…she is still boiling with fury.
      I think that a lot of the problem is that she feels that were she to have an emergency then doctors will not look at the situation in isolation, but will. should she sign the form, put her on the Liverpool Care Pathway which, as in use at her local hospital, is a disgrace.

  5. I wonder if these young doctors ever stop to think about how they would feel if they were asked the same question. We all have to grow old…it will be their turn eventually. Age is just a number. It doesn’t matter how old you are. If you are reasonably fit and healthy, you should always get the care and treatment you deserve and a bit more respect than that shown to your mother. I’m glad she is so feisty…good on her!

    1. Mother’s view is that if she is in a state where she can’t enjoy her life then she’s prefer to be allowed to die…but not by being deprived of water which is what she fears will happen if she signs up to this document. There is something seriously wrong with what is happening to elderly people at her local hospital – far more than some urban myth amongst the elderly – and it worries her.

  6. What an appalling question to ask your mother at such a time. How lucky that she has all her mental faculties, and a good friend, to protect her. What safeguards are in place if one of these doctors asks the same question of somebody who is alone, temporarily confused or distressed who does not fully understand the implications at the time? As for the insensitive doctor, she needs a resounding rap on the knuckles with a walking stick.

    1. I’m very glad that the group of friends look out for each other as they do because I can’t see any safeguard in place if a doctor were dealing with someone depressed or not in a fit condition to understand the implications.
      My mother’s G.P. would know that she would not sign up for any such thing….but would he see the file if she had an emergency?

      I’m contacting her G.P. about this visit…he will be almost as annoyed as mother!

  7. I wonder if the young doctor took anything away from this. I presume if your mother refused the ubiquitous water pill, she may also have set the young medic straight.
    I once saw a young medic educated. My mother was terminally, terminally ill. I was at her hospital bed, together with her oncologist and his young side kick. Her oncologist asked mother if she would like some treatment, I don’t recall it. Mother said no, she intended to close her eyes and die. There was a strangled sound from the young medic, who said No! We can do xyz. The oncologist led him from the room and presumably explained patients wishes to him.
    That was nearly twenty years ago; the young oncologist is now an older oncologist. I think of him from time to time and wondered if he learned grace from my mother.
    Now I’ll think of your mother’s young medic and wonder if she learned charity and empathy from her encounter.

    1. I hope she took away the notion that there are appropriate and inappropriate moments to ask certain questions…and I would be pretty sure she took away several pithy phrases too.

      And as for the ubiquitous water pill…seems to be the answer to everything and it’s the last thing mother needs to take. Her G.P. knows about her blood pressure being abnormally high for a woman of her age – and also knows it always has been – it’s just how she is.
      This doctor cannot have read the file.

  8. I love that picture of your mom! I want to be just like her when I am 97!

    I can’t speak at all to the situation with the hospitals and the care they provide where your mother lives. However, I would like to put a little bit different perspective on the question the female doctor posed to your mom. I suspect that what was asked, and what was thought to be asked, were two different things.

    My oldest son and his wife are both doctors, and they have told me horror stories of elderly people whose families insist that they be resuscitated no matter what. Resuscitation at the most extreme levels is an awful thing in terms of what is done to the patient. The ideal thing is for someone to let their family know ahead of time what measures they would like taken should they fall seriously ill. It might be that they would like intravenous antibiotics administered, several attempts made to restart their heart with paddles, but maybe not their chest ripped open and heart massage undertaken.

    It is a shame that the doctor who saw your mother didn’t make clear that this was a routine question, ask what levels of intervention your mom would like done, and then say some reassuring words to your mother so she didn’t feel as if she was being treated as if her life didn’t have value.

    1. I take your point and agree with you.

      If this doctor had said…while I’m here, we could go over a few things together, the reaction would have been very different. Mother is quite clear about what she wants and doesn’t want.

      The context to this is the situation in her local hospital where the Liverpool Care Pathway procedure is in place and the fear of elderly people that signing up to non resuscitation means being placed on this procedure and being deprived of food and water.
      She sees it as an all or nothing decision – and in truth there does not seem to be a mechanism for the discussion you describe.

      She does look pretty good, doesn’t she!
      I was paying off the taxi and she was in no mood to wait so was heading off with the luggage trolley!

  9. In the past I came across old folks afraid hospitals only wanted bits of their body for others! Today however, especially after the Staffordshire crimes, there is a real threat to any old person in hospital. In the past some would not be brought back, the effort would kill them anyway, but in 1974 my ward always attempted to save those able to survive.
    The NHS is not what it was, the selling of the NHS and grubby business policies have failed it.

    1. Enter business – enter modern business lack of morality.

      There are genuine worries in my mother’s area to which the hospital management is totally unresponsive….I can understand her reaction.

      I’ll be talking to her G.P. – he knews what she wants, but fears that he can’t ensure that she gets it.

  10. Your mother looks absolutely terrific! I think the real problem her is that your mother’s doctor doesn’t seem to know when is the appropriate time to ask a question. When my mother was diagnosed with terminal cancer she was asked what she wanted by the doctor – especially, if she had a crisis did she want to be taken to hospital? The answer was emphatically no. She didn’t want her life prolonged and she wanted to die in her own bed (which she did, but in my house not hers). But she was asked all that when she’d had time to absorb the diagnosis – not as soon as she’d been told she wasn’t going to recover, so she’d had time to think about it.
    Having seen my father linger for two years in conditions that would have had my mother prosecuted if he’d been a dog because she insisted he wasn’t going to be allowed to die I’m determined that won’t happen to me and have given copious instructions to my family about my care. Basically that if I’m terminal or not able to make up my own mind I be kept gloriously comfortable but have nothing that prolongs life, and that includes flu injections.

    1. My mother’s G.P. knows what she wants…which is to be treated if it is something treatable with a good chance of recovery and to be let go as peacefully as possible if it is not….but there are problems with the local hospital as outlined above.
      This doctor was, to say the least, insensitive, and cannot have read my mother’s file before asking the question…it both infuriated and distressed her.

      She does very well, doesn’t she! Beetling off with the luggage trolley while she thought my back was turned!

  11. What a super photo. Your mother reminds me strongly of my dear mother-in-law (who is 8 yrs younger) before her memory started to falter. She too would be off with the trolley if she thought I was dillydallying. 🙂

    I think the doctor posed her question badly and at a totally inappropriate time and I’m not surprised your mother was livid. Nevertheless I’m with those who think the doctor meant simply to establish whether your mother would want all possible measures to be taken if she was in a state of collapse. My MiL is quite sure that she doesn’t want that to happen and made her wishes clear long ago in a Living Will.

    As it happens it was announced in the summer that the Liverpool Care Pathway is to be phased out over the coming year, though I’ve not heard whether another accepted protocol will replace it. Let’s hope that news may help to calm the understandable fears of those who feel vulnerable and alone.

    1. Mother sees the question as much more complicated than simple resuscitate or not…she feels that it depends on what is wrong and whether it is worth working on or not in terms of her quality of life.

      She thought the doctor concerned was just ticking boxes with no real appreciation of the realities…and, was, as you say, livid, and then depressed, feeling that elderly people are regarded as of no value.

      It will take something to overturn suspicions of her local hospital…

      I could not resist the photograph, for which I have since been upbraided as she was wearing her comfortable sandals…….

  12. Hi Helen

    I hope you don’t mind another email comment, on your blog post. [It’s no good, i can’t deal with these hysterics from WordPress :)]

    Your mum looks amazing ! and it is good to know she is happy with her life. Sounds as if the doc was pretty crass but I think the problem with resuscitation from a heart attack is that it involves a very violent assault on the patient – often breaking ribs. Why on earth the doc didn’t make it clear that THIS is a big part of the issue I don’t know. I do know many doctors themselves find it extremely distressing to have to do it to an old, frail and sick patient.

    I understand that it’s policy for them to have to approach elderly patients with this option these days, too. I don’t suppose they look forward to it much themselves …..crikey…..

    As for the hospital, I think these old workhouses -turned -into -hospitals are plain scary. I have every sympathy with your mum’s thoughts on this. I’m certainly a supporter of Dignitas.

    All best wishes, Jenny — Jenny Woolf

    1. She is amazing…wears me out when I’m with her!
      It was lovely to see her so enthusiastic about the trip to Spain and wanting to see and try everything.

      What bothers my mother and her friends is the way the Liverpool Care Pathway is being used in their local hospital…they do not want to die deprived of food and water.

      She certainly doesn’t want treatment involving such injury that she would be unlikely to live long after it as in heart resuscitation and she is very suspicious of a tick box procedure that doesn’t allow her to say at what stage she does not want to be resuscitated and in which circumstances.
      It is all too simplistic….especially when she does not trust the hospital.

      I’m with her on the morphine….

  13. I haven’t read any of the comments so don’t know what you and your commenters have already agreed/disagreed on.

    Unlike your mother we are very much in favour of not being resuscitated should our hearts stop. That is what it means. I do not wish to be kept alive artificially. In fact, we have made living wills stipulating so; although our GP, when asked by me, stated that she would not pull the plug, never mind what my wishes were in the matter. She agreed that she’d want it done for herself when the time comes but that she wouldn’t do it for me. Ethics, I suppose.

    Nobody is going to bump you off, they don’t do that sort of thing here. It is regrettable that your mother and the other old people don’t trust their hospital but I have seen too many old people being kept alive when there clearly was no longer any point to it.

    Not for me, thank you. No machines, no artificial respiration, no permanent feeding through tubes with me lying in a coma.

    1. Quite agree with you from my own point of view…though I’d prefer to be allowed to have morphine and sort myself out if at all possible.

      Mother’s not giving a blanket consent to non resuscitation whatever the circumstances.
      If there’s a fair chance of coming through with some quality of life she’d like to go for it, and she would hope that doctors would use common sense rather than looking over their shoulders at insurers.

      What made her furious was the crass way in which the question was put…as if being elderly and living alone was an indicator that your life was not worth living.

      As for not bumping people off….see Tynecastle’s comment above.
      And it’s the manner of bumping people off too….no water and no food. You wouldn’t treat an animal in that way without being prosecuted.

  14. Crikey! How would anyone give the “order” to not recussitate them at some day in the future? That’s awful, inconsiderate and downright insensitive. I’m glad that your mum has struck up a watchdog partnership with Adolpha – they sound like the perfect team. The reputation of UK hospitals appears to be declining… How sad that we live in a world where our parents have to be suspicious of the medical profession. 😦

    1. This is mother’s point….she’s not giving a blanket consent, especially when there is the problem of trust in respect of her local hospital.
      She is lucky to have a network of friends who look out for each other…we rather rudely call them the Norns – handing round the eye and the tooth – so that all can function.
      She’s off to see her G.P. , chesty cold or not, to get this sorted and make it clear what she does and does not want, and I am contacting him in respect of this young doctor.
      Adolpha tells me the attitude was one of looking around, lips pursed, before asking the question and that there was no empathy whatsoever.
      She certainly left mother with the impression that by not signing up she was a nuisance…..and, tough old bat that she is, it left her very upset.

      Mother said to me that she had seen the start of the NHS…and by the way it was going there was a fair chance that she’d see the end of it too…

      1. I looked up the Liverpool Care Pathway, and can’t see the “care” element of it; since when has depriving people of water and food been humane? Scary- particularly when you read the BBC report about a lady who went into hospital for a shoulder problem and was rescued by her family when they found her deprived of water and food for no reason at all… I can’t believe that this can happen in this day and age.

  15. it all depends on what exactly one is asked to sign, how it is formulated, what every word means, whether or not there is room for interpretation etc.
    In some instances and cases such a declaration might be helpful, I assume?
    If I look at your mother’s photo and read what she is up to… I understand her point.
    Excellent genes, Helen!

    1. This is spot on….a ‘tick the box’ approach is not at all appropriate.

      Mother is seeing her G.P. to try to formulate what it is she wants….but has some doubts as to whether that will be respected at her local hospital.

      She’s quite a ball of fire for 97…….

  16. Ball of fire! Vesuvias revisited more like…. I love your Mom’s spunk and her outrage, but most of all yours! Their lack of confidence must be based on something, correct? Something pretty dismal. But it does sound as if she is handling it well and has a good support system there.

    1. The lack of confidence is based on what their friends’ families have told them about their own parents’ deaths in this hospital. They have a lot more trust in eye witness reports from family than they do in PC speak from the hospital.

      And as for Vesuvius…as I say, never ring her when a major horse race is on the television…..unless you want your ears pinned back long term.

      What has upset me most is that this crass question has made a woman who has lived a full and valuable life, who has maintained her independence, feel that she is, in the eyes of the health service, worthless.

  17. How horrible. I had to look up what the LCP was (been away too long), and I found there had been a major review, headed by Lady Neuberger, who had this to say: “Caring for the dying must never again be practised as a tickbox exercise”. Neither should care for the living, and someone needs to remind this insensitive doctor of what her job is about – care.

    1. One hopes she might grow into it…but I doubt it.
      Mother is lucky with her G.P. who reckons she is better health than he is…but she is worried what happens when he retires.
      As it is, most of the visits are down to locums who vary wildly from the good but nervous to the incomprehensible – thus the mutual assistance between friends.

      The accounts she and her friends have heard from the family of their friends who have died in that hospital remind me of P.D. James’ ‘Children of Men’…except there are no chains and no flowers.

  18. I hadn’t heard of the Liverpool Care Pathway when I read and commented previously. I have been reading up on it and I too am horrified by what people are saying and how it’s being administered – I can hardly believe something so inhuman is legally possible.
    I understand your mother’s (and your ) attitude much more now and join in with that feel of total outrage at the fact that elderly people might be living in fear of such a death. Absolutely not on, Helen, and I apologise for not really getting the gist of your concerns first time round. Axxx

    1. No apology needed.

      No one acquainted with the NHS as it was, should be and can be could imagine that this abomination is possible.
      I only know about it from the very real worries expressed by my mother and her friends based on the accounts of their parents’ passing in the local hospital from the families of their friends.

      Anecdotal evidence…perhaps. But when you know and knew the people concerned…it has value.

  19. Hi Helen, it is so difficult for me to respond to this but I am glad you are sharing it and I have been reading the responses. I wanted to let you know that for some reason, and it has been quite some time, that even though I have subscribed to receive e-mail updates of your posts I have not received any in quite a while. 😦 I also wanted to let you know that I was unable to e-mail you as I can no longer find your e-mail address, but I know that I had it in the past. Google has made changes and when they made the changes I lost several contacts. Thank you so much for all your comments on my blog, it really means a lot to me and I am honoured to call you my friend. Hugs.

  20. Linda, thanks so much for the hugs!
    I was so furious at having a woman who is normally so tough lft feeling depressed and unwanted….
    I enjoy visiting your blog…fun music, lovely photographs – ideal to unwind in good company.
    All these changes really mess one up…there are blogs I like that I can’t comment on, for example…the comment box just doesn’t come up…
    I’ll send you my e mail over the week end…stroms approaching and time to unplug the computer before it is grilled.

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