‘I wanna tell you a story…’

If that hook isn’t recent enough to resonate with you, then step forward a generation, to an advertisement for beer, made by Peter Kaye, parodying changing social values.

Son rushes home to tell his mother to pack her bags, time to go, he’s found an old people’s home that will take her, as he wants her room for a snooker table.

‘But I’m only 55’, she protests…

‘Don’t matter, they’ll still ‘ave you. It’s for the best…’                                                                                                           

That scenario was pure fiction, but what about this one?

The scene: somewhere in a hospital in England, 4.20 p.m, Friday afternoon. Mid-point between the state’s abolition of the fatal Liverpool Care Pathway, and the advent of the ‘end of life’ medication regimes upon which the Covid protocols later relied. 

The players: consultant and patient.

Based on a detailed case record, around actual events and all too tragic hindsight, I wish to construct the kind of conversation that might have occurred between the two.                                                              

‘Ah, Mr Smith, apologies, I only got on to the ward in the last ten minutes. The doctors and nurses tell me you woke up forty-five minutes ago, and your blood pressure had dropped. Is that right?’

‘Yes.’                               

‘And that they gave you a blast of IV fluids and have been stabilising you?’

‘Yes.’

‘So how do you feel now?’

‘No better, no worse, really, than usual. It is what it is.

‘They also tell me you were resisting insertion of the cannula into your arm.’

‘Well, yes, I woke up feeling bad and groggy, and couldn’t make sense of what was going on. Three strangers right on top of me.’

‘Now, you were brought into A & E with loss of thrust on standing, lasting about five seconds at a time, that’s correct?’

‘Yes, but I’ve never had that since. And you twice refused me general physiotherapy for the legs.’

‘We gave you flu, three days in, we hadn’t told you at A & E that it was back in the main hospital building, where we’ve unfortunately been unable to shift it.’

‘Yes.’

‘You recovered, but then a week later, ten days ago, you were bringing up minute quantities of phlegm one morning, which they’ve recorded in your file as ‘pneumonia’, nonetheless?’

‘About right.’

‘At which point we decided to stop all blood tests, indicative of levels of infection, and of dehydration, which you were found to have developing for the one and only time.’

‘Wasn’t told that.’

‘Then we stopped your antibiotics, four days ago, and you’ve been examined by a doctor just twice in the last week?’

‘If you say so.’

‘Mr Smith, you are dying, and there is nothing I can do to save you.’

‘Whaattt? What’s wrong with me?’

‘Well, I don’t really know. I’m hazarding a guess, something like an infection in the chest area. Or possibly, my junior doctors speculate, sepsis.’

‘You mean you have no diagnosis?!! ‘Cos you can take what they say with a pinch of salt.’

‘Err…no.’

‘So you’re going to test? X-Rays, bloods?’

‘Err…no. I’m going to put you into ‘end of life care’ instead.’

‘Ehh? But I’ve got no cough, no temperature, I seem to be breathing normally… nothing.’

‘It’s in your best interests, all that type of thing, Mr Smith. So I’m going to suspend your set meal times…’

‘I do NOT want you to do this… Your nurses watched me eat two full meals with my family just yesterday, and walk around the bay.’

‘A blip, Mr Smith. AND I’ll be blanket sedating you. We have this handy little drug called Midazolam, Levomepromazine as well, and we’ll throw in the odd painkiller and anti-psychotic. A right good chemical cosh!’

‘I do NOT want you to do this… That’ll mean I never get to eat and drink again!’

‘No, you can have food and fluids, as long as you are sitting up and alert.’

‘But that’s Catch-22, how can I be sitting up and alert, if I’m sedated? You are going to carry on giving me intravenous fluids though, to compensate?’

‘Err…no. I’m withholding any more.’

‘Oh, no, you’re not doing THAT to me as well!’

‘Mr Smith, it’s this simple. I’m telling you I can’t say you can’t get better. But this will ensure a nice, peaceful death for you. Trust me, I’m a consultant, I have this sixth sense when someone is dying. I don’t need to go on facts.  AND, don’t forget, I’m reinstating your antibiotic.’

‘But you’re a doctor of general medicine, you know antibiotics won’t work on a dehydrating patient. And that Midazolam without hydration kills, in itself…’

(Silence) ‘And there will be daily medical reviews, to see if the sedation can be lifted, if you’ve made progress.’

‘Well, that’s something. But you can’t gauge progress without the bloods, BP and temperature tests, all of which you’ve stopped. And what about my family? I’ll be separated from them, and they’ll be forced to watch me starve and dehydrate to death. And I’m due home, just the other side of the weekend, Monday morning.’

‘Leave it to us, we’ll spin them some load of old fanny that you’re suffering, and that it would be unfair to carry on treating you. Emotional entrapment. After all, you wouldn’t want to get over this, and go through it again in a week, would you?’

‘No, I don’t want to suffer…but I don’t want to be left to die, either. Isn’t what you’ve just set out euthanasia? And why is there no other member of staff here to witness what you’re saying? No, I don’t want to be put into ‘end of life’, I want to be treated for what’s wrong, like anyone else.’

‘Afraid it’s my medical decision, Mr Smith. Don’t worry, you’re dying, you won’t feel hunger or thirst.’

‘Won’t you leave me as I am, without sedation, see what I can eat and drink, to get stronger, over the weekend?’

‘No. You see, I shouldn’t be telling you this, but this ward is implementing a six-month trial to see what beneficial impact on resources taking these decisions earlier can have. Particularly on a Friday, ahead of the weekend. Too many people have been allowed to hang on protractedly at end of life.’

‘I’ll call the police!’

‘CALL the police, it won’t make any difference.’

‘I want a different doctor.’

(Contemptuous, peeved, arrogant, hostile, threatening, patronising; with all the sensitivity with which a doctor, struggling to grapple with new notes at outpatients, might swat away a fly; looking away and down, really pissed off at this untoward opposition):

‘No-oo, I’M your doctor.’

Mr Smith dies, 72 hours later.

No duty doctor was sent for by ward staff to discuss lifting the sedation, even when he ate and drank through it, with assistance from his family, in plain sight, for a full hour, more than 24 hours in (‘You won’t feel hunger or thirst’).

Responses from Complaints Department:

  • ‘There was no other member of staff available, to take into a meeting’ (literally about life and death). (So it wasn’t as if it couldn’t be delayed slightly, until there was?)
  • ‘We did not unilaterally offer Mr Smith the option of a second opinion (as guidelines insist, at ‘end of life’), as there was no obvious conflict (of opinion) to warrant doing so.’ (‘I’ll call the police’ etc.?)
  • ‘No request for a transfer of care (to a different doctor) was made.’
  • ‘No promise of medical reviews (none came) was made by the consultant.’

They declined to comment (and did so for two full years) on why all professional guidelines as to preference for IV hydration were broken.

They are still choosing not to address the period of the trial itself, in relation to breach of mental health legislation and safeguards, even though their most senior medical personnel have already hypothetically decided any such terms would have gone against such patients’ (or indeed any patients’) best interests and rights, in any set of circumstances. 

There was apparently nothing special or untoward, that the consultant, in switching away from curative treatment, acted in defiance of her / his statement Mr Smith could ‘still get better’; it was represented by the Trust as a personal foible of his / hers, to emphasise this, in every case, as ‘when an unexpected recovery happens families can find this distressing’…  (no comment!)

‘The consultant has been open and honest in all their communications’ (Ombudsman) (apart from what they’ve chosen NOT to record).

And how was the consultant allowed to get away with not treating their patient? Because ‘Mr Smith’ – the patient – was my father, and he had dementia…

All the dialogue attributed to him in this piece of disturbing faction (you’ll recall, I said this was a conversation that might have taken place, with him) was actually – word for word – what myself and my horrified late mother had to offer up – on his behalf – that terrible weekend, now exactly nine years ago. (But which, even with Power of Attorney, can then be ignored. Not many people know that… )

The consultant did not object to the barrage of honour-defiling, libellous lies we received back from the Complaints Dept, to get him/her off the hook and spare both his / her and the Trust’s reputation. The Trust turned away three sets of polygraph tests we passed and submitted, asserting it did ‘not accept that they provide a definitive answer to the issues you have raised’; rather, there had been a ‘genuine misunderstanding’ (‘I’ll call the police’?!!!) on the part of the consultant (not even any language barrier to plead, they a native English speaker).

Basically, you’ve had your say; now go away, and leave us alone.

We are not accountable.

Promotion, and kudos, since, for the one party, nought but unending trauma and violation for the other – me. 

All I would ask of each of you reading this is simply to share this newfound knowledge on other platforms and hope that one day equity prevails more than it does now, over such inhumanity.