"41 year old female. DIB. Lung cancer patient"
In health care, no one really wants responsibility. We are bottom of the food chain and from us, upwards, there is a long line of people to pass the buck onto. We pass the buck to a nurse, who passes it to an HCA, who passes it back to a nurse. The nurse in turn passes it to a House officer (junior doctor) who passes it onto a Senior House officer who passes it to a Registrar. If the Registrar doesn't know what to do he passes the buck onto a Consultant; top of the food chain. If they don't know what to do, you'll probably die. Sometimes however, this marvellous system of avoiding blame is scuppered by someone not going to hospital. The problem here is that if the GP has been to see them and wants them to go to hospital he or she will phone an ambulance. If the patient refuses you end up with the buck stopping with the lowest level of the NHS. The only place we can turn is our illustrious Clinical Support Desk. However, those who have had contact with our CSD will know they have a phrasebook consisting of only three phrases:
- That's a decision you'll have to make.
- I'm afraid that's a grey area
- Please hold the line..................That's a decision you'll have to make.
This particular job was a case in point. We were sent to a private residential address where the GP had already visited. He had assessed our patient and been told by the family that our patient did not wish to go to hospital and would not go to hospital. Needing to pass said buck, we were called. Whether he thought we could convince her to go or just didn't want the responsibility of leaving someone struggling to breathe I don't know but the end result was the two of us entering Amy's bedroom armed with our bags and a smile. Amy had lung cancer. The very late stages of the disease. The disease that had manifested itself throughout her body. A disease that can attack anyone without cause. She'd never smoked, lived a healthy life and worked hard. Where is the justice? She was in palliative care, at home, with her family at her side. When we walked in we were introduced to her two daughters and her husband. Her mother and father were also present. It was a very sombre affair.
"Please don't take her to hospital, she wants to die at home, please"
"We won't take her anywhere she doesn't want to go"
As I said that, Amy took hold of my hand and gently squeezed it. She didn't have the strength to speak but mouthed 'thank you' to me. She was struggling to breath, her resp rate was high and her SpO2 was very low so with her permission we gave her some oxygen. We spent a while talking to her family while checking her over and it was a very humbling experience. They were such a lovely family, at peace with the inevitable but had called the GP because their mother / wife / daughter was suffering. She was on a syringe driver for pain and everyone was just waiting for her last moments to come. I felt like an impostor that didn't belong there. This family needed to say their goodbyes in private but we couldn't leave our oxygen with them. Obviously when Amy was comfortable we could leave but in taking the oxygen away I didn't want to be the cause of her passing. I phoned clinical support and got a combination of answer 2 & 3 from their book of knowledge. We agreed that we'd go and do our paperwork then come and get our oxygen before we needed to leave. I told Amy what we were going to do and in a moment that I'll never forget she closed her eyes with a smile. As she opened them a tear trickled down her cheek. Being left at home with her family was her only wish and we were able to give that to her. In all honesty we should never have been there but that's the system.
We sat in the ambulance for a little while doing our paperwork, it was a very sad job and one that frustrated us. It wasn't the fact we were called knowing there was nothing we could do, it wasn't that the buck was past. It was the fact that we'd intruded on a families precious last hours and had to stick around so we could tick all of our boxes and cover our asses. For every job there is a paper trail. One that is scrutinised by our service and what our performance is judged on. That was frustrating. We went back in to get our O2 and leave a copy of our paperwork. I was halfway up the stairs when an unmistakable sound engulfed the landing. It was the sound of sobbing, the sound of pain, the sound of grief. In the fifteen minutes that we had been gone Amy had passed away. Passed away with everyone she loved, and who loved her, at her bedside. Her suffering was over. We sat on the stairs for twenty minutes feeling rather numb. Her husband came back out of the room, tears pouring from his face, yet he was smiling. He was happy his childhood sweetheart could hurt no more. I entered the room to confirm death so I could fill out our Recognition Of Life Extinct form. She looked asleep still with the half smile on her face. She was at peace. I felt the lump in my throat so decided just to grab by bits and make my excuses. I'm sure there is some procedure I didn't follow to the letter and a box I didn't tick but I don't care. There was nothing for us to do and we had no place being there now. I left the paperwork on the dining table so the family could make the arrangements they needed to. Us? We went to go and do another job.