There are good things and there are bad things. The trick is to enjoy the good things as much as possible and do everything you can to avoid making the bad things any worse than they need to be. Death is one such bad thing. In fact, I’m calling it: death is the baddest thing of all. So anything that can make it any less unbearable is worth some thought.
I wrote about my dad dying because, in the circumstances, I couldn’t apply myself to any other subject. I wasn’t sure this was the right thing to do. It was taking oversharing up to 11 out of 10 on the Spinal Tap amplifiers. And when I realised it had helped take some of my pain away, I felt something like guilt about being blessed to have a platform as great as this on which to share my thoughts when 99.9% of bereaved people have no such thing.
But I’m afraid I’ll have to write some more, because I’m tormented by the memory of something that happened three weeks before Dad died. Something that made everything worse. Something that was completely unnecessary and, as far as I can discern, just plain mad.
I got a call on a Sunday evening from a nurse in the community hospital where my dad had been since a fall at home had left him with a fractured shoulder. On his first night there, to my considerable dismay, he’d had another fall, but the GP covering this hospital checked him over and, bar some bruising, found that no further harm had been done.
Now, the poor man had taken another tumble, trying to get from his chair into his bed next to it. Nothing to worry about, the nurse thought, but she said she would be getting the out-of-hours doctor to check him out. OK. I slept no more uneasily that night than any other of late. However, in the morning, I woke up to a 6am voice message to say that at midnight he had been taken to A&E at the nearest major hospital, half an hour away.
Naturally, I assumed the worst, that a heart attack or stroke or some such catastrophe had come to pass. But no, it was almost worse than that. It emerged that the out-of-hours doctor had decided on this course of action as a precaution. So it was that, as a precaution, he was carted off, alone, without his hearing aids, on potholed country roads in the middle of the night, to an A&E department where, as a precaution, he was to spend the next 36 hours, miserable, distressed, confused and largely alone. Finally, after a day of increasingly frantic pleading on my part, he was discharged whence he came.
Before this turn of events, in his three weeks at the community hospital, while he had hardly come on leaps and bounds, his health at least hadn’t got any worse. Over the three subsequent weeks, he went into a steepening decline and died. It’s entirely possible, given his frailty, that this would have happened anyway. But I’m struggling to come to terms with the fact that two of his few remaining days on Earth were spent in quite unnecessary distress.
I’m sure there are doctors who will read this and ask how I, as a non-doctor, can describe it as unnecessary. A fair question, but believe me, I would genuinely have preferred it if someone had told me it was all necessary. I was yearning for someone, anyone, to tell me that this had to happen for reason X, Y or Z. That would have made it a whole lot easier to deal with. But I’ve spoken to people involved in each stage of the whole episode and nobody has even tried to argue that it was the right call.
I can’t even bring myself to get angry with anyone, because they all seem to have meant well, but the process, the system, the protocols, the whatever, take hold and the wrong thing happens even though everyone can see it’s wrong but is powerless to put a stop to it.
I’m led to believe that the out-of-hours GP took the decision to send Dad to A&E without even coming in to see him, which doesn’t seem right to me. I’m sure some degree of risk aversion played a part. If Dad had stayed that night and died in his bed, I suppose it might have been on the out-of-hours GP’s head. Fair enough, up to a point. But as far as I was concerned, we had already made ourselves clear, as a family, where we would stand if it came to these kinds of decisions. I don’t know if this was in the notes, but it should have been, as well as directions for us to be consulted. I would certainly have welcomed the chance to weigh up the relative risk to him of not going to A&E versus the much higher risk of A&E being the nightmare it turned out to be.
As it was, the doctors in A&E found lots wrong with him – none of which was news – and now it seemed to be their turn to be risk averse, about discharging him. “It’s mad, I know,” said one poor young doctor I spoke to. “It’s not even that we have a bed for him here, but there’s nothing I can do.” A shrug from him, shrugs from the nurses and the GP back at the community hospital. Shrug, shrug, shrug. It was just the way it had to be.
I don’t know where the blame lies. I hesitate to blame doctors when I can’t imagine what it’s like to make these decisions. Is it the deadweight of insurers and lawyers being brought to bear? Really, I don’t know. The only thing I am clear about is the end result: an obscene waste of NHS time, money and expertise causing the patient nothing but harm and distress.
I relate this not out of anger; I don’t want anyone to get into trouble. I just want someone to try to put a stop to this kind of insanity. Obviously, universal luxury geriatric care in five-star hospitals would be nice, but in the meantime keeping daft decisions to a minimum would help no end.
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Adrian Chiles is a broadcaster, writer and Guardian columnist
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