I will begin by declaring that I was once a newspaper reporter who saw all ‘issues’ and ‘events’ as potential front-page leads – each one bettering the previous in style, content and relevant parties successfully interviewed and quoted. The thrill of seeing my byline on the front page story as the printing press churned out the more prestigious Friday edition of a twice-weekly local London paper is a memory I still cherish.
Doorstepping
On the other hand, even at the age of 19, I baulked at the door stepping my job demanded when one morning a boy of 8, glue sniffing on the roof of flats in Hackney, tumbled to a tragic death and I had to go to the house and invite the family to ‘pay tribute’. I sympathised to some extent – I didn’t yet have children of my own – but feared more a loss of face (and job) if I failed to deliver. The truth is, beginning with ‘I am so, so sorry but I don’t suppose you wish to pay tribute to your little brother, do you?’ to a red-eyed and tearful teenager just a few years younger than me was a major cop out – I’m very happy to report.
Broken hip
Now, very much older, I’m ostensibly a health journalist who possesses, I like to think, a little more insight and sensitivity with regards to those ‘issues’ and ‘events’. But, today I am confused. This confusion focuses on the question: when is the right time to address DNACPR with an over 75? During a GP check-up when their health is not (at that point in time) severely compromised and there's already an on-going discussion about palliative care? Or, following serious haemorrhaging a couple of weeks into the road to recovery following a fall and a broken hip, as she lies in A&E devastated with this setback wondering if their life possibly hangs in the balance, her next of kin having stepped out of the room for five minutes?
Sneaky look
My mother (81 in July) is today in hospital awaiting the results of tests following this haemorrhage. A sneaky look at her records by my younger brother showed us the box had been ticked regarding DNACPR. Neither my brothers nor I have discussed DNACPR with medic or mum, but hope to chat further with a senior consultant sometime today, following a chat initiated by the ward sister who, independent of our discovery, drew my attention to my mother’s choice.
Kneejerk
Reading around the topic of DNACPR, Dr David Oliver writes about the Daily Mail’s typically kneejerk reaction to the drawing up end of life care plans for people over 75, published last month.
In his online article, Fear mongering headlines can harm end of life care, he rightly points out that: ‘I and many other clinicians try every day to help patients with incurable conditions and their families to exercise some choice and control, to try to die in the place of their choosing – generally, not in a hospital if they can help it. Good advance planning can enhance people’s chances of dying in their own homes or care homes or making it to a hospice.
Adding, ‘I don’t seek to defend insensitivity, poor communication and poor judgement by clinicians. I don’t approve of unthinking, blanket application of box ticking policies linked to performance incentives with no regard to the individuals they affect…’ and ‘Do not resuscitate orders discussed fully and sensitively with patients or their carers can also prevent an undignified and over-medicalised end to older people’s lives.’
Flipside
And, indeed, there is a flipside to all this angst of mine over what feels a little like insensitive timing on the part of the doctor because choosing to turn off the life support machine on behalf of an ailing parent who has suffered a long illness and has not made any end of life decisions is dreadful – with memories of it that can haunt and torture and depress.
Therefore, for all the reasons above, as I nudge 50, I will be addressing my own wishes and sharing them with relevant parties as soon as my mother is on the mend and I have the much-needed time to consider it all whilst still blessed with my health.
Bedside
And, perhaps, therein lies another question: why has NHS England limited this to the over 75s and younger patients with serious conditions? Is it not something we all should do – if not, when knocking at death’s door or speculatively hovering some miles away from it? End-of-life plans do need to be discussed to ensure dignity and to meet the expectations of loved ones – indeed, my mother has paid for and organised her own funeral and written a will. But I am pretty sure I didn’t see a funeral director with a clipboard and a form to fill sneak in as we left her bedside for one fleeting moment...
I remain ambivalent but know that, like so many things in life, an ‘end of life’ discussion is all about timing – and the delivery.
References
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