The Way We Die Now Read Online Free Page B

miraculously, survived. On the Monday morning, along with one of the ICU consultants, I met the family and talked with them for over an hour. Again, we tried to persuade them that Intensive Care was too interventionist for their mother. One of the daughters angrily accused us of attempting euthanasia. Another daughter announced that she would take her mother to a private hospital, where she would be treated ‘properly’. The meeting ended acrimoniously and unresolved. The ICU consultant stood his ground and told them that in the event of a further deterioration, the ICU would not admit her.
    The old lady went back to the general ward, and lingered for several months. Over that time, I had many meetings with the family, along with regular correspondence from their solicitor and the hospital risk managers. The relationship between the family and the ward staff grew increasingly strained. The daughters constantly challenged the nurses and junior doctors and, on occasion, interfered with the electronic settings controlling the delivery of intravenous fluids and antibiotics to their mother. One of them took to writing instructions on the drug-chart, stating that her mother was not to be given morphine under any circumstances. As the situation deteriorated, a committee convened by the hospital’s clinical director finally decided that the patient should be made a ward of court, so that the hospital would no longer be answerable to the family. While this legal process was getting under way, the old woman’s condition suddenly deteriorated, and she died. Her death was farcical and undignified. Although I had made it clear to the family that we would not attempt cardio-pulmonary resuscitation, when the poor woman finally died, two of the daughters attempted their own cack-handed version of cardiac massage and mouth-to-mouth resuscitation.
    Around the same time, a woman in her forties with liver failure, caused by alcoholic cirrhosis, was admitted under my care, and I endured a similarly bitter and unedifying conflict with her brother and sister. She eventually died after enduring a long, painful series of setbacks and complications over six months. She was not a candidate for liver transplantation, but I failed to persuade her family that this was so. A second opinion was asked for and provided, only for the patient’s sister to accuse me of unduly influencing the doctor (a liver transplant specialist) who gave this second opinion. I requested a third opinion, which concurred with both my assessment and the second opinion. Again, a great deal of correspondence passed between solicitors and hospital risk managers.
    Her sister, a successful lawyer, tended to visit the ward late in the evenings and demand an update on her sister’s blood tests – the more obscure and clinically irrelevant, the more she agitated. The nurses and junior doctors were terrified of her. I met this sister on many occasions in an attempt to mollify her, but it became clear to me after several of these meetings that I was making no progress. After one bitter weekend, when this sister created mayhem on the ward, I refused to engage in any further discussions with her and dealt with her younger brother instead. The brother, unfortunately, simply passed on his elder sister’s instructions and demands. I tried to engage openly and honestly with the patient herself about the problems we were having with her sister, but she continued to defer to her elder sibling in all matters. I tried, in vain, to persuade her to see the palliative care services. She died slowly and painfully, over six months, in an atmosphere of conflict and denial.
    Shortly after her death, I learned something about the complex family dynamic from her brother, who finally broke rank. My patient, who was single, had given up her job when her elderly mother became ill and could not look after herself. She cared for her mother for several years. When the old woman finally died, my patient was