I want to make up for lost time type:
I haven’t seen my mother since I was 16 and left home for New York. I am now 45 and I am told she is dying at 84 years of age in this calm idyllic country hospital. I want everything to be done for her. IV fluids with difficult cannulation repeatedly? Yes Please. Twice daily blood tests for our satisfaction? Of course. Full body imaging although it is unlikely to add any value to her management? Oh yes. Invasive ventilation of this thin old dear? Definitely. Full Cardiopulmonary resuscitation on this osteoporotic chest? Particularly that. (Would you like fries with that) I am going back to London today, but I will phone you from there to see when she can go home.
(Junior doctor's response: Great. I can now unleash hell. I have been waiting to get some competencies signed off. At the least I could get cannulation, Arterial blood gas analysis and catheterisation signed off. Ordering the CT scan and writing reams about my conversation with this passionate daughter should help bring 5 pm faster)
I am watching you type:
Ok doctor, I have a few questions for you. I have written them down to remind me. (reads from notebook) First, why did the nurse who came to the room yesterday midnight reduce the volume of the radio? My mother was soo distressed as she could not hear her favourite radio 4 presenter. So, you were not here at midnight? I was not here either, but I am sure the volume was reduced at midnight. Ok, second question, why has she not been fed anything since coming into hospital? She is starving to death and has had nothing to eat for the past 6 hours. Nil By mouth? But I didn’t give permission for that. Ok, I will take it up with the managers at the hospital. Third, When is she going to get better. There has been absolutely no improvement for the past 2 hours that I have been with her, feeding her and talking to her. My father died at this hospital when he was only 94 and I won’t let that happen to my mother. Hang on, you think she is better. Let me write this down for future reference.
I don’t believe you type :
So when do you think she can come home? Next Monday? But that is what you said last Monday. Has she got her antibiotics for today? Can you please look at her drug chart again. she is still on glucose drip. Don’t you think she should have sodium drip? Has her diarrhoea stopped? You think so? I don’t think so, because the nursing chart says she had two type 4 stools today. Did you know she is allergic to penicillin? No? God, every time she was given penicillin she has vomited. So will she be ok doctor? (doctor: difficult to say, we need to see how the week goes) Oh no, You think she has no chance? She is going to die? Has she been seen by a cardiologist? What about the kidney doctor. Don’t you think she should be in the ICU? No? Ok, as long as you know what you are doing…..
Caring for everyone type:
I can’t bear to see her like this. Please don’t do anything more. She has had a good life. Let her pass away peacefully please. That is what she would have wanted. She would never have chosen this. Oh, you agree with me doctor? Thank you for all you have done for her. You are so kind. (the good doctor even gets a mention at the funeral service and a thanks in the local newspaper column for doing nothing)
There are more silos that we can fit relatives into. Are they always difficult like that? Or was it a response to poor care or perceived poor care in the past? Or did you bring it out of them due to your own body language or a careless casual word? Or was it a reaction to previous injustice or perceived injustice? Or a previous loss that they suffered? Or is it just frustration at this point in time that will improve with the patient? …The real question is, are you self-aware?