Family and Palliative Care

 Gurgling. the old italian was gurgling. There was a collection of fluid at the back of his throat that he could not swallow.  It was 730 am.

The assistant fed him a 1/2 cup of juice and a spoonful of cornflakes with milk for breakfast. He then pushed her away and swore at her.

He was assessed as a high risk of aspiration- he was sitting bolt up right in bed, and was given food when wide awake

After about 45mins  the old man started coughing and coughing, choking, spitting everywhere, spluttering, vomiting. He pushed away the yankeur sucker that i tried to shove into his mouth, he got really angry with me for continuing to try, and swore at me in Italian. It lasted at least 30 mins. 

Loud, blustering coughing, on and on.

The 3 co patients were all crying , “save him”, “some body do something”. “Please stop it”. “I cant stand it”. 

The room sounded like a cacophony of mayhem and madness.

Finally the old man coughed up enough to be able to breathe again. When he settled, a probe placed on his finger read 89% O2 saturations when settled. He was barely getting enough oxygen when at rest.

His family requested he be given food “to give him comfort in his dying days”.

He had been admitted with a broken hip and aspiration pneumonia, community acquired, the family were his carers.

The wife and daughter arrive at midday. They were allowed 2 hours to visit. They stayed about 1 hour, moving silently about his bed.

They feed him everything that was supplied in the lunch meal. He didnt flinch, he didnt cough, he just ate it.

The wife settled into her chair and defiantly stared at the staff in the room. The daughter sat, typing on her laptop. Their body language made it clear they had no interest in communicating with staff. 

An invisible stonewall stood between staff and the family. Witnessing the old mans struggle to breathe left staff feeling distressed and the situation hopeless. The family had the right to make decisions about his care.

That he be given what ever he wanted, was clearly not in the patients best interest.