Thursday 15 February 2007

(NFR) = NOT my FUC***G RESPONSIBILITY













This post is actually about NFR/DNR (Not For Resuscitation/Do Not Resuscitate). I will call these NFR as I’m old fashioned in this regard and this is what I understand.

I will start, however, by stating that Valentines Day is over. I am glad about this, as I don’t like it. I am also pretty pissed but, surprisingly, not too depressed.

I, once upon a time, spent it with a wonderful, beautiful woman whom I loved very much. The bitch did not like me as much though so she must be mad. Obviously. Broke my heart and I’ve only just forgiven her. Well I forgave her a couple of years ago actually and hope that all is well in her life. Feel sorry for the man she’s with though, nutter.

Tomorrow is my birthday. Just another day but the day that I get older. Older, older I hate that. Why cant I be 18 forever. Still feel 18. My body feels about 80 but I’m still the stud I was 20+ years ago, in my mind. Would love to be able to try and prove it.

This story is an example of something that has become more common over the last year or so. I can’t say that I remember these things happening before, but the situation described has occurred a few times over the last 8-9 months.

I was on a dayshift and, unusually, was in early. I don’t generally do mornings very well but this day I must have been hyper. A 999 call came in 20 minutes before the start of my shift so I volunteered to let one of the night shift crew get home on time and cover their space. The call was to a nursing home about three minutes from the station and I figured it would not be anything too serious. We don’t usually get spurious calls to this place. If there is anything near a good nursing home this may be it. Probably because it’s run by nuns, but still-------.

As we entered we asked what was going on and got the reply, if you can believe it, “we think she’s dieing but just want your opinion!”

What sort of thing is this to say to anybody?

Her daughter was on the way and all they wanted from us was to say, “Yip, she’s on the way out”. The home manager had previously discussed the option of an NFR. This is where a person is known to be at deaths door and a decision is made that any attempt at resuscitation is not in their best interest. CPR is not to be undertaken.

We entered the room and did the basics. The woman was obviously near the end of her life. Sometimes you see people and know that the worst thing you could do is try and move them. The very action of trying to move them and take them to hospital will result in their death. A “nurse” turned up with the documentation that they have and points to a signature under a heading at the bottom of a sheet relating to a NFR.

Now, this means nothing to us, as ambulance personnel. As it stands, where I work, the only legally relevant documentation relating to an NFR is: -

A signed letter from the patients GP.
An audio recording from the patients GP
A preforma signed by the patients GP.

In reality if we don’t have a letter from the patients own Doctor there is no NFR in existence.

The nursing home manager knew this. In my opinion the very fact that they had the discussion and had not formalised it is negligent. They know the legal requirements as well as I do. If they have not been negligent at the very best they have misrepresented the facts to the relatives. I can only hope that they get sued at some point in order that they stop knowingly misleading the relatives of people nearing the end of their life. The distress that this causes became all too evident to me as time went on.

If we moved the woman she would die. You get to recognise these things. This does not invalidate our legal responsibility regarding duty of care. We had to do everything in our power to ensure the survival of this woman.

Blood pressures, BM’s, Oxygen sats, ECG, GCS were all taken as was temperature. The picture was not good. Knowing the circumstances we did all we could to kill time untill the daughter turned up.

The relatives were all under the impression that their mum had been placed in this home for palliative care, with the NFR in place as discussed with the “nursing home” manager. To be looked after until she died. On hearing that we had no option but to remove her mum to hospital the daughter became, understandably, distraught.

While we were, at this point, taking no actual moves towards moving the woman the daughter actively started preventing us from doing so.

I understood her actions completely. Her mother had been placed in a home to die. This had been discussed and her understanding was that everything was in place: she had made her peace with this. To have a 6’3” stranger trying to explaine that yes, we know your mother is going to die and that this is almost certain to happen if we move her but that no, the nursing home lied to you about the NFR and we have no option but to move her and effectively kill her, is not a nice thing.

All the while the daughter is crying. I feel like crap. I know that I don’t want to do what we have to do. That if I follow the rule of law I will be subjecting an old woman to unwanted assault and her family to unnecessary stress/distress.

I ask everyone to leave the room for a minute and my partner and I have a quiet word. She’s way ahead of me. Experience is everything and she’s been around a lot longer than me. Obviously there is no point in calling her GP at 7am (they’ll still be in bed) so call the out of hours service.

While we can hear the daughter crying outside the door we try and explain the situation to a Doctor who has never even heard the woman’s name before. Fortunately he’s a good one. He takes the decision to permit us to withdraw. I have no idea how ethical this is but it was the right decision. It could have been so much different.

We apologise to the daughter and she seems to appreciate the actions we took. Despite this her eyes are still red. All she wanted was her mum to pass away in peace. While we did what we could, we stole some of this. We were an unwanted presence at a time of sorrow and distress.

The home should either not of called us or ensured that they fulfilled their legal obligation to formalise the NFR.

Three times in the last nine months this has occurred. I never expected to be put in this situation. If it happens again I’ll inform the police. Nursing homes have responsibilities that they should not neglect. Nor should they place the responsibility for their negligence at our feet. Their job is to care!

Fuck, I hate nursing homes; and this was one of the better ones.

8 comments:

Anonymous said...

That is the most appalling story I've heard for a long time. I'm feeling sorry for you, of course, but also for the poor daughter. I've got an elderly Mum and my husband and I have already decided that there's no way she'll ever end up in a home. He's a qualified EMT, PHTLS, ALS etc, so we'd be alright for medical care (I can just about manage a plaster!!!), and the thought of Mum going somewhere where nobody loves her is heartbreaking. I'm lucky I have that option.
I hope you have a happy birthday but, if my math is correct, you're younger than me, so no sympathy on the getting older thing. xxx(for the birthday)

Anonymous said...

Tricky situation well got out of.
Its never easy trying to make a spot decision on what to do for the best but I think all it takes is to stand back and view the problem from a different angle.
I,ve had the situation where I,m doing CPR and a relative turns up and pushed me off the casualty saying that he (the casualty) would not have wanted to be resused. I had no idea who this relative was or what were her motives?
So I carried on CPR and thankfully a GP turned up and called it.
Sorry about your recent loss, the beautiful woman....theres always a bloody woman at the bottom of things! You cant live with them and you cant live without them...!

Iain MacBain - or maybe not!!?? said...

Kingmagic, not so much a loss as an escape.

Anonymous said...

It says something like [if !supportEmptyParas}

Iain MacBain - or maybe not!!?? said...

Trainee, thanks for the heads up. Hopefully it's gone now. Wrote it in word and imported while very drunk. Not a good combination.

Carmello, thanks yo you too. Hope all is well with the studdy :-)

Anonymous said...

Was going to say.. "it's better to have loved and lost"...etc but that's bollocks anyway.
Its like going ...here's what you could've won and then kicking you in the guts.
With you on the shameful treatment of the elderly in this country, nursing homes have to be challenged.
Have a great birthday X

Anonymous said...

I had almost exactly the same situation recently for an elderly man - but with no document of any kind on file, just the 'care' home staff assuring us that the GP and family had discussed having a DNR and wanted to get one. Not good enough! Again fortuanatly we were saved by a nice out of hours doctor who came out and let us slope off, but it was an unpleasant situation to be in.

Anonymous said...

The number of nursing home staff that just lie point blank to my face when I ask them about NFR is ridiculous. Usually they say the patient is NFR, but when I ask them for the paper work it's amazing how there is no such order. Sometimes, there is a box with a tick for yes. Again not legal. Maybe we should complete a NFR on anyone who deliberately lies about the topic.