Saturday, July 22, 2023

WEEKENDER: DNR - A Suitable Case For Treatment (NHS)

Those letters in the heading above which I alluded to in a previous post hospital piece, needed fleshing out as I have become more aware and informed of what happened to me, and it can happen to anyone.

Firstly I will relay the events that affected me personally.

This bit may bore you but lays the foundations to what was imposed on me and why this form of legalised murder or attempted in my case, should be exposed, it is a far more common event than the vast majority of population would realise.

In my case, and I will try and keep this part brief, I felt unwell at home went for a lay down and woke roughly five weeks later in the Norfolk and Norwich hospital unaware of what had happened to me.

It transpired that my collapse was the result of fluid on the brain and I was sent to Addenbrooke’s Hospital in Cambridge for treatment as it has a specialist brain unit. I was operated on but shortly afterwards it was discovered that a bleed had been shown up and I underwent a second brain operation.

I was sedated all this time and a week later was complaining of severe stomach pains. The diagnosis revealed I had a perforated bowel, this I was told much later was a result of the brain problem, as I could not relate personally to how I could be so unlucky to get the bowel problem at the same time as the brain, but apparently this does happen, it is the brain that caused it, or so I was told.

The bowel operation was a big one which necessitated leaving the bowel outside the wound for some days as they needed to flush it out on a regular basis to try and get rid of the infection it had, thank God I was asleep during this period.

Oh and it was found I had covid during this period, so quite a load in one hit. 

Fortunately I was still sedated and started to come round once I had been transferred back to the Norfolk and Norwich after five weeks to be nearer home.

I remember absolutely nothing about my time in Addenbrooke’s.

This is where it starts to get interesting as obviously I had a different team ‘ looking after me.’

Shortly after the transfer my wife visited and met the consultant/doctor in charge of my case. He told her that he doubted I would make it with the infection I had in the bowel and I would be put on a DNR, I'm not sure if this was the original infection but presume it was a new one. The wife after what she had endured through me at Addenbrooke's was naturally concerned. No discussion of any alternative treatment or my current state which turned out to be somewhat different. The indifference shown by this doctor was appalling.

The following day my wife arrived back to visit with a good friend who drove her there to discover my bed was empty and no one to say what had happened. They found me in an unfurnished side ward on my own with all the tubes drains drips etc removed. She immediately called the nurse responsible to be told I had had a Do Nor Resuscitate order put on me by the doctor.

My wife rightly demanded to speak to the doctor and a call went out for him to attend. After numerous failed attempts he could not be found but after waiting all day my wife was eventually told he would see her the following morning at around 10.00.

She dutifully turned up at the requested time but no doctor; once again calls were put out but he could not be found. As the end of the day came my wife’s patience and demeanour changed to one of anger, she demanded that he come and explain what had been put in place and started (rightly) to make a scene.

One of the two nurses who were dedicated to me me suggested another doctor who was available come to her and have a word. A short time later he turned up and spoke to the wife and read my notes; he told her he would go in and see me and speak to her afterwards which he did.

His reaction was not one of doom. He explained he had spoken with me and I was very aware of what had happened as I was not taking it well, I had also it transpired tried to leave the bed to go home, not exactly taking it lying down so to speak even though I could not walk.

He went on to say that he did not agree with the previous instruction (he must have been in a superior position to have overridden that) and ordered that I was to be put back on a normal ward, my drips etc to be re inserted and I was immediately fed and watered and he said from then on he would oversee my case, which he did.

My recovery started from there. Despite the usual items getting in the way the infection cleared my memory started to come back and the demonic visions, which are quite normal in these cases, went away.

The front line staff on that ward were first class and I thank them all for their professional and personal help.

Not so much on the last week in the departure ward, which was largely a shambles and very unprofessional, resulting in a couple of big rows which I could have done without in my condition; that though is a tale about management and their desire at all costs to empty beds even when patients are not ready to leave.

I then had a week or so at a rehab unit, very good it was too as were the staff but again even though I was not allowed to walk anywhere without a chaperone it was considered all right to send me home after about ten days so a bed could be released; this was happening to others all the time.

The day after I returned home I had a fall and banged my head on some furniture. Fortunately a scheduled x-ray two days later showed no damage, but I should not have been home that early, my walking was still very rudimentary and faltering.

Subsequently after finding my feet and settling down at home, the truth of my time was gradually put together and as I became more aware of the whole period, what had happened and been done to me I started to question the DNR aspect of it.

The legal side is interesting, and I doubt many will have bothered to check out who holds sway in this matter, this is the bit that is used by the doctors.

“Doctors may decide to impose a DNR order on a patient even without their consent. Crucially however, there are processes which a doctor must follow when making this kind of DNR decision. Also, such a decision can only be made on one of the following grounds:

    Where the prospects of successfully carrying out CPR are so low it would make any attempt futile.

    Where the treating doctor considers that CPR would not be in the best interests of the patient. This could cover situations where any possible negative effects from the CPR would outweigh the benefits, or where successful CPR would just serve to prolong a patient’s suffering. However, making this assessment should be done in consultation with the patient and their loved ones."

Clinical guidance for doctors sets out a process to be followed when faced with a DNR decision. Patients should also be aware of this process to ensure their doctors are handling their situation correctly.

The process starts when doctors anticipate that there is a clear risk of the patient’s breathing or heart stopping. At this point, they should assess how likely it is for CPR to be successful in the patient’s case.

Whenever doctors are faced with a DNR decision, they should discuss and explain the situation to patients and loved ones in a timely and appropriate way. This is to avoid any misunderstandings or extra distress which may be caused.”

None of that was done in my case, and a CPR was not necessary at any time, as my heart and breathing were not affected.

This passage contains the weasel get-out clause re senior doctor, but even here the basics were ignored.

“The loved ones of a patient are often entitled to be involved in DNR decisions, even if they are not the patient’s appointed legal representatives. They cannot make legally binding decisions on the patient’s behalf, however, so the final decision will be made by the senior treating doctors.

Those close to the patient can include family members, friends, and carers who have been involved in the patient’s care.

There are some limited situations where those close to the patient cannot be involved in a DNR decision:

    When the patient has requested that loved ones should not be consulted or involved. Patient confidentiality means that doctors would be unable to discuss the patient’s case with their loved ones in this situation.

    When the patient has lost mental capacity but has made a legally binding Advance Decision.”

The one system that is without doubt the bulwark for the patient and family against doctors' wishes to impose a DNR is a health Power of Attorney. The appointed attorney must be consulted and can override the doctors' decision, though in some cases this could involve a complicated court hearing.

By chance a visit by our heating engineer recently resulted in a conversation that revealed he had been put under pressure for a DNR to be served on his father who was in hospital for some time after a brain operation. He had the health Power of Attorney for his father and stopped the consultant from putting a DNR on his father; his father is home and well now!

What is obvious despite this...

... it is still going on under a different name.

And here…..

It beggars belief that through all this no one has been sacked never mind prosecuted. The 'covering their backs' campaign has been in full on mode since day one. The sordid conditions in many care homes along with inadequate human care should have lines of people responsible queueing up to be charged with gross negligence and more, but no, after various inquiries all settles down as before as if nothing untoward had ever gone on; along with much else in this country today nothing works and few care that it doesn’t work. What an indictment of the UK in this century.

One reads this and at the end asks ‘Well what did you do about it apart from taking on the Mayor of Manchester job’ and the answer was bugger all, but it always is:

I have no proof but it is alleged that some hospital trusts have little compunction in issuing these DNRs, some have more compassion. I certainly had no help and only my wife who persisted and stood her ground and the doctor who took over my case saved me from the clutches of the four horsemen.

After the Mid Staffs Hospital affair and the Liverpool Pathway scandal one would think a major overhaul of procedures would have taken place but it is obvious that this attempt to cull elderly patients to release beds, for that is what I believe is behind it more than anything else, is still going on apace. Dr Mengele would be proud. I am not finished with this, though getting further information is difficult: even the name of the doctor who issued the DNR has mysteriously been expunged or is not being

Suitable for a caption competition…

If I had been kept in Addenbrooke's I doubt this DNR would have occurred as they had invested a lot of time and expertise in getting me through. I could of course be wrong, but I believe this was a Norfolk and Norwich hospital problem; trust managements make their own rules in many of these matters and that again is wrong. Murder on the whim of a doctor who in this case was not even responsible for the original treatment is not something to be brushed under the carpet, yet time and again it is, it has to stop and those responsible for crass decisions such as mine should be held to account.

I was in hospital long enough to see the NHS in all its guises, the good the bad and the ugly. The good I am grateful for and all those involved, the bad and the ugly need sorting big time along with all the other top down decisions from government and trusts that have reduced the service to its current level. No longer is it owing to lack of money, we are comparable with many other countries with better health services on that score; nor to lack of staff - no, we have the largest workforce in Europe so it has to be something else and choice - we have no choice, at the moment of course choice is a dream, getting to see a doctor whether at a local surgery or the hospital is now just a desire.

It comes to something when arriving by dinghy gets you a twice a week visit from a doctor but the local paying population can go whistle.

I am in no rush to return to that particular room with no window and no furniture, no food or water, no anything... appalling, yet dozens are put in this situation every week never to return.

The NHS in the meantime puts out endless press statement about the latest cancer miracle drug that could be coming and various other life saving procedures that could be used. All is just a diversion from the actuality of the real NHS. I will gladly shake the hand and thank all those who helped me survive, but I will not be clapping the sorry hulk that is the NHS today.

Will it change as it should and needs desperately to do? Doubtful; too many ingrained beliefs and dogmas among those chosen to run things, plus a Labour party who can’t see beyond their ‘baby’s’ conception, too many who believe the whole organisation is theirs and only they have valid reasons as to how it should be run and funded. It actually of course belongs to the population who fund it through taxes; that concept is of course sidelined at every opportunity by the idiots who believe it is still worth saving in its present form.

It is beyond the pale that a couple of days ago I was told that a small operation to correct the original bowel procedure I had requires an eighteen month waiting list and an awaited replacement hip op that has taken 3 years from diagnosis to fruition has now had to be cancelled because my recent problems make it far too risky. Of course in a decent world I would have had that replacement two years before I fell ill and it would all now be history.


Wiggia also notes: 

If you cannot make decisions for yourself, for example because you are unconscious or unable to communicate, the doctor should talk to your family or carers about your likely wishes. However, your family and/or next of kin don't have an automatic right to decide which treatments you should or should not receive, unless you have given them the legal power to do so through a Lasting Power of Attorney for Health and Welfare.

1 comment:

Paddington said...

Here in the US they will often do more than everything possible, then bankrupt you.