Saturday, 1 February 2014

Liverpool Care Pathway - 'That' Conversation

Yes, we speak of things that matter, with words that must be said...

       And the dangling conversation
       And the superficial sighs
       Are the borders of our lives.
     - Paul Simon

I picked up a message left on my phone. It’s the Care Home. My brother is not well. He has a chest infection. The doctor has been and he has given antibiotics. Can I call back, please..?

Hello. Yes, you rang me. You left a message asking me to call back...

The voice confirms the message left on my phone. I was asked to ring back.

He’s okay, the voice responds.


It is a good care home. Everyone is friendly. They know me by my first name. They’re just letting me know.

The phone rings.


Your brother is not well...

Yes, you rang. You left a message on my phone to ring back.

[I recognise her voice]

A chest infection, yes. The doctor has...

He has given antibiotics. We are doing all we can, of course.

I’m coming in the morning.

[I see him regularly every week]

She pauses.

It’s the weekend.

[Something nags at me in my brain]

Yes, yes, he will be pleased to see you.

The usual friendly greetings, acknowledgements are made and exchanged. I come to his door and he is sleeping but he stirs. He is drowsy but he does not appear ‘chesty’. The antibiotics must be having effect.

He has seen you?

I turn and she is standing in the doorway. I nod. Yes.

It is good he has seen you.

The nagging begins again.

You still want it, the CPR?

[Some two years ago when the new company took over the home the SRN – a lovely lady – took me aside. She had been asked by the new doctor what were my wishes should anything ‘happen’. It was not what I ‘wanted’; it is what you do. You do all you can. It's the LCP I said instinctively. She paused to take thought. No, no, it is the GSF, the Gold Standards Framework. The doctor entered. He repeated to me what had been said and I heard myself repeating to him what I had said to the SRN. I asked her after if I had done the right thing. It was not for me to sign a warrant to deny him life. She had smiled in return and said that I had.]

He has not been well, she continues. She has moved into the room and peers over him.

I am stilled, stunned... It’s a chest infection. The doctor has given antibiotics.

You don’t want it, the DNR? [I shake my head] I will come back to give him his medication.

We are left alone for minutes, seconds. A face appears at the door. It is the carer we have known for years. We nod in greeting.

How is he? He has seen you. That’s good he likes to see you. He has not been well.

The nagging, the nagging. She reminisces...

I remember when you used to come here with your mum. She looks across at the photos arranged on the closet door. I tell everyone how he used to go on the computer when it used to be out there. She indicates with a nod through the doorway to the staff room. I tell them how he used to send me emails. They say, no, really?

I acknowledge with a nod.

He has been so unwell. His nose has been running. Poor man.

It’s a chest infection. It’s that time of year. He has been given antibiotics.

Oh, but he has been so unwell. You know, he has been crying. Crying... He looked so unhappy.

[Wessex Guideline non-vocal communication]

No-one’s happy when they’re unwell.

You won’t sign a DNR...? If he gets bad, you want him to go to the hospital?

It’s a chest infection... [isn’t that what happens when you’re unwell; you get sent into hospital to get better...?]

Well, I’ll leave you both together, then.

We’re left alone again and we complete my visit.

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