Monday, 5 May 2014

Liverpool Care Pathway - The Final Repose

Living Matters Week is a celebration of life and living... because life is a gift and life is precious - and living matters!

Whatever belief system it is you follow; whether it is once you live or many times, this life, this time, matters. Life is resilient and life strives to be, but life is ever fragile and must be cherished. And though trying might seem futile, still, you try; you always try to save that life...

Because living matters.

This is The Telegraph –
Giving evidence at her inquest in Doncaster on Wednesday, Mr McKenna admitted he failed to follow the correct procedure but claimed there was nothing more he could do.
The hearing was told Bella had complained to her mother Lorna Easen that she was struggling to breathe at around 2am and was given her nebuliser and medication.
Giving evidence in court yesterday (Weds), Mr McKenna said that when he arrived at 3.13am Bella was "pale, with blue lips and unresponsive" but he started to perform basic life support and asked a police officer to do chest compressions on Bella.
He said: "There was nothing more we could do. I carried on with CPR but soon knew there was not going to be a response.
"Because of her age, I now know it is protocol that she should have been transferred to hospital but I was under the impression that because of her age she would be classed as an adult - she wasn't a baby."
The court argued, and found, that Mr. McKenna should have continued with CPR. The court argued that, in this case, protocol demanded that he did. In other cases, there are those who argue that CPR should not even be commenced.
J*** has been put on a nebuliser and is nil by mouth. He has a peg feed and is being fed Fresubin. I have had a further phone call. I am on the ward, in J***’s room, waiting to meet with the doctor. A voice calls from the open doorway. It is a nursing assistant. She enters.
I return her greeting. She asks me if I would step outside for a moment. She has to check J***. I oblige and exit the room. The door is closed behind me.
I exchange greetings with an elderly gentleman who treads ponderously, with caution and care, out of the main ward to visit the WC. Minutes pass which seem like forever.
“All done.” The nursing assistant stands in the open doorway of J***’s room. A gentle smile adorns her face as she secures the door and beckons me to enter.
I re-enter the room. J*** is repositioned, his gown disturbed. I thank her and she retreats from the room.
The meeting has, again, been arranged to discuss resusc.
In less than10 days, the Death Cult is to hold their annual death fest. Dying Matters Chair, Dr. Mayur Lakhani, has warned against the "false hope" of CPR. The same and similar arguments are made for not offering medical procedures to the elderly. Factors such as age and frailty weigh against the chance of success, they say, but when the choice is a chance or no chance at all, you clutch at the straw that is offered you.
Do they think of making death their friend,while by their practice they make God their enemy...?
When the choice is life or death, there is no choice.
It is more than half an hour past the time agreed to meet. The doctor has not come. I stay awhile longer, then say my goodbyes to J***.
It is next day. I have decided to take the battle to their gates.
They are obsessed with identifying the dying. Like Clyde Bruckman, they wish to divine your final repose. This obsession has, through the EoL Strategy, wrought a medical holocaust. This is the Philosopher's Stone they seek - the tool which will tell them when you are to die.

This is Mail Online –

The parents of a little boy who doctors believed was just hours from death are preparing for his third birthday.
Emma Wilkinson, 32, and Gary Marshall, 42, were told their son Calvin was unlikely to survive emergency heart and stomach operations in the weeks after he was born.
The little boy was born with a heart condition which was picked up at Miss Wilkinson's 20 week scan.
'Sometimes I think back to those moments when we didn't think Calvin would survive, and think how lucky we are. Things could have been completely different.
'I really think of him as a miracle. But his survival was all down to him. He's got a strong fighting spirit.'
Setback followed on setback, but they couldn’t give up on little Calvin. Never once could they let themselves consider, ‘We can’t put this little chap through this; we’ll let him go…”
It is Friday. I have taken a few spare moments to phone the ward. I have been told the doctors go home at five. Can I come in in the morning? I can come tomorrow, Saturday. It is agreed I come in tomorrow at ten.
Twenty minutes have passed. The phone demands my attention. The voice in my ear is a woman’s voice, urgent and precise. She confirms who I am. I cannot have my meeting tomorrow. Tomorrow, the duty doctor is on. He covers for all the wards. He will not be able to discuss J*** with me. I need to speak to the doctor who knows all about J***.
Will he discuss the infection with me; how J*** came to get the infection; when J*** will be returning to the nursing home?
He wants to discuss resuscitation.
J*** didn’t come into hospital with the infection. He has caught the infection in the hospital. This is a hospital-acquired infection.
J*** had the infection when he was admitted to the hospital.
I am fazed...
This is Mail Online –
'I was amazed,' reveals Theroux. 'The doctors had repeatedly told us – and told his family – that the best-case scenario for him would be that he remained in a vegetative state. Best case! 

'So to have him wake up and walk again and converse normally was mind-blowing. I remember being in the office when my director came off the phone from Langston’s sister and said he’d woken up. I didn’t believe him.

'It just goes to show, doctors don’t know everything. Seeing him reunited with his twin brother after he woke up was one of the most moving things I’ve ever seen.'
 “Doctors don’t know everything...”

That isn’t true. That’s not my understanding at all. John went in with a seizure. He suffers from them periodically. When they can’t deal with it in the home, they send J*** into hospital. It happened twice last year. He’s kept in for observation and then returned to the nursing home.

When J*** came in he was vomiting.

I continue to insist he has caught the infection there and say I will check on this with the nursing home.
I comment upon the poor reputation of the hospital. She responds that I do not like the NHS. I have not mentioned the NHS...

It is agreed that I will meet with the doctor after the weekend.

I am phoning the nursing home. The phone picks up. It is W***, the lady who takes the medicines round, who answers. I confirm who I am. I ask her if J*** went into hospital with an infection. Was J*** vomiting?

There is surprise in her voice. No. J*** had a seizure. They could not control it and sent for the ambulance. No, no. J*** was not vomiting. J*** had no infection.

She phoned the hospital on the Tuesday following his being admitted. She expected J*** to be reviewed and returned to the home. She was told they were keeping John.

No, J*** did not get the infection here. They said that? They have lied...
It's Living Matters Awareness Week already!

Living Matters Awareness Week 

Your event

A Living Matters Awareness Week event can be large, small or anywhere in-between. To give you inspiration, here's a small selection of ideas:
  • Coffee morning at the library in aid of the Red Cross, with resources on display. Red Cross will be happy to assist.
  • Living matters for pets, too. Promote that Pet First Aid App from the American Red Cross.
  • A Red Cross or St. John's display to promote CPR instruction in schools.
  • Ask Red Cross or St. John's for promotional materials on First Aid and hold a 'Live In' event.
  • A Life Cafe. 
  • An afternoon of activities, including screenings of the Vinnie Jones videos on You Tube.
  • Hold a sponsored sing-along of “Staying Alive” in aid of your local Red Cross.
It's a week away. There's still time to organise something. We don't have their resources, but we have right on our side.
It is Saturday. I have gone into the hospital to have it out with them. They have lied. I don’t like being lied to.

I am at the desk on the ward. There is no-one there. I catch someone’s eye. It is the sister. She comes to the desk. No, the duty doctor is not available. He is about the hospital. He has to cover all the wards.

She listens as I relate my concerns. They had lost J*** on B*** Ward. There was no paper chase to show where J*** had gone. Who was the chap in the check shirt? She does not know. She refers to the nursing record.
Two in the morning? Yes, they were concerned J*** was close to death. They have just recommenced antibiotics.

Recommenced? Did they take J*** off them?

This is the second course of antibiotics.

There is no explanation for what was said. Why was I lied to? Lied. That is the word used by the lady in the nursing home. How did J*** get the infection.

She ploughs through the notes. John was assessed to have aspiration pneumonia...

There is no explanation for what was said.

Resuscitation needs to be discussed.

I have already told you that on the phone.
“Decisions about CPR are sensitive and complex and should be undertaken by experienced members of the healthcare team and documented carefully.”
The doctor would rather speak to you personally. It can take a time to explain things properly. CPR really isn’t that successful and it can be most unpleasant.

That’s what that chap in charge of Dying Matters says...

She looks back blankly.

You want to tell the Heart Foundation that and Vinnie Jones on You Tube. When the choice is life or death and the alternative is the end, you do everything you can; you don’t throw in the towel.

We’re not throwing in the towel. J*** is receiving the best of care.

She confirms I am to meet the doctor after the weekend.

I can see you’re frustrated...

Not frustrated, alarmed.
“Discussions about resuscitation are an important part of care plans.”
Care plans can involve the removal of tubes. These tubes might be to supply the very basics of life. They will call this respecting dignity. They will starve J*** to death.

We shall see...
Let's do some Life Café -

This is Wate.Com –
Father David Boettner of Sacred Heart Cathedral says what started as a peaceful lunch with friends, quickly turned into a desperate situation.
"They started calling out to a doctor, so I climbed over the booth and I could see that this gentleman was unconscious," Boettner said.

Walter Fitzgerald Jr., who works at South College, had stopped breathing. Boettner sprang into action, trying to save his life by doing CPR.

"One of his coworkers and I started working on him. She was doing mouth to mouth and I was doing the chest compressions," Boettner said.

But Fitzgerald still wasn't breathing.

"I was very scared for him, and I was worried that this was not going to end well," Boettner said.

Father Joe Reed was there eating lunch with Boettner and says as quickly as things turned bad, they got better.
"All of a sudden the man just came to. It was very dramatic, but it was wonderful to see how quickly Father David jumped into action," Reed said.

"I was so excited. I was so overwhelmed that he was breathing again," Boettner said.

Now, Boettner is preaching about the importance of CPR training
Pertinent reading –
Liverpool Care Pathway - The Joy Of Living
Liverpool Care Pathway - Crossing The Rubicon

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