BEST PRACTICE
A good death R
OBERT is 75 and dying of metastatic lung cancer. He presented late and no further treatment is possible. He has
become housebound due to breathlessness, weakness and pain. His wife has made six house call requests in the last four weeks and Robert has been seen by five different doctors. He has not been seen by a community nurse. Robert has little idea of what is happening
and no idea what to expect. He and his wife are becoming very anxious. He now finds everyday activities a struggle. He can no longer get out of bed and can barely swallow his medication. It is a week since he was last seen but his wife is reluctant to call as she feels they are a burden. Robert wakes at 03:00 on Saturday morning
with worsening pain and increasing anxiety. Despite all her best efforts his wife cannot manage to get him to swallow his painkillers.
16
She phones NHS 24 and a visit is arranged. A GP arrives 90 minutes later and, though very attentive, clearly has no idea of Robert’s treatment up to this point. An injection of diamorphine alleviates
Robert’s pain but he is unable to swallow diazepam and his mouth is too dry for lorazepam s/l. A prescription for midazolam is written and the OOH service contact the on-call pharmacist. At 06:15 the medication arrives via the palliative care taxi and a community nurse administers midazolam s/c. Robert’s anxiety is relieved. Te following day a syringe pump is
commenced and Robert remains symptom free. Four days later his wife wakes at 05:15 and finds him cool. She ‘panics’ and phones her daughter who isn’t sure what has happened and so tells her mum to dial 999. Robert’s wife is told to start CPR. An ambulance arrives 18
In the first of a two-part series Euan Paterson, a Macmillan GP facilitator, discusses the challenges of providing high-quality palliative care in the community
minutes later and the futile CPR is stopped. Te ambulance crew contact the OOH service and a doctor attends. Robert is pronounced dead. His wife feels angry, guilty, sad and confused. She doesn’t know whom to turn to.
Would you consider Robert’s death a good
one for both him and his family? What do you think went wrong and more importantly why did it go wrong? For many doctors, palliative care is one of
the most important and difficult aspects of their job. Tough the number of dying patients an average clinician will treat may be relatively small, the impact of a death for all those affected by it cannot be over emphasised. When thinking about how to provide
high-quality palliative care it is helpful to consider two broad headings – competencies
SUMMONS
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24