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Walk Away Ending: Why I chose not to complain about my mother’s NHS care

January 7, 2014

It started late at night on December 3rd 2009. My mother, eighty years old, fiercely independent but physically frail, fell down the stairs. Her body was shrunken. Her bones were like chalk. This probably sounds cruel, but I sometimes thought she reminded me of a tadpole: all head and not much else. It was no surprise to me that the impact shattered her femur  – broken in four places.

My dad rang for an ambulance. At the hospital, they took her to theatre and rebuilt her leg with metalwork. Within a few days, she was up and about with a zimmer frame – but there was a new problem: the anaesthetic had left her terribly confused. On the ward, no one seemed to take it seriously. They sent her home the week before Christmas.

The situation was difficult: I live sixty miles away, I don’t drive, and I had to go to work between visits to my parents. Because Mum could no longer climb the stairs, we had to convert the living room into a bedroom and Dad and I took it in turns to sleep on the sofa so one of us was available to help her to the commode in the night. Her mobility was poor and she remained intermittently confused. We coped like this for eight days.

On December 22nd my dad called me at work. He said that Mum had experienced increasing pain in her leg overnight and he had phoned the GP, but before any action could be taken, the wound, which had looked fine from the outside, burst open. He stood down the GP and phoned for an ambulance instead. Next day, I caught the first available train.

Mum returned to theatre on the morning of December 23rd. Afterwards, the surgeon phoned us. He said the wound was so badly infected that he had had no choice but to remove all the metalwork; the only option now was an indefinite period of skin traction combined with industrial strength antibiotics and regular trips to theatre for lavage. His tone was pessimistic. He advised us to come in and see her. The words “while you still can” seemed to hang unspoken in the ether.

I explained to my father the gravity of the situation. Although it seemed unlikely ever to come to it, I thought it best to broach the subject of resuscitation. Dad said Mum’s views were typically forthright. “Never put me in a nursing home” she’d told him. “I’d rather be dead.” We were clear on that, then.

I suppose we must have visited that afternoon, but I can’t remember anything about it. It’s been completely obliterated by what happened the next day, Christmas Eve. We got to the hospital just after two. Mum thought she was there because she was having a baby. She pulled it together a little when her best friend dropped by. She praised the nurses: said nothing was too much trouble for them, they were kindness itself and – extremely important – had kept her spotlessly clean. Then at three o’clock, she suddenly turned to us and said “I want you to go now. I’m tired”.

“We don’t have to leave yet Mum” I said. “Visiting doesn’t finish for another hour.”

“Please” she said. “I want you to go.”

Before we left, I sought out one of the nurses. I said, amongst other things, that the family would not oppose a DNAR* order, if doctors thought it appropriate. Then we went home.

We were watching TV at about quarter past eight when the phone rang. My dad answered it, then with an expression of puzzlement, handed it to me.

It was the hospital, of course. The staff nurse, whom I recognised as the one I had spoken to that afternoon, gabbled something about Mum ‘having a bleed’.

Shock made me stupid. “A bleed?” I said. “What sort of a bleed? Has the wound re-opened?”

“No…she’s had a…well, she’s had a…haematemesis. The team is with her.”

“The team? What team? Do you mean the crash team?”

“Yes.I…I know you said you didn’t want resuscitation, but there was no one to put it in writing, so we had to…”

When we got there, she was waiting at the ward door, plainly terrified of what we might say. Mum had been successfully resuscitated, she explained, but was unconscious and still bleeding. The doctors, covered in blood, ushered us into an office and asked us what we wanted them to do. My father and I looked at each other for cues, but because we had discussed it, we knew  exactly what we would  say. I didn’t hesitate. “We don’t want you to do anything” I said. “Just let her go”. She died half an hour later, the two of us holding her hands.

For legal reasons, there had to be a post-mortem. The results told me nothing I didn’t already know: catastrophic haemorrhage from stress ulceration of the stomach. The Coroner offered us an inquest. I said no. Why? Well, not because I didn’t have questions. In particular, I wish I could have asked why a woman with no cardio-vascular history was prescribed 150mg of aspirin a day with no PPI** cover. Probably there was a reason; I would have liked to hear it. But really, what good would the answer have done me? It wouldn’t have brought Mum back.

The truth is, I turned down the inquest for the sake of my father. Because although my mother was dead, he – despite being eighty-four years old – was full of life. My overriding priority, I was certain, was to give him the best chance I could, in whatever time remained to him, to rebuild and move forwards, unhindered by feelings of guilt and recrimination. So I walked away – and in so doing, I believe I set both of us free.

Because actually, I was thinking of myself as well as him. I had no desire to become a ‘person with issues with the NHS’, my life consumed by bitterness and negativity. Do I think my mother’s cardiac arrest could have been avoided? Yes, it probably could. But ask me whether I think she would have survived the admission as a whole, and the answer is no, I don’t. At some point in early 2010 she would have died anyway, overwhelmed by sepsis and probably confused to the point of stupor by isolation and anaesthesia. Her time had come. My father and I are content to view it so, and we have no regrets.

To those who think I should have gone for the inquest, or at least made a formal complaint to the hospital so that ‘lessons could be learnt’, I say that whatever lessons the staff on duty that night were going to learn, they were already learning them as Mum lay dying. I bet more than a few of them still remember her. They were good people; they never intended my mother to bleed death on Christmas Eve. How much satisfaction would vindictively subjecting them to the trauma of an inquest have given me? None.

The first days of 2014 have witnessed what may turn out to be the beginning of a reaction against the barrage of bad news about the NHS that was such an inescapable feature of 2013. On 1st January, the Guardian published a letter from ten leading NHS figures, who pleaded for a new mood which ‘strike[s] the right balance between recognising the extraordinary achievements that NHS staff deliver every day and the need for improvement’. The next day, Radio 4’s flagship Today programme followed up with something similar.

Continuing negative publicity about the NHS has distorted public perceptions and made the work of staff much harder than it need be. No, the Health Service is not a sacred cow, and yes, it needed to take a long, hard look at itself. Parts of it still do. But let’s agree that any future work should be conducted against a background of appreciation and acknowledgement of the amazing work the NHS does every day of the year, and of the hundreds of thousands of dedicated and compassionate individuals who make it happen. Let’s make 2014 the year we big up the NHS!

* Do Not Attempt Resuscitation.

** Proton Pump Inhibitor. A type of medication given in conjunction with aspirin (and certain other drugs) to counteract their irritant effect on the lining of the stomach.

For the ‘ten leading figures’ letter, see:

http://www.theguardian.com/society/2013/dec/31/new-year-herald-new-start-nhs

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13 Comments
  1. Despite the sadness of this post it was an amazing read, very powerful.
    I’m very sorry to hear about the loss of your mother. I’m also glad to hear that you still found peace with what happened and that you still saw good in the staff who cared for your mother, something that the media are determined to prevent in the NHS.
    And I agree, let’s make 2014 the year we big up the NHS! It’s about time we stopped standing back and accepting that all our good work is ignored 🙂

  2. Thanks you for commenting. @BunzBird made a similar point to yours over on Twitter when she said that despite the fact that things weren’t perfect – which they weren’t – I still thought of the staff as caring. As a nurse myself, I could sympathise with their position. They got some things wrong, but I was prepared to believe that overall, they were good people. The question then becomes, should we punish good people who get things wrong? My view was that to do so would achieve nothing, but the prevailing view often seems to be that health care professionals should be super-human, and exacting revenge and questing for ‘justice’ is a kind of duty. I did not want to get bogged down in those horrible, life-sapping emotions.
    You could, of course, argue that I over-identified with the staff on the ward, that I didn’t complain because I saw that their predicament could all too easily have been mine, or that I was frightened by the possibility that because I sometimes make mistakes, I too perhaps fail to measure up. By not complaining, was I refusing to confront the possibility that all might not be well with my own nursing practice? All I can say is, it didn’t feel like that at the time.

  3. very brave of you to write this. thank you

    • Thank you for commenting.

      • You’re welcome. thank you for the work you do in your life. We all need people like yourself because courage is something so important. And you clearly love your work too.

  4. John permalink

    How will the NHS ever improve if we do not complain & search for higher standards
    After Midstaffs and the union attacks & venom many are now scared to complain about OUR NHS

  5. I am not sure that I understand why the Mid Staffs scandal has made people afraid to complain (I should have thought the opposite was true) or what you mean by ‘the union attacks and venom’.
    The question I am asking is this: is it right to demonise professionals who are caring but make mistakes, or should we empathise and forgive on the grounds that we are human too and we also make mistakes. I make mistakes. I found it very difficult to point the finger at someone who could have been me. Perhaps you believe it reasonable to expect health care professionals never to make mistakes? You may be right, but assuming such people could be found, is it likely they would also have the empathic ability that we say we also value so highly? What concerns me is that we seem to have got ourselves into a position whereby anything less than super-human qualities in our HCPs is cause for outrage.
    Like you, I want the NHS to improve. But I do question whether a workforce demoralised by the corrosive effects of constant negativity and unrealistic expectations is in the best position to bring about that improvement.

  6. Pamela Jean permalink

    This is a helpful example of why we might choose our battles more thoughtfully. I had a similar choice to make with the untimely death of my brother. As I read, “So I walked away – and in so doing, I believe I set both of us free.” I experienced that sense of freedom once again for myself. Thank you for articulating this difficult experience so sensitively.

  7. Thank you for commenting. It’s interesting how we can experience death as a kind of freedom. We shouldn’t feel guilty about saying that.

  8. This story of your mum’s death and its aftermath has some parallels with that of my father-in-law and I agree completely with your sentiments about the sometimes dubious value of complaining and the impact of the continuing negative publicity about our poor old benighted NHS. I am getting very tired of hearing friends slag off the NHS. As members of the public, they do not fully appreciate the impact of the insidious disinvestment in the NHS over the last few years or the current state of the nursing profession, the morale of which is lower than I can recall since the 1980s (when Thatcher was in power and blaming nurses for the recession.) According to the RCN, in the space of one month last year, the number of full-time equivalent qualified nursing, midwifery and health visiting staff in the NHS in England fell by around 1,000 (between March and April,2013) meaning a total drop of a almost 3,000 since April 2010 in England alone. Nurses have not received a real-terms pay increase since 2006 while I hear in the news the government refuses to cap bankers’ bonuses and RBS are still considering paying 200 per cent bonuses to bankers earning over 1 million per annum. Nurses are not the enemy but it suits our government to whip up a popular wave of blaming the ‘unproductive’ public sector, rather than holding the wealthy elite (of which they are part) accountable for the state of the nation.

  9. Hi Tony, thanks for commenting. I think there is a case for saying that negative publicity about the NHS serves the Coalition’s (or at least, the majority party’s) purposes very well in that it encourages people to believe that a different model of health care might serve them better. It softens us up, in other words, for a shift to private providers.
    The pay issue, I think is also related to this – we are all working harder for less pay (in real terms) because private providers would find large wage packages unattractive. I honestly think that is why the government is showing such reluctance over this year’s already paltry 1% rise. They also want to get rid of automatic increments for the same reasons.
    My mother’s care could have been better – but I think the staff who cared for her, medical, nursing and therapy, already knew that. I felt making the point by pursuing them through a Coroner’s court was unnecessary and vindictive. I just wanted to get on with my life, and I wanted them to get on with their lives, too.

  10. Thanks for writing this, I’m sure the staff learnt a lot that night. Think hospitals often have issues with getting DNARs done – i’ve seen end of life patients who still haven’t had a DNAR completed until much later on. There seems to be some reluctance to talk about DNARs and get them in place in some wards.

  11. I was very happy to talk about it, although I don’t know at what stage the staff would have taken the initiative and approached me. The fact that it was Christmas Eve probably didn’t help. More broadly, our experiences demonstrate the value of having ‘that conversation’ before it’s too late. You never know when too late is going to come. It will probably be when you least expect it.

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