wakingthebaby

Love Weirdness

On the back of the Order of Service for my son’s wedding his wife had found a great quote:

“We are all a little weird and life’s a little weird and when you find someone whose weirdness is compatible with ours we join up with them and fall in mutual weirdness and call it love.” – Dr Seuss

So here is an offering on this subject of a weird love story.

To the tip, my darling.

You could meet me at the tip my darling

By the sump oil or waste cardboard skip

For a long hug and a kiss my darling

It isn’t a very long trip

I’m sat in the garden my darling

With a book and enjoying the sun

I’ll meet you there my darling

I think it will be such fun

You weren’t at the tip my darling

There was no one to hug or to kiss

I just thought it a lovely idea

To add to our feelings of bliss

How I missed you my darling

And tried not think of our hug

So I dumped all my bits and my pieces

Along with a heart, too heavy to lug

Blame the sun my darling

Beaming all lovely and hot

I fell asleep my darling

I wasn’t that I forgot.

I’ve been to the tip my darling

I searched through all of the dross

And there was your heart my darling

Rescued and found by the boss

We’ll both go to the tip my darling

Thank the boss man for all of his trouble

And if all goes to plan my darling

We can kiss and hug by the rubble.

©JohnDaniels 2017

Becoming Invisible

No one noticed at first

Sloughing off, his mind

Except his wife, of course

Who had to cope as best she may

As so slowly he slipped away.

Just when he left is hard to tell

As something about his shell

Seemed it might just retain

A hint of who he once had been

But by the end, it was gone unseen.

They had cared for others, he a man of God

And raised a family and flock together

Overseas to serve, one place cold

The other hot, until their, quite overdue

Time for a rural retirement quietude.

Short changed it was and soon confused

He took to wandering to find a church

Where he could do his pastoral duty

Then wander and wonder why he’d been

So bars on windows came on the scene.

Then drugs to ease the burden, slightly

Except by now lack of inhibition nightly

A magazine he would use to smite his wife

It wasn’t the worst thing for her to bear

‘Where is the man I love, that I now fear?’

Side effects gave a sweet tooth and theft

Of cakes when he escaped was in order

From an understanding baker down the road

Occasional respite given in a psycho ward

Among the outcasts vulnerable he’d board.

Lord alone knows how she coped, but she did.

She took it all, frail though she became

And hardly ever known to complain

Except to pray that his mind was now with God

And please not long for the rest under the sod.

Sadly In the end his kidney failed and almost

Gladly all that remained was laid in the ground

By family and those who remembered him well.

She missed him, but could not resolve

The mystery of when he really went.

This is a true story of older friends both gone now. Dementia is a family affair with the burden falling on those who themselves are becoming frail and tired.

Dolphins

All day

We watched the sea

Each mood a promise

Nothing like it could be

All day

Taunting waves

Odd ships and sea birds

With sun dried eyes.

Then –

Joyous

Headlong

They came

Sewing the sea

Stitching the waves

Into the dusk of our vigil.

We took a trip on a ship, The Pride of Bilbao.

Inappropriate medical intervention at end of life in particular Cardiopulmonary Resuscitation or CPR

I guess most of us have seen ‘resuscitation’ with actors on TV or film in a hospital setting; obviously, it isn’t for real.

Real life CPR is brutal and sadly, even with fit young people more die than will survive. Out of hospital it is a very different story. If CPR is not started or a defibrillator used the casualty’s brain will die within THREE minutes, that is why hospital resus teams run!

I am of an age where one’s mortality needs to be considered and dealt with so as to get on with the business of living. There are things I would wish for at the end of my life and some definitely not. If for any reason I am not able to say what these are then the burden would fall on someone else to decide. From a socio-medical point of view technology and skills have changed greatly. Intervention can be traumatic and not always appropriate

So. if your heart stopped would you wish to have rib crushing CPR performed on you?

A tough question deserving some thought because your answer will depend on the circumstances.

If you’re fit, otherwise healthy, suffer a cardiac arrest and CPR can be started immediately, then obviously, yes and if you survive, fantastic.

With a cardiac arrest it is the heart that stops first with the other organs failing afterwards.

With an ‘ordinary death’ the other organs fail and the heart is last to go. CPR is no use with an ‘ordinary death’, but CPR is being done in these situations.

There are people, nurses, carers, families, in some instances members of the public and even doctors who have been and are still being placed in the untenable position of suffering the consequences from performing inappropriate CPR. Conversely medical staff have been sacked and disciplined for not performing CPR even though there was no medical reason to so do. These are specific concerns over CPR, but other interventions, though not so obviously traumatic, are still potentially inappropriate.

Currently I believe the rules are inadequate and have been made such that clinical judgement is not given due consideration. As a consequence there is a trend towards inappropriate intervention becoming the norm. Partly this is due to digital technology directing the requirement for CPR and partly risk averse institutions fearing negative actions which might cost reputations and money. It requires sorting out for all concerned.

What is true is that anyone who is concerned about their own end of life should start the conversation about their wishes whilst they are able. You can require that CPR is not attempted inappropriately whilst other procedures are given to benefit your comfort.

For families and carers etc. it is difficult to initiate these discussions. If possible talk to the person concerned, it may well be welcomed and do speak to the doctors and nurses.

Now I’m not a medic so this is from one who is. Warning it is a tough read!

“Break his sternum. Break some ribs; crack beneath your hands. Push, push, push; one hundred times a minute please. ‘Good compressions’ calls the computerized voice from the defibrillator. Don’t stop, now feel for a pulse; you’ve got it? OK, now leave him to die again. Pillow? There are no pillows in A&E, we will find a blanket and roll it up under his head. He isn’t for intensive care. What’s his name?

I don’t know it.

You could tell that story many ways and it is the story of many. I could paint it rosier, add more details, but when I relive these cases I often don’t. I recall it just like that.

‘Cardiac arrest call ED resus, five minutes; ITU to attend’ the voice crackled over my bleep. I arrived in to resus to receive a woman in her eighties who had choked on her dinner, stopped breathing and then had a cardiac arrest. CPR was started at her care home and an ambulance was called. They arrived, cleared her airway as best they could, continued CPR and brought her in. She had what we call ‘return of spontaneous circulation’.

The patient arrived unconscious with a pulse. We transferred her on to our trolley. She had fluffy white set hair like my grandmother, I used to like to pat my hand gently on top of it and watch her laugh when I told her it felt like a cloud. I looked at the patient’s soft wrinkly skin and her tongue, that lolloped out of the side of her mouth next to the laryngeal mask airway that had been pushed inside.

We knew very little about her, but we set about the basics as a start.

‘This airway isn’t working properly’, I said as I pulled it out of her mouth and discovered a match box sized lump of meat partially clogging the end. Moving on inside, I continued to clear the remainder of her stomach contents that had exploded into her mouth with CPR.

Airway: check

Breathing: check

Circulation: check

What happened next? The A&E consultant logged onto the computer and gathered what information we could about this patient who arrived without anybody who had ever known her before.

Dementia, diabetes, hypertension, full-time care and previous admissions to hospitals for falls.

I phoned my consultant and we discussed the situation. She would not be escalated to intensive care. Death was inevitable; of course it was, that was true from the first time her heart stopped.

I put down the phone and looked at the monitor. Her circulation was already failing again, so we rolled a blanket under her head and a nurse found a clean gown to place over her broken chest. She was given all the dignity A&E resus could afford her.

Her family came later and the A&E consultant told them about the series of decisions we had made. They understood and recounted many years of their loved one living with dementia and co-morbidities. They agreed they wouldn’t have wanted her to have CPR and they wouldn’t have wanted escalation to intensive care anyway.

They wouldn’t have wanted her to have CPR.

There’s a form for that, I thought, as I remembered standing in a busy resus department looking at her broken, see-saw chest heaving irregularly on front of me.

There is a form for that. ”

By the Secret Doctor

Read the blog and follow @TheSecretDr on Twitter and check out #CalmEndOfLife

Some advice on what to do when a death occurs

http://announce.jpress.co.uk/help?page=lasting_post%2Fwhen_death_occurs;s_source=jpno_dfpc_gco

Many thanks to Dr Gordon Crawford for allowing me to give these links — Imagine you are coming towards the end of your life, can you paint me the picture that you see in your mind’s eye of your dying bed?

https://www.dropbox.com/s/sxs9kiva9soh2ex/NEJM%20Paint.pdf?dl=0

Giving the medical background for my layman’s blog.

Time to Change from Do Not Attempt Cardiopulmonary Resuscitation

https://www.dropbox.com/s/8gmbn8z3cbbf41n/V2%20Time%20to%20Change%20from%20Do%20Not%20Attempt%20Cardiopulmonary%20Resuscitation.pdf?dl=0

Some potentially useful Links:

Advanced Decision http://www.nhs.uk/Planners/end-of-life-care/Pages/advance-decision-to-refuse-treatment.aspx

A report: Discussing death

Most people express a considerable degree of confidence around discussing death and planning for the end of life. Planning for end of life Yet this expressed comfort and confidence is not always translated into actual discussions and practical planning, largely because death is seen as far off – even among many older people. Recent policy, legislation and campaigns advocate greater openness and discussion around dying and planning for end of life care. What are the public’s attitudes on this issue and how far do these vary for different sections of the population? How far have individuals put plans in place for the end of life and what factors are inhibiting planning in this area?

http://www.dyingmatters.org/sites/default/files/BSA30_Full_Report.pdf