An excerpt: ‘My mother died nine days ago. She was seventy and had suffered a heart attack…. My sister Kelly found her dead in her chair. Kelly dialled 999. The voice that answered ordered her to lift our mother on to the floor and start resuscitation by compressing the sternum to restart her heart. Kelly obeyed.
‘While she was carrying out the instruction she heard a crack from the ribcage. She says she will never forget that crack. “Two men arrived very quickly… and started work [I arrived shortly afterwards] and pleaded with them ‘Stop it. Can’t you see she’s dead?’ They just replied, ‘We’ve got to. We can’t stop yet.’”
‘They pushed a tube down into her windpipe and pumped in air, or perhaps it was oxygen. They cut open her nightie and wired her up to [an Automatic External Defibrillation] machine, which they switched on. I couldn’t bear to see her like that, on the floor, she was so modest, her nightie pulled away, and two men over her. I tried to cover up her lower parts, so she wasn’t too exposed – it was silly really but I kept thinking how mortified she would have been.’ (In The Midst of Life by Jennifer Worth)
What the author of that piece tells us a little later on is that her mother had probably been dead an hour and a half before attempts were made to resuscitate her.
My own aged mum is doing brilliantly, considering she has just past her 96th birthday. But when I visited her recently, I saw how wobbly she was; how, after sitting for a time – watching television or having her meal, for example – when she stood she’d sway about like a little boat trying to steady itself in a storm.
What if she fell? I asked myself. ‘What if she then hit her head and killed herself, and maybe a fellow resident at the ‘”living home” sounded the alarm and then she was put through the same kind of scenario’? My mother would be ‘mortified’; so would I be.
In the same chapter from which that incident is quoted we’re told that ‘Anyone involved in health care, however loosely … are all shown how to use the AED machine, and the rule is that an attempt to resuscitate must be made unless there is a clear and unequivocal order not to do so. This is the DNAR order (Do Not Attempt Resuscitation) commonly used in hospitals. However, in the wider community such an order is not generally available, even if at some time it has been made. A person may have a living will [aka Advance Health Care Directive or Advance Decision], but if they collapse at the shops, who is going to know?
‘…Everyone should have proper information about what resuscitation involves; what the initial success rates are, the long-term success rate, and what the possible side effects are.’ (p251)
The author does concede that the ambulance team has an unenviable job. ‘They do their best, but they get a lot of blame from the general public, which is demoralising. In a situation such as the one described above, with [the two daughters] so clearly upset, it must have been profoundly distressing for them. But, legally, no relative can say what medical treatment should or should not be given to another person.’ (p253)
When I recounted the incident involving the elderly woman to my mother, she agreed that it was horrific and no way would she want to have that happen to her. I then told her about a Living Will or, as it is called in Australia, an Advance Health Directive: a document in which her wishes regarding such an eventuality could be recorded and taken into account when she was’ unable to make reasonable judgments in respect of…treatment’. She agreed she’d like such a document; clearly her doctor needed to know, so he was our first port of call.
I had no idea how he would receive the idea but as it happened by the end of our discussion he actually thanked me for bringing the issue up, saying he must look to other elderly patients of his to see if they wanted to follow suit. Whatever is recorded in the directive isn’t legally binding, he confirmed, but doctors ‘certainly take the patient’s stated wishes into account’. [In England and Wales, the Advance Directive is legally binding.]
Having got the appropriate forms from him, and his signature, the next step was the all-important filling out of the form. My sister joined us for an evening meal one Sunday and afterwards we helped Mum formulate exactly what she wanted. In the event, Mum decided for the following:
1) In the following circumstances of being found unconscious, I consent to the following treatment – to whatever needs to be done in order to establish the reason for my falling unconscious.
2) In the following circumstances – If I am not restored to full consciousness within seven days I refuse consent to the following treatment – any form of life support; any removal of my organs; any organ transplant.
3) In the following circumstances – my being found dead, I refuse consent to the following treatment: in any circumstance to any attempt to revive me.
That was then signed by my mother, by the local Justice of the Peace and a witness. My sister happens to be a Justice of the Peace and, though she could not act as such in this instance, it was great to have her when, a few days later, we went to the nearest town to have the document signed. She knew the ropes and the particular JP who was on duty that day and it was all conducted in a friendly, relaxed way.
We had numerous copies made – one for my mother’s doctor, one for my brother, one for my sister and myself, and finally one for the supervisor of my mother’s residential village. In a way, that last person was the most pivotal in that most likely it would be she who would either find mum or would be summoned to the scene, if my mother were found either comatose or dead by someone else. For my own peace of mind I wanted to know that she understood exactly what the document stated. I need not have been concerned: she had Directives from other residents and was perfectly at ease with what was wanted from her.
Many of us have elderly parents and getting the forms together is not rocket science, time-consuming or costly (it’s free!) to make some moves towards ensuring that their wishes about their health, when they are not in a position to convey them, are on record. I’m really glad now that I happened upon that disturbing episode as recounted in In the Midst of Life. Of course, there are no guarantees that my mother’s last moments will be as graceful and peaceful as she and I might wish; but I do feel glad that we did what we could to that end. The rest is in the hands of existence.
For more information about Advance Decisions in the UK, see Advance Decision & Lasting Power of Attorney.