The majority of elderly Australians want to die at home
But that’s just not the way it happens.
Only 14% of Australians actually die at home. And over half die in hospitals.
The irony is that with modern technology we are able to predict with far more accuracy when people will actually die. However we are not having honest conversations with people about the end of their life wishes.
And the result is an increase in hospital deaths.
Would you want your final moments spent in an Intensive Care Unit? Is the last thing you would like to hear beeping equipment, the unwrapping of medical equipment and complete strangers discussing your cardiac output?
An elderly male was brought into the Emergency Department by Ambulance after collapsing at home.
He was found to have suffered a very severe heart attack.
The left side of the heart is an extremely powerful muscle that pumps blood against pressure in the bodies main artery, the aorta.
The acutely ill man was taken to the cardiac catheter lab where a stent was inserted into his heart via his groin, to open up blocked vessels in his heart.
Due to the severe damage to the left side of his heart, the tissue of this normally powerful muscle was fragile.
During the procedure the tip of the cardiac stent inadvertently pierced through a heart artery and lodged in the heart wall.
Very rarely is medical treatment stopped because it is futile
Most people don’t realise how afraid Doctors and hospitals are of being sued.
Hospitals get paid the same amount of money to perform useless procedures as they do to perform practical and life saving ones.
This creates an incentive to ‘do more’, even when there is little chance of a positive outcome.
Unable to extract the stent in the cath lab, the medical team decided to take the patient to theatre to have the stent surgically removed.
This was late at night, with no experienced thoracic surgeons in the hospital. Open heart surgery was done, and the stent was finally extracted from the heart wall.
The left wall of the man’s heart was ‘friable’ due to the extensive damage from the heart attack.
The surgical team realised the heart muscle was incapable of standing up to the pressure of pumping blood. So they decided to sow a patch over the damaged part of the heart muscle to provide support until it could recover.
The man was sent to Intensive Care after surgery. Strict orders were given to keep his blood pressure levels within a narrow range. This was supposed to keep the pressure on the damaged left side of his heart to a minimum.
However the man’s blood pressures became unstable, swinging high, then low. Doctors ordered drugs to reduce his blood pressure. Nothing worked.
Doctors then decided to order morphine; reasoning pain might be driving his blood pressure up. A small intravenous line was found, and morphine was injected through it.
Suddenly the man’s blood pressure shot up extremely high, then crashed. His chest drains suddenly filled up with blood.
‘He is bleeding into his chest cavity” yelled a doctor.
Despite cardiopulmonary resuscitation, the man died.
Staff went through the patients hospital notes from both Theatre and Emergency. They discovered that the same peripheral intravenous line used to give the morphine, had been used to give a powerful cardiac drug called adrenaline.
There was discussion that this line may have had some adrenaline in it, which was injected along with the morphine.
Speculation began among the doctors that the person who had given morphine via this line had “killed the patient”.
A junior doctor who has used the line to give morphine broke down and cried, saying how sorry she was, that she did not mean to kill anyone, she was just trying to save the patient’s life.
A senior doctor set about ‘analysing’ how much adrenaline the man may have received. Mils of fluid and ratios of adrenaline per mil were discussed. This academic debate went on for an hour.
Finally, the staff all walked off.
The dead man’s body lay naked on a narrow trolly, covered barely only by a sheet. He was surrounded by discarded medical equipment packages. All around him equipment beeped, and numbers on monitor screens flashed in primary colours.
The impersonal atmosphere of Intensive Care
The man’s nurse was told to clean him up and prepare the bed for the next patient.
She removed his invasive lines, catheters and ventilation tubes.
The mess around his bed was swept into a corner then put in the bin.
He lay covered in only a sheet, a solitary figure surrounded by beeping machines for an hour, until the attendants were free to take him to the mortuary on a metal trolley.
The moment his body was taken out of Intensive Care, another Emergency patient was booked to take his bed.