An elderly man presented to the to Emergency Departments with shortness of breath.

Doctors diagnosed widespread vessel disease, also called peripheral vascular disease. He also had a poorly functioning heart valve.

The result was an accumulation of fluid in his lungs, also called acute pulmonary oedema. The man knew the end of his life was approaching. He considered ceasing all medical treatments and just accepting pain relief and supportive care. However his wife insisted that he get an expensive heart specialist to review his case.

‘Doctors can perform wonders’ she urged. ‘You have got private insurance, why don’t you use it?’

The heart specialist stated that he could fix the man’s problems with cardiac surgery. The man finally agreed. He was quickly booked in for coronary artery bypass graft and valve replacement in one operation. He was eighty nine years old.

After the operation, his wife came to visit him in the hospital. The man was distressed, and started to cry, saying “take me home. I’m going to die”.The wife brushed aside his concerns and urged him to be positive. A few days later he suffered a major heart attack.

The small hospital did not have the resources to manage his deteriorating health, and he was transferred to an Intensive Care Unit in a public hospital. Nursing and medical staff expressed frustration that an elderly man with a serious medical history had been given open heart surgery. His children all came to see him. They were distressed to see their father attached to a ventilator, a tube stuck down his throat. His wife was convinced he would soon turn the corner, and recover.

The man’s kidneys failed due to lack of blood flow. He was put on dialysis. Cardiac drugs were given intravenously, to increase the pumping of his heart.

These drugs also decreased the blood flow to his hands and feet. Over the next few weeks his toes developed black ulcers. The man failed to recover. His children could not communicate with their father. He was in a dream like state, on sedatives, intubated and hooked up to a ventilator machine.

The Intensive Care Unit was noisy, busy and focused on aggressive medical treatments. No one noticed that the tapes holding in the breathing tube were cutting into his face. Or that his fingernails were dirty. Or that he was half naked most of the time.

Six weeks after the surgery, the man died, in Intensive Care.

His family remain bitter about his treatment. Their final memory of their father was deeply distressing.

The hospital and cardiac surgeon were never asked to take responsibility for the poor outcome, for both the patient and his family.

Wikihospitals 2014