The majority of elderly Australia's just want to die at home.
But only 14% of them actually achieve their wishes.
Half of the elderly frail people in this country actually end their lives in noisy, impersonal hospitals.
And all too often they die in the middle of futile and painful treatments.
The irony is that for all of our modern science and technology, we have not found a way to convert the simple wishes of elderly people into a peaceful, home based death.
And the result is often unnecessary pain and distress.
Let's make this personal.
Would you like to spend your final moments in an Intensive Care Unit -
- Lights blaring 24/7
- The beeping of medication pumps
- The squeaking of ventilator alarms
- The crinkle of cellophane as packets of medical equipment are unrapped
- In pain, unable to sleep, talk or drink, an uncomfortable tube stuck down your throat, hallucinating and having nightmares
- While complete strangers stand around your bed discussing your cardiac output and venous return?
An elderly male was brought into the Emergency Department by Ambulance after experiencing chest pain, vomiting then collapsing at home.
He was found to have suffered a catastrophic heart attack, caused by a total blockage of the left anterior descending artery in his heart.
The gravely ill man was rushed to the cardiac catheter lab where Doctors heroically tried to insert a stent into his heart to open up the blocked vessel.
During the rushed procedure the tip of the cardiac stent broke through an artery and lodged in the wall of his heart. This normally powerful tissue was so damaged by lack of oxygen then it was 'friable', more like tissue paper than a muscular wall.
Unable to then extract the tip of the stent from the heart wall in the cath lab, the medical team decided to take this dying man up to theatre, cut open his chest, remove the lodged stent tip.
This was late at night, with no experienced cardio thoracic surgeons in the hospital. The on-duty surgical team removed the stent from the heart wall.
They realised the heart muscle was now incapable of standing up to the normal pressure of pumping blood. So they decided to sew a patch over the outside part of the heart muscle, to provide support until it could recover.
The man came to Intensive Care at 2 am in the morning.
Strict orders were given to keep his blood pressure levels within a narrow range. This was to minimise the pressure placed on his damaged heart.
However the man’s blood pressure became unstable, swinging high then low. Doctors ordered short acting IV drugs to be given to stabilize his blood pressure; Meteramonol when it was too low, Nitroprusside when it was too high.
Doctors then decided to order morphine; reasoning it might be pain that was driving the man's blood pressure up. Another small intravenous line was found that had been inserted in ED, 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.
Nurses jumped on to his chest to do CPR, trying to avoid the ECG wires, central line and multiple peripheral IV lines. Doctors ran to get emergency kit to crack open his chest.
But it was too late. Stark naked, at 2 am, amid a litter of medical equipment and drug packages, surrounded by complete strangers and with no family around, the man died.
While the man's nurse began to pick up the empty packages littered around the floor the Doctors went through the man's medical notes find out 'what went wrong'.
They discovered that the man had been given adrenaline by the Ambulance officers, via an intravenous line they had inserted.
This lead to speculation that perhaps the person who had given morphine via this line had inadvertently given him some left over adrenaline and “killed the patient”.
Overwrought, the female anaesthetist who had nursed the sick man through his complex late night procedure and post operative treatment admitted that she had used the line to give morphine. She 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 ICU Doctor set about the task of ‘analysing’ exactly how much adrenaline the man may have received to kill him. Mils of fluid, ratios of adrenaline per mil and corresponding cardiac output were discussed. This academic debate went on for an hour.
Finally, bored with the debate this set of hemodynamic equations, the staff drifted off and returned to their duties.
The man's nurse continued pulling ECG dots off his chest, removing IV lines and finally, covering his naked body with a sheet.
The impersonal atmosphere of intensive care
He lay covered in only a sheet, a solitary figure surrounded by a large room of beeping machines until morning. At 6 am the attendants came to take him wheel him off to the mortuary on the metal trolley.
His family was called but could not enter the hospital until visiting hours started at 10 am.
When most people say they want to die at home, they don't realise how easy it is to end up like this man, caught up in a series of unnecessary and unnecessful medical procedures, then dying in a noisy Intensive Care Unit, in the small hours of the morning.