Read on Twitter
Reading a lot about decisions at end of life, in particular the issue of DNR, at the moment. I’ll share my thoughts - if helpful - though I can’t promise to be tactful or to be eloquent about it.....
Late last October it became obvious my Nan, 93, was starting to deteriorate. A diagnosis of rare and agressive skin cancer had been made earlier in the year - no treatment was being given, due mainly due to the massive impact it would have on her remaining life....
...and outcomes not necessarily good. We didn’t argue this with medics. We understood dragging her backwards & forwards to hospital appointments would be detrimental to her wellbeing. So we went home and waited and in October noticed a change
And started providing her with round the clock care. Everything else was put on hold so she never spent anytime alone. Some days we wondered if we were imagining deterioration, even after we started engaging with primary care for more support. Her wish was always to die at home
And this meant one of the conversations we had to have was around resuscitation. She was fairly adamant this was what she wanted, which for a painful few weeks meant knowing that if she had crashed on my shift I’d have to decide - call for help, knowing that...
...she would be rushed to hospital, have invasive procedures carried out on her and unlikely not survive but die in the place she was adamant she didn’t want to die in. Or I would just not call for that help. It was a sickening thought.
It took us several weeks of talking this over and over with her to help her understand what all this meant. Of going over and over potential scenarios with her, reminding her how unpleasant it was when grandad was in hospital, resuscitated, connected to machines and died.
Talking about this in a way where we didn’t want to force her to make the decision we felt was right but where we also wanted to support her request to die at home. She had full capacity. And she’s always been at peace with dying. But it felt like as she neared the end she didn’t
want to let go (turns out she was really worried about ‘leaving’ my mum - her daughter) and that was I think why it was hard for her. Eventually she recognised what wanting resuscitation would mean for her and she agreed it wasn’t the thing to do. And she was able to die at home
With a lot of support from @FromeMedPractic @DorothyHouseHC and district nurses. None of us need to get yo ‘old age’ to have these conversations, the opportunity to ‘plan ahead’ is something we should all do - so it becomes the norm
and not a difficult conversation when the time to die is rapidly approaching or when life and death is staring us right in the face as it is with COVID-19. The pressure on hard working NHS and primary care staff has never been greater. They are sometimes having yo open up this
question with their patients. It’s a sensitive one and it’s upsetting people. I get that (although I’m pretty practical about death - we all die after all and I’ve experienced quick sudden premature death of dad & long drawn out painful death of nan)
But I wish this was something people could talk about with their loved ones as a matter of course. Tricky subject but I feel sad seeing medics being criticised for raising it now. Maybe one day - as things have changed with organ donation - it will be
something we all have noted on our medical records...I know everyone is different and these are just my views but I feel so much better getting that off my chest! Now back to seed sowing once I’ve reminded boyfriend of my wishes 
