New here and not sure if this is the right place. Apologies in advance for the long post...
My grandmother is unwell in hospital. She's 79 and originally went in for a broken leg and fractured hip after a fall in February and was supposed to remain in hospital to receive physio to get her walking again. However, she's been unable to do any physio for a few weeks now due to her deteriorating. she's developed a hernia and has an infection of some kind. The hernia is quite big to the point she looks 'pregnant' and is causing her discomfort and pain. She's weak, constantly drowsy and can't eat properly. This has been a recent development as she has been in hospital since mid-February, and other than the broken leg/hip was happy and lovely (as much as you can be when bedridden). She's also developed a slight irregular heartbeat and been given a DNR order. The doctors don't seem to be telling my family much despite going to see her daily. They seem to be giving us mixed messages by saying they can't operate until her condition improve and then also saying that they might not operate on the hernia at all considering her age.
Considering her condition is unlikely to improve enough for them to give her an operation for the hernia it seems like we're just waiting for her to die considering the DNR.
Is there any advice anyone
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Christopher94
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Is the DNR something that your Grandmother and you? or other family? have agreed to?
I would get that DNR removed so that everything possible is done for your Grandmother.
That hernia is huge. Why have they left this so that has become this big? So much of her of her intestines and other gut must be outside. They have to operate on that. They have to. Would you leave a dog in that condition? Sorry to say that but it appears to be neglect. With this done she could begin to try to get out of bed onto the chair, and physios to help her to walk again.
Your Grandmother is probably drowsey due to the pain relief she is being given.
My mother fell and broke he hip at the same age and they do try to get you out of bed pretty quickly. When getting my mother out of bed she felt very faint and she had also lost her appetite. I noticed on her chart that the pain relief fhe had been given was one that had made my mother feel very strange drowsey and would not eat prescribed for a previous condition. It was changed and she perked up to here usual self.
To my knowledge, my family were informed of the DNR order rather than consulted. Apparently the hospitals reasoning is that an attempt to resuscitate my Nan would cause damage to her ribs that would cause more harm. I'm not involved in her care at all. My uncle is her next of kin however, apparently he's 'kicked-off' according to my Mum at the hospitals lack of action and my Mum believes this has only led to them doing less, although I'm not sure if this is true.
As I said, she originally went into hospital for a broken leg and fractured hip. she received an operation on the leg to fix it and soon after that the hernia was discovered. However, it was not seen as an immediate problem. in the last three months or so she's been moved between hospitals in the area to receive physio and was then moved into a care home to recover further (I assume to free up bed space). The care home however was not equipped to do physio with her (or just wasn't doing it with her) and my family got her moved to a 'recovery ward' in the hospital she is currently in about three weeks ago.
About two weeks ago my uncle noticed the size of the hernia and informed the nurses. I believe plans were made for doctors to see what could be done but then she developed an infection and was deemed too weak for an operation. She then developed an arrhythmia and the DNR order was put on her.
My family all understand that there is a risk she wouldn't make it through an operation in her current condition. she's barely eating and is unable to feed herself because she's so weak at the moment. But this isn't going to improve and if she doesn't improve she's unlikely to make it anyway.
My family has asked if she can be moved or taken to a different hospital considering she's only on a 'recovery ward' and the hospital she's at doesn't have an A and E in the hope she'll receive treatment there but the hospital have refused to move her.
I asked my Mum and apparently all she's getting is paracetamol for the pain along with antibiotics for the infection and her diabetic medication. She's also been put on a water drip as well as potassium drip.
My family feel there isn't enough being done for her. I suspect it's because as I said, the ward she's on is for recovering elderly patients and is supposed to be temporary, but the hospital have refused to move her so we're not sure what else can be done.
Many thanks,
Christopher
Hello Christopher. Unfortunately it looks as if your grandmother has become a 'victim' of over-aggressive hospital treatment for her multiple medical and surgical conditions. A broken leg alone should not have kept her in hospital for so long, if she had sufficient help at home for her to be discharged. Long term hospital treatment is as likely as anything to cause her to deteriorate and increases her likelihood of infections and pneumonia through inactivity. Over-enthusiasm to treat every symptom has killed off many elderly people who would have done far better with less intervention and a quicker release home.
I think that all you can do now is to be more robust with your grandmother's physicians. Don't be fobbed off. Ask for a proper appointment with her senior physician and write down ahead of time all of the questions you want answered, and when you are asking them, don't be too overawed to ask anything that may be awkward.
If your family is able to put measures in place at home or wherever she resides, for your grandmother to be helped there, let her doctors know that you are there to support and take responsibility for her.
There should be no need for a lady of this age to deteriorate to death through misguided hospital intervention in her ailments, none of which are, on their own, sufficient to cause death.
The problem is she is receiving no treatment for her conditions, other than antibiotics for her current infection. She is bed ridden and unable to walk on her leg on her own as she snapped her leg and it is still recovering. She will continue to be unable to walk until she is getting regular physio to to ensure the leg heals properly and she can only receive this in hospital or certain care homes. As she is bed ridden we cannot provide the care she needs at home and her hernia means removing her from hospital would be irresponsible.
Hi Christopher. Then you need to be sure to take charge of her treatment in hospital. Don't let your grandmother become a victim of the system. If you think her DNR is holding back treatment, then discuss with all concerned, removing it. The NHS is very paternalistic and authoritarian in its treatment of people and sometimes it is quite challenging to take it on. But don't be afraid to do so!
Ask what the implications are of no surgery on her hernia. Although they can look large and scary, it can be scarier in outcome to have surgery on them and can lead to complications that can cause death.
Ask why she is so drowsy and unresponsive and if it is a direct result of medication.
Ask when exactly physio will become appropriate or are they going to even bother.
I watched my husband die in hospital due to this sort of inertia. There was no need for it to have happened. He was only 78 and went into hospital with a relatively curable problem. He ended up dying in there of septicemia and I understand now how pro-active next-of-kin need to be. Don't be victims yourselves of a system that won't pause to explain its action or non-action to you.
I hope you manage to bring this around for your grandmother. She really should not be dying of these conditions. Something is radically wrong.
I looked up DNR and doctors can put this on a patients file with no consultation needed with the patient or the relatives. I was rather shocked by this.
It seems events have caused a deterioration in your Grandmothers health, after a probably successful operation to mend the fracture.
Physios come the next day to get you out of bed and sitting in the chair. Then progression with a walking frame, to the point that you are walking well enough to go home.
Physios are not always available every day. My experience is visits three days of the week. Ideally every day is best and then home sooner.
I know of the above from when my mother was knocked over and the fall broke her hip. Mum was moved from the main hospital to a cottage hospital where the physios visited. The ward had several ladies who had similar injuries, and many did not persevere with the walking and then remained in bed. My mother made herself get up and walk even though painful. I was there every day and the physios allowed me to supervise her walking as they were only there three times a week.
Mum was in hospital for 6 weeks altogether, so it does take time. I had to arrange for someone to come to the house early morning to help her get up and dressed and her breakfast, and another in the evening to help her get to bed. I was able to come in the daytime and make her lunch etc.
I hope that gives you some idea of the time frame for the recovery of the fracture.
It is so important that your Grandmother is helped out of bed to her chair and then for a physio to help her make some progress. Laying in bed there is great danger of developing a chest infection/pneumonia that she may not recover from.
What about arranging for her to go home, and organising for hospital bed to be borrowed, and to contact her Gp so that nurses can visit, and whatever other help she needs. she may really perk up at home. Could you all take turns to stay there overnight especially in the early days?
If something cannot be provided for you by the NHS it is possible to get this yourself - if you wait and wait for this to happen it probably wont so take it over as project manager and you will get what you want. It would be possible to arrange a physio to visit and to pay for it each day.
Best of luck in rescuing her
Susie
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