1.4.4 Case study 1: Vic Harris – a hospital death
Vic was a 68-year-old man with a long history of chronic (pulmonary) obstructive airways disease and was therefore a regular in-patient at the medical ward of the local hospital where he received treatment. Vic had been on Crawford Ward for two weeks and was feeling very concerned that he was not making any progress. Previously he had experienced quite a marked improvement after a few days’ treatment but this time, instead of improving, his breathlessness and lethargy were getting worse and this was causing him a lot of concern. Despite this anxiety, Vic did not want to express his fears to the ward staff, although he knew some of them well. He was a very private person who was not used to showing his feelings to people.
Vic's personal life was complicated by the fact that he was divorced from his wife who now lived in Ireland with her new husband. Their two sons had not had a particularly close relationship with their father and after the divorce had only made contact at Christmas. Neither of them had visited their father for five years. They had each moved to different areas and Vic did not have their new addresses. He would have liked to see them, and felt very sad that he had not made more of an effort to stay in touch after the divorce. One consequence of losing contact with his family was that his two neighbours were the only visitors he received and therefore visiting time was difficult for Vic. The afternoons and evenings when there were visitors on the ward acted as an acute reminder of Vic’s loneliness, which was made worse because he was unable to leave his bed. On previous stays Vic had been able to escape to the day room and watch television during the afternoon and evening. The ward staff tried at first to sit with Vic during visiting time, but increasingly they felt he pretended to be asleep, which they interpreted as a sign of wanting to be left alone. In turn, Vic felt that the staff had started to avoid him and feared that their reason was that they were withholding something from him about his condition.
One of Vic’s symptoms was increasing mental confusion. Because his confusion was worse at night the night staff put cot sides on his bed to prevent him from falling out. Vic found this humiliating. His increasing confusion, breathlessness and persistent chest infection led the staff to realise that Vic’s condition was likely to be terminal and that he was unlikely to recover. The ward staff could not decide what approach to take in terms of communicating with Vic about the severity of his condition, although they agreed that if he asked questions they would not conceal information from him. A decision was made that Vic’s next of kin needed to be made aware of the seriousness of his condition, and the ward social worker was asked to try to trace his two sons. It was agreed that it was best to wait until the children arrived and discuss the situation with them.
Vic’s two sons, Connell and Terry, were contacted and agreed to visit their father at the hospital at the weekend. By the time of the visit Vic had developed a severe chest infection which was not responding to antibiotics and he was therefore much worse than the children expected. His breathing was noisy and laboured and his moments of wakefulness were infrequent during the day. However, Vic continued to experience distressing nights in which he was confused, restless, and agitated.
His sons were shocked to see their father in this state and were very tearful and upset during their first brief visit. They felt unable to talk to their father or make physical contact with him. The ward sister, Mary, had known Vic for several years. She was concerned with the extent of the children’s distress and took them to the ward visitors’ room and spent some time listening to their account of the past. ‘Dad and Mom were either fighting or not speaking, that’s what I remember,’ said Terry. ‘That’s right,’ said Connell, ‘but there were times when we were together and had lots of fun. It got really bad after dad lost his job. Most of the rows were about money.’ Terry and Connell seemed to be angry with their father, not because his illness meant that he couldn’t work, but because he seemed to take it out on the family. They both felt a strong allegiance to their mother.
Mary asked Connell and Terry if they thought she should contact the hospital priest, because she was concerned that Vic should be given a chance to receive the sacrament of the sick. This seemed to be an enormous responsibility and they didn’t know how to make this decision. They decided to wait and see if their father improved and then to ask him what his wishes were. Mary felt frustrated about Vic’s emotional and religious needs. She was also aware, however, that she could not force the family to respond in what she saw as the best way.
Connell and Terry agreed with Mary that they should try to say their good-byes to their father. They both wanted to be told when Vic died and if at all possible they would try to be present at the death. This seemed to be important to them, although they did not want to keep a deathbed vigil.
When Connell and Terry visited the next day there was a slight improvement in Vic’s condition. He had spent a better night and the new medication for his breathlessness seemed at long last to be affording him some relief. Also Vic seemed to recognise them despite being unable to say anything. Although his sons wanted to say good-bye it seemed that it might be too upsetting for their father: after all, this improvement had not been expected and there was still a possibility that he might recover. Mary was off duty that day and Connell talked to the senior nurse, who agreed with them that the improvement could be sustained and that Vic might not die as expected. She also cautioned Connell that nothing was certain and that his father could deteriorate again. Connell and Terry wanted to talk to their father about his dying wishes, but thought it was inappropriate to do so that day. They decided to leave their father to rest and to spend longer with him the next day, and so they left the ward, asking to be contacted if there was any change in their father’s condition.
Immediately after lunch Vic’s condition quickly deteriorated and the Medical Registrar was called and spent several hours attempting to revive him. Despite these efforts, Vic became unconscious. The senior nurse tried to contact the family, and left a message for them at their hotel. She also contacted the hospital priest, because Vic’s wishes remained unknown, and she felt it was better to do something that might be unwanted than to fail to do something very important.
Vic died suddenly at ten past four that afternoon, so that when Connell and Terry arrived back at the hotel, having spent the afternoon visiting local friends, they were greeted with an urgent message to contact the hospital. They immediately went back to the hospital feeling guilty that they had spent a good afternoon believing that their father had made a significant improvement. Despite these misgivings, it seemed to them that their father had somehow been released by their visit and were glad that they had made an effort to do so.