1.4.5 Case study 2: Li’s death – a residential home death
Li was a resident in a home where she had lived for the previous five years. She had led an exciting and unusual life, travelling from China at the age of 30 and living in England for the remainder of her life. After her husband’s death Li felt unable to live alone and moved into a residential home which employed some Chinese-speaking staff and had a small Chinese day unit attached to it. Li maintained her use of Chinese language, and continued to wear Chinese clothes. Despite these strong cultural expressions Li became a Baptist and attended Western religious services.
The home’s policy of welcoming residents to install their own furniture was particularly welcome to Li, who wished to continue to sleep in her marital bed. Her bedroom became a microcosm of her home and provided her with a degree of comfort and familiarity. Her dressing table became a security concern for Li since it was here that she stored her Chinese herbs, her religious icons and her winnings from her games of cards.
Li’s use of Chinese medicines, which she sometimes supplemented with Western bio-medical drugs, was occasionally a source of conflict between her and the home staff, who expressed fears to Li and her family that combining the drugs could be dangerous, particularly the beta-blockers that Li was taking for her heart condition. Despite the staff’s concerns, Li managed her drugs in a way that suited her needs as she experienced them, and her family supported her in this.
Li’s heart condition became increasingly problematic and after consultations with GPs and social services a transfer to the nursing home attached to the residential home was arranged. Li soon recovered sufficiently to resume attending the day centre where she played cards with her Chinese friends. Although there were other Chinese residents in the nursing home Li did not associate with them. It was her belief, as it is with many Chinese people, that in order to protect one’s own health it is unwise to associate with people who are sick.
On the occasions when Li was too ill to leave her bedroom and the staff who spoke Chinese were off duty, she had to manage with limited and restricted communication with the home staff who had learned a few basic Chinese phrases. There were therefore many lonely times for Li and these were often when she was at her most vulnerable. Her family of two sons and two daughters visited frequently, but only at weekends, because they lived over 100 miles away.
One evening Li developed severe chest pains and after some debate because of her age it was decided to transfer her to hospital, where she stayed on a medical ward for two weeks following a diagnosis of myocardial infarction. On her return to the home Li resumed her routine activities but was noticeably more frail, and appeared not to have fully recovered from the heart attack. She suffered a series of chest infections and occasional stomach upsets which meant she had to stay in bed for days at a time. Despite visits from the day centre staff and her family, Li became more depressed and withdrawn, and the nursing home staff began to wonder if Li might be dying.
In the early hours of one morning Li suffered a very severe stroke which left her unconscious. The staff of the home and Li’s immediate family decided that her condition could not be rescued this time and that it was therefore most appropriate to nurse Li in the home until she died. Because she was only expected to live for a few days at the most, the family decided to keep a bedside vigil because they wanted to be with Li when she died. Although they took turns to sit at Li’s bedside, they found the task exhausting and they needed a lot of support from the home staff, both physically and emotionally.
Because of Li’s strong cultural beliefs a lot of preparations had to be made for her death and subsequent journey into the next life. The staff made careful note of the clothes Li was to wear and these clothes were hung in the correct order on a coat hanger in the bedroom. This display of clothes served as a sign to the family that the staff took Li’s needs for her death seriously. Also, when the family were unable to find the correct shoes before Li died, one member of staff was dispatched to the town’s Chinese quarter to buy them. The family were very distressed and exhausted and the home staff were trying to support them as much as possible. Part of this support involved ensuring that Li’s dying wishes were achieved by taking the correct actions after her death.
Li died early on the Sunday morning, three days after the stroke, with one of her daughters present. The staff washed and dressed her in the clothes according to the family’s instructions. Meanwhile, Li’s sons spent many hours arranging with funeral directors for her body to be transferred nearer to their home town, where she was to be buried. These attempts were hampered by the difficulty in getting Li a death certificate, since Li’s regular GP was away at that time. At lunch time the staff became anxious about Li's body staying in the home and therefore she was taken to a local funeral parlour until these complex arrangements could be sorted out, which they were the next day. Li’s death was as much a complex mixture of cultural traditions as her life had been. The staff and family worked hard to find out what her wishes were and to carry these out.
When the family wrote to the home after the funeral they acknowledged the home staff’s efforts and thanked them. Despite all the sadness at losing a resident who was such a character, the staff of the home felt that the process of managing Li’s dying and her death provided them with a lot of satisfaction. The family also shared the feeling that what their mother would have wanted had been done for her. It was particularly important for the family to be present at their mother’s death to be able to send her on her journey and for her to be appropriately dressed.