Death. A thread.
My nana, my mum's mum, died a couple of weeks ago. Her funeral was yesterday. Tonight, on the Archers, Joe Grundy died. Both of them were a ripe old age.
My nana, my mum's mum, died a couple of weeks ago. Her funeral was yesterday. Tonight, on the Archers, Joe Grundy died. Both of them were a ripe old age.
They were both in their 90s, an age when well meaning people tell you, "they had a good innings". My nana was born in 1924 in London. She was a postie and bus conductor during the second world war.
She also worked as manager of the Odeon restaurant in Marble Arch where she was once propositioned in a lift by Errol Flynn. She was a very beautiful woman all her life (I wish I'd inherited more of her looks, but I do have her asymmetric nostrils!)
She married my grandpa Harry, and had three living children; my auntie Marg, my mum and my uncle. She worked evenings as a waitress (grandpa wasn't good with money), scrimped and saved and kept the house and fed the children.
She waitressed well into her 70s, a vital and energetic woman with extraordinary will and not a vast amount of tact. She also helped to care for Marg, who had MS and was progressively more disabled.
She lived through the death of her husband in 2003 and her elder daughter (from complications of her illness in 2009) and continued to look after grand- and great-grandchildren, shop, attend old lady clubs and generally live life.
She moved down south to live with my mum a few years ago, and though her will was iron, her body gradually started to fail her. She spent time in hospital last winter with pneumonia, but came home and fed herself up with doughnuts as she was appalled at how much weight she'd lost
She broke her leg near one of her knee replacements (both done in her late eighties; she was an active woman and the surgeon was confident she'd get the wear!) and spent most of the last months of her life in hospital.
I've learned a huge amount from Nana and she's made me laugh countless times. How she died was more of a professional lesson to my career in geriatrics.
She bore the frustration and boredom of hospital with fluctuating patience. Initially we all thought she might beat the odds and escape to fight another day. But the weeks went by, and she did less and less.
The inadequately staffed physiotherapists did their best. The inadequately staffed nurses ditto. The orthopaedic team were pleased with the surgical result. The orthogeriatricians gave as much of their time as they could. I hope.
But no-one except my mum, a bright and brilliant woman who staffed a school first aid room for decades, seemed to notice as she faded away. My mother has been magnificent as Nana's advocate. But two things:
1. She shouldn't have to have been. We, the healthcare professionals, should be all our patients' advocates.
And 2. We, the HCPs, should notice as our long stay patients gradually deteriorate. They survive an infection here, an exacerbation of a chronic illness there. We should be noticing their trajectory.
Our patients are becoming increasingly frail, they have more comorbidities, they are older. People should not be graduating university without knowing this, and having the basics of management in their skill set.
I don't know what the orthopaedic team was waiting for. All I know is that mum, encouraged by me and the rest of Nana's family, pushed for her discharge home for what, as had become evident, the last period of her life.
But the time it took to effect this meant that by the time Nana came home, she was too frail to sit out in her chair and see her garden, and too delirious to hold meaningful conversations.
If this thread has a point, other than how much I miss my Nana and how sad I feel, it is this. If you work in healthcare, you shouldn't be afraid to speak to patients and their loved ones about the deterioration you see.
We're all going to die, and most of us aren't lucky enough to pop off peacefully in our beds after a good day's cider pressing like Joe.
I think we'd all want dignity and agency over our last weeks on earth, and most of us aren't lucky enough to have advocates like my wonderful mother. But even she was hamstrung by the well meaning reluctance of staff to talk about the outcome we could all see coming.
And if you're a nurse, or a junior doctor like me, please please look at your patients and really see them. They aren't "the fracture" or "wanderers", they are human beings who've loved and lost and worked and laughed. They're my Nana and yours.
That's it. I miss my Nana. I know how lucky I've been to know her, to carry her memory with me every day. But I just wish she could have sat in her chair and seen her garden bloom one more time.
