“How Could the Nurse Not have Known My Grandma was Dying?”

Submitted by Anonymous

I still reflect on my grandma’s death.

I tried to see the positives immediately after. And now I’m reflecting on the things that potentially could have made it a bad death.

I only raise this because I think there is a lot of work still needed in the training of nurses and personal carers on death and dying.

My grandma had advanced stages of dementia and as a family we knew she was ‘dying’, perhaps not imminently well, at least not until the day of her death.

It was a Thursday afternoon and I felt this need to go and see her before an appointment I had. So I dropped in on my way home.

When I saw her, immediately I knew she wasn’t well.

She was struggling to breathe – extremely short of breath, cyanosed (blue in the face). I could see this was the beginning of the end. There was no way we (as a family) where going to send her back to hospital.

We did that 6 months earlier and I had regret ever since. She came back worse to the nursing home. More impaired and calling out significantly distressed. It wasn’t a life I knew she would have wanted.

I immediately went to get help from the nurse. I told the nurse, “my grandma’s dying and I’m not happy with how uncomfortable she is, can we give her something for her breathing, like morphine or rubinol?”

Nurse: “We don’t have any medication like that for her because she isn’t palliative.”

Me: “Pardon? What do you mean she’s not palliative? If we are looking at the same lady, she is dying.”

Nurse: “No palliative care is when we have a family meeting with the doctor and everyone’s on the same page for no further treatment”

Me: “No offence – but we have missed the chance for that meeting and we aren’t going to have it”.

It clearly came as a surprise to the nurse. I had asked for the GP to come in straight away – which was good enough that he did. He confirmed she was dying and started her on a small dose of morphine.

I called my family in.

And 4 hours later my grandma died.

Had I not chosen to come in that night. Had I not been aware of a deteriorating person. I wouldn’t been there for her death. She would have suffered on her own. She would have died in the night. Without her family.

Luckily for my grandma, this wasn’t the case. Luckily she ended up dying incredibly peaceful as the morphine slowed down her breathing. She had all her family surrounding her like she would’ve wanted.

This could’ve easily been a different story.

It’s not all the nurse’s fault. The GP has to play some role in this. Only months earlier I had requested a referral to palliative care service. He got rather short and said “she doesn’t need that yet”.

It was obvious to us that she had basically stopped eating, only having thickened fluids and was confined to bed, incontinent and sleeping more. A significant change from a month or so earlier.

Had the staff all been aware that she was palliative perhaps they would’ve been in tune with what to expect.

I don’t know what the answer is here. But I feel maybe RN’s working in aged care need to do a placement in a specialist palliative care unit to get more experience. With clinician’s surrounding them.

How do we prevent potentially ‘bad deaths’ from continuing to occur?