Some time ago we had a 98 yo lady (whom I will call Betty), transferred to our emergency department from a local nursing home. Betty was having palliative care at the nursing home and was well aware that she was soon going to die.
Betty had completed an advance care directive (ACD) stating her wishes not to be resuscitated and that she did not wish to die in a hospital, but in her current environment.
She also stated that she would very much like to be able to listen to some Scottish music and in particular ‘Danny Boy’ at the time of her death.
Betty had awoken at 1am with frequent haemoptysis and severe abdominal pain, and despite her wishes and the ACD, the staff at the nursing home decided to call an ambulance.
I don’t know why this happened. Perhaps there was a mix-up with her directives, perhaps there were new staff on who did not know her plan, perhaps they did not feel confident managing her haemoptysis, perhaps they rang her doctor who told them to transport her.
Perhaps it was a combination of things. I don’t want to be judgmental, but I will say that it is my experience that this sort of thing happens far more than it should.
On arrival in our department Betty remained quite alert, and stated to our nurses that she knew she was about to die.
Following a conversation between Betty and our senior doctor, she was given some sedation and analgesia and our nurses made her as comfortable as they possibly could within the context of a busy, noisy, crazy, crowded, abrasive Friday night in the ED.
Oh….and something else happened that night amidst the crazy.
Something so simple and so wonderful, that it made the hairs stand on the back of my neck.
Two of our nurses had noted Betty’s request in her advance care directive.
One of them pulled out their iPhone, they down-loaded Danny Boy…. and then they played it to her as she died.