It was Scarlett O’Hara, in Gone
with the Wind, who said ‘Death, taxes and childbirth! There’s never a convenient
time for any of them’. And death, dying and staying alive all featured in my
thoughts last week. I think it was just one of those weeks. It started when I
read of Emily Pringle, who was involved in a car accident and ruptured an
artery in her neck. She was making a national awareness-raising appeal for more
male blood donors to come forward. I didn’t realise, but twice as many women as
men donate blood, and the number of male donations has fallen by nearly a third
since 2014. What I also didn’t understand fully was that male blood is often
more suitable for creating blood products such a plasma and platelets, and that
men typically have higher iron levels than women.
My second encounter was the
reporting of two people who had died recently. The first was the remarkable
Grace Jones (nicknamed Amazing Grace), who was Britain’s oldest person. Her
death was confirmed last week after reaching the fabulous age of 112. She was
reportedly fit and active right up the point of her death. The second report
was of the death of Leonard Bailey, who died aged 76. He was a transplant
surgeon, who became famous (or infamous depending on your view) for
transplanting the heart of a baboon into a child dying of congenital
hypoplastic left heart syndrome. Back in 1984, when he performed the baboon
transplant operation, this condition was nearly always fatal. These days,
although still a critical condition, much more can be done to help those born
with this condition. Sadly, the patient who received the baboon heart only
survived for a further 21 days. Dr Bailey performed the first successful heart
transplant in a child the next year and went on to perform 375 more over his
career as a doctor.
Last week, like love, death felt
as if it was all around us. And it probably was. Globally it’s estimated that
55 million people die each year, which is less than half the number of births.
When this number is broken down, it reveals a staggering set of statistics:
151,600 people die each day, that’s 6,316 people each hour, or 105 people each
minute, with nearly two people dying each second (1.80). In that very same
second, there will also have been four births.
Where and when people die was
something we considered at our monthly Quality and Safety Committee. Each month
we look at our mortality data. There are two measures that we and all other NHS
Trusts use: Summary Hospital-level Mortality Indicator (SHMI) and the Hospital
Standardised Mortality Ratio (HSMR). Both of these measures look at the actual
number of deaths of patients following hospitalisation and the number that
would be expected to die based on average national mortality figures. SHMI data
also includes those patients who die within 30 days of being discharged from
hospital. In England during 2018, there
were some 9.2 million discharges from which 293,000 deaths were recorded either
whilst the patient was in hospital or within 30 days of their discharge.
While the actual number of deaths
in hospital has steadily fallen in our Trust, 48% of all people who die in the borough, do
so in hospital. This figure reflects the national average (of 46.9%) of all deaths
occurring in hospital. However, in looking at the data, we found that the Trust
has a higher proportion of deaths at the weekend of people who have very short
admission (0-2 days) than the national average. The Trust operates a seven-day
service, with access to the expertise and experience of the doctors and nurses being constant. Any lack of availability of expertise wouldn’t account for this statistic.
So, the question we asked ourselves, was whether these patients were being sent
into hospital to die?
There were certainly a
significantly high number of weekend deaths for patients who were aged 75 and
above, and whilst many had been admitted from their own home, there were a lot
of patients who had been brought in from care homes. Work is going on to
explore any variation in the level of community and primary care services during
the weekend to ensure those patients requiring end of life care can have this
provided at home. However, discussions with families has revealed that although
most wanted their loved one to die at home, many were frightened at the
prospect or didn’t live close enough to be with and support their loved one in
their last few days and hours of their life. Thankfully, for many people they
will only experience the death of another infrequently. For doctors and nurses,
this is not the case. Death is part of the professional world they inhabit. I’m
sure many nurse readers of this blog will have had to make that phone call to relatives
advising them to come to the hospital as soon as possible. Death and dying are
not easy subjects to talk about and I think all those involved in palliative
and end of life care are truly special people.
I would like to end this posting
on a lighter note. Last week I was an examiner in a PhD viva. The student’s work
looked at the impact of acculturation (assimilation into the host country’s
culture) on the mental health of refugees coming to live in the UK. It was an
enjoyable viva and the student did very well in defending her thesis. It was even
better to hear how her participants who had come to live in the UK, had gone on
to build lives that showed their resilience, courage and humour. To quote the classic ‘Simple Minds’ song, they were truly alive and kicking!
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