Thursday 16th July 1992   Morning surgery 10:10

“Right . . .” my Dad hesitated, “how are you, Mrs Shaw?”
“I suppose I am not too bad, considering . . . It was quite a shock, you know. I certainly did not expect them to find a brain tumour.”
“Your symptoms were very suggestive of a straightforward stroke.”
“Yes, Dr Bradley suspected that the tumour had caused a small bleed. He said that that had led to the sudden paralysis. It’s much better, now. I have only got very slight weakness left.”
“They’ve put you on dexamethasone?”
“Dr Bradley said it will reduce the swelling around the tumour. It seems to be working. The headaches have gone.”
“Are they going to give you any other treatment?”
“I wouldn’t have surgery at my age, not brain surgery. They have offered me radiotherapy but I don’t think I will go ahead with it. My cousin, Cicely, was very vague after her radiotherapy. I wouldn’t want to be like that. They have said that they can’t get rid of the tumour completely, anyway. They think it is a recurrence of my bowel cancer. That was 7 years ago! I thought I was clear of it.”
“It is unusual for bowel cancer to come back after that length of time.”

“Well, I thought that I ought to come to see you, Dr Dennis, now that I have been discharged. I wanted to put you in the picture. I am feeling quite well at the moment. The girls are very upset of course. Nancy is coming down next week.”
“As it happens . . .” my Dad cleared his throat. “There was something that I wanted to ask you.”
Mrs Shaw smiled.
“The health authority has given us a new form to complete with all our terminally ill patients. It’s called the ‘palliative care check list’. Would you be happy for me to fill it in?”
“Of course, doctor.”
“The check list is intended to help you to think about the treatment you want as your condition deteriorates and whether there are any treatments that you don’t want.” My Dad paused as he read the form. He looked up at Mrs Shaw.
“It sounds like a good idea.” She smiled again.
“Right, we’ll start. Mmm . . . where would your preferred place of death be?”
“At home, doctor.”
“Yes, I think most patients would prefer to be at home.” My Dad ticked the form. “If we cannot manage to look after you at home, would you be prepared to go to a nursing home or the hospice?”
“The hospice, I think. They are very good. Cicely was happy there.”
“I presume that you would agree to have any treatment to make you more comfortable: painkillers, anti-sickness medication, oxygen . . .”
“Yes, I think so.”
“What about a drip? If you were unable to drink, would you want to go on a drip? We could even do that at home.”
“Not really. Wouldn’t that just prolong matters?”
“I suppose it would. I’ll put no for that, then.” My Dad cleared his throat.
“Do you want antibiotics if you get a chest infection or a water infection?”
“Yes, I don’t mind having antibiotics.”
“Alright . . . if you couldn’t eat, would you want to be fed artificially? That’s usually through a tube that goes into the stomach.”
“No thank you, doctor.”
“What about a ventilator, a breathing machine. Would you want to be put on a ventilator?”
“No thank you, doctor. I am quite sure about that.”
“Lastly,” Mrs Shaw, “what if your heart stopped beating or you stopped breathing? Would you want to be resuscitated?”
“Mmm . . . I suppose it depends . . . what do you think, Dr Dennis?”
“I can’t decide. It’s up to you.”
“Well, if you thought I would be alright and live for a few weeks, I would like to be resuscitated but if you thought that I would end up as a vegetable I wouldn’t.”
“I am sorry, Mrs Shaw, there’s no room for comments on the form. It has to be yes or no.”
“I’m not sure, doctor.”
“You’ll have to decide.”
“Can I think about it? Could I discuss it with Nancy?”
“Not really! I was hoping to send the form in tomorrow. They want them back as soon as possible.”
“I don’t know.”
“To be honest, I don’t think that there is a lot of point in resuscitation at this stage, taking everything into account.”
“Alright, doctor.”
“I’ll say no, then.”
My Dad signed the bottom of the form and put it into the wire tray on his desk. He got up to help Mrs Shaw out of the chair.

The palliative care check list.