One of the most tragic issues that have arisen in the context of the coronavirus pandemic and concerns the cases of patients who (due to health protocols) die in isolation, brings to the surface "Today Online".
The reason is the case of a recently deceased cancer patient, who was hospitalized for about 1,5 months at the Oncology Department of the Nicosia General Hospital. The patient was diagnosed with metastatic cancer and from the beginning the criticality of his condition had become clear to his family, who were informed that the chances of long-term survival were minimal.
After his diagnosis, a psycho-destructive course followed, both for him and for his relatives. For weeks he was treated virtually alone, without being allowed to visit his relatives due to the health protocol applied at the General Hospital.
The complaints of the patient's family (notified to OKYPY –17 March 2022–) relate to two levels: The mandatory isolation (due to protection measures against coronavirus) and the behavior of the Management and some members of the medical and nursing staff.
Isolation of patients: "So we will never see him, except when he is in a coma?"
Due to the measures against the coronavirus, the visits of the relatives of the said patient were prohibited, following strict instructions of the Director of the Oncology Department. It is noted that under the relevant decrees of the period of hospitalization of this person (which is not mentioned in this article for the purpose of protection of his identity), visits to hospital premises were prohibited, except in exceptional cases for which approval could be granted by the Director, the presentation of a negative 24-hour PCR test.
In the meantime the patient's condition was deteriorating rapidly, while he was having panic attacks and could not sleep because of the pain he was feeling. "We begged them to let us see him," said his daughter, noting that the response they initially received was that they would be notified when he was due to die. Due to the nature of the disease, this implied (in all probability) that the patient would have no contact with his environment and would not be able to perceive the presence of his family when he reached the brink of death. "That is," his daughter commented to the doctor in question, "we will never see him, except when he is in a coma and he does not understand?" And he told me that these are the instructions and that in fact they will do us a favor, because this is normally forbidden as well ".
According to the family of the deceased, they were forced to seek the mediation of various people to be allowed to visit: "We ended up using media, known and unknown, friends of friends, to be able to see him. We made endless phone calls to mayors, directors of nurses, friends of doctors, employees of the Ministry of Health "to talk to the director of the Oncology. As a result of these interventions, it was possible to grant a visit permit lasting 10 minutes.
However, the patient's condition required the constant presence of a person next to him, in order to serve his basic needs. His daughter explains: "My priest was so weak now that it was difficult for him to raise his hand and eat on his own. We insisted that they let us stay longer to help him, but they were adamant. So my dad ate almost nothing and no nurse ever went to help him eat. "They do not consider it part of their responsibilities."
Constant immobility, due to lack of assistance, aggravated the patient's pain. During the ten-minute visit he was entitled to, his relatives tried to help him with massages. However, the rest of the day he remained motionless. Especially in the last 2-3 weeks, the 24-hour presence of a person near him was imperative. "I realize that this is not possible for the staff of the General Hospital," his daughter said. "Also, yes, a nurse could not be there 24 hours a day, but they did not even go often, not even when they heard him screaming in pain."
The need for empathy: "Now I can not, I will go to medicine for another job"
In addition to the change in visitation policy applicable in such cases, the family of the deceased focuses on one more point: The treatment of terminal patients by hospital staff. The constant contact with such incidents is natural to bring about some kind of "familiarity" with the idea of imminent death. This, however, does not justify the lack of empathy reported in this case, which resulted in making the patient's last moments even more distressing and intensely tragic. The ex-patient's daughter states, for example:
"We spoke on the phone with a doctor from the Oncology General Hospital (not the doctor who was watching him, another who was on duty that day) to see if a psychologist could visit my father. The doctor informed us that they did not have a psychologist and when we insisted that it was impossible for the General to not have a psychologist, he told us that he was absent due to a coronavirus. We then asked if we could get one of our own psychologists and he answered angrily - literally - that he is a doctor and he is not interested in the psychology of patients ".
In addition, other incidents of indifference on the part of the nursing staff are reported. For example, when his wife went to the hospital to inform him that the patient needed water and painkillers (as his calls were not answered) the following incident occurred, according to their daughter: "My mother, who stayed there at the entrance, he asked a male nurse to give him water. He told her: "Now I can not, I will go to the medicine for another job." My mom told me she begged him again and he just left. She saw him enter the hallway where the rooms were and thought that maybe he was sorry for us and went to my priest. He saw him heading deeper and finally, instead of entering the left room where my priest was, he went to the door on the opposite right, which was probably where his other job was. He did not bother to come next to him for half a minute to give him some water ".
In the last days before he died (and after intense and painstaking efforts of his relatives), it became possible to move the patient to another medical center. His movement coincided with the last day during which he maintained his senses and contact with the environment. At his new hospital, he was allowed the constant presence of his wife with a PCR examination and the one-hour visit of his children with a negative rapid test. His relatives point out, therefore, that despite the validity of the same decrees, in the second hospital a more "humane" treatment of the patient was observed shortly before his end. He himself, according to his daughter's testimony, commented: "It's better here. "There [at the General Hospital] they were wild."
Shocking audio document
"Simerini" owns and publishes an audio document, which reflects the parameters set by the family of the deceased former patient. It is a dialogue between him and his daughter, with the intervention of nurses. The audio file has been edited so that the speakers' voices are not recognizable and names are not visible.
The history:
The patient was already in the Oncology Department of the Nicosia General Hospital for a few days. During the recording he talks to his daughter, as he feels unbearable pain and feels helpless. Other members of his family try to contact the hospital by telephone (as they are not allowed to visit on the spot) in order to provide assistance to the patient. The latter seems unable to call for help, while at the same time he does not have the strength to drink water. Eventually his wife goes to the hospital in order to notify that the patient needs help and asking to be conveyed the message (to improve his psychological condition) that she is in the area.
The patient's despair is evident. In the audio file he can be seen saying: “En rtasin. Delayed gums. […] There is an hour when I am constantly in pain. […] It's time a lot jia en rtan. […] Water, a water re, a water. Water… Tell them to bring me water… ».
The recording takes about an hour. After 40 minutes of talking to his daughter, and after his wife went to the hospital (where she was not allowed to enter), a nurse went through the patient's room to reassure him. However, he did not have time to ask for water, as the nurse left in a hurry. His daughter notes: "My mom is outside at the entrance and begs them to let her in. He also tells them to give him water and a nurse replied "He has water", while my priest could not reach it to drink ". At his wife's further insistence, another nurse visited him and tried to reassure him. He told him that his wife was out and that she would visit him at 12:00. She assured him that she would come later to take care of him and told him that she would give him painkillers to calm him down.
The patient remained thirsty, while (apparently in confusion) the previous nurse put his cell phone aside. Consequently, his wife asked another nurse to help him drink water and give him back his cell phone. The recording is completed a little later, when another nurse gave him back his cell phone.
Need for changes at the level of institutions and mentality
The ex-patient's family wants the incident to be made public, seeking institutional awareness, both in terms of excluding terminally ill patients from general regulations (as regulations can lead to isolation until death) and to deal with such cases by the nursing staff. As his daughter notes, "Our main goal is to change the situation at the institutional level and not just to assign responsibilities. In addition, any responsibilities should not be concentrated solely on nurses. The latter generally followed the instructions of the Management. What the family points out, then, is the need to train staff (at all levels) to deal with such incidents, so that communication with patients (and their relatives) is done in terms of greater empathy and understanding of the conditions . At the same time, they point out the need for training and evaluation of the administrative staff, with emphasis on human psychology and the humanitarian factor.
In addition to the psychological nature of the issue, the presence of familiar faces of the patients is also important in terms of providing assistance to those who are unable to self-care patients, since the members of the nursing staff can not be constantly by their side. Regarding the imposed different treatment of end-stage patients, the daughter of the deceased explains that there can be no regulatory - horizontal application of any regulations adopted, without taking into account the humanitarian aspect of the issue: "The same cannot apply for all patients. I can understand that someone who has hit his leg and will undergo surgery at the General Hospital does not need to be visited. Cancer patients, though? Patients who are serious and in the final stretch? "Is there a decree saying that visits are prohibited and we are done?"
Possible disciplinary investigation by OKYPY
"Simerini" contacted a representative of OKYPY, who stressed that the Organization shows great sensitivity to such incidents, as well as to the humanitarian treatment of oncology patients. However, as noted, "there are some departments that are very 'sensitive', because the patients who are in are terribly vulnerable groups." As there was a risk of the coronavirus spreading from visitors, which would put the lives of patients at immediate risk, the Hospital Management chose to strictly enforce the health decrees. "But the human factor and sensitivity do not cease to exist."
The same representative of the Organization noted that the family was asked to submit a written statement of the facts, in order to be able to investigate them. Due to the nature of the complaints, the representative of OKYPY noted, "we have to conduct an investigation and, depending on what will happen, to proceed with a disciplinary investigation in case a person did not do his job properly."
Source: TODAY