Tales from the Front Line: End-of-Life Care

Bending the Rules

Yes, we do have a bed,” the nurse says.

“That’s great. I’ve given him some morphine and midazolam to help with the pain, but his condition has deteriorated so rapidly. I’d like to get him over to you as quickly as possible. Could you please arrange for an ambulance?” I ask.

“We can arrange an ambulance,” the hospice nurse replies, “but it will take about four hours since we don’t have permission to expedite it.”

“Leave it with me,” I say. “I’ll speak to the ambulance service directly.”

“Hi there, I need a level 2 ambulance with an 18-minute response time,” I inform the operator. “What’s the indication?” asks the call handler.

“I have a gentleman with pancreatic cancer who has rapidly deteriorated and needs to get to hospice as a matter of urgency.”

“That’s not a normal indication for a level 2 response,” the handler replies.

“So, to be clear, I can’t magic up a syringe driver on a Sunday in the next hour,” I respond.”He has less than 24 hours to live, and he’s going to need more pain relief …