#YouToo

by Candy Denman

  ‘I wanted to see how Ben, her son, was bearing up,’ Jo told her. ‘It’s been a tough few weeks for him.’

  ‘All straightforward, is it?’ Hazel asked as Jo knocked at the door. ‘Cancer of the head of pancreas. Been on palliative care for a month.’

  Hazel nodded.

  ‘Good, I’ve got a meeting to get to at eight and it would be nice to at least say hello to the family before I’m off out again.’

  Jo wondered, not for the first time, how her colleague managed with being a full-time GP and having five children, especially as her husband always seemed to be working away. She could only assume that there had been an army of nannies in the past and perhaps now the children were old enough to look after each other.

  The door opened and Jo was surprised to see one of the district nurses, Anne Cockcroft. Jo had seen her at many patients’ homes, and she was a caring, conscientious nurse in her late forties. The patients generally liked her, although Jo had heard a few complain about her rigid views on a number of subjects. Nurse Cockroft, it seemed, was not above giving her patients a telling off if she felt they were not doing their best to get well again.

  ‘Hello Anne,’ Jo greeted her. ‘Dr Johnson and I have come to do the death certificate.’

  As she ushered them in, the nurse pursed her lips.

  ‘Perhaps I could have a word in private,’ she whispered to the two doctors.

  Ben was in the living room and was quite red in the face.

  ‘You are being quite ridiculous, not to mention offensive,’ he said to the nurse and then turned to Jo. ‘This woman thinks that Mum might have died of an overdose rather than the cancer.’

  ‘I just think it’s odd that she was quite well yesterday when I last saw her, and then suddenly she’s dead.’

  Ben looked as if he were about to explode.

  ‘You must know that the final days of someone’s life can be very unpredictable,’ Jo said calmly despite feeling that she could have kicked Nurse Cockcroft for being so insensitive. In what way was she helping?

  ‘Of course I know that. I’ve nursed hundreds of patients at the end of their lives, Doctor.’ She clearly didn’t like having her judgement and experience questioned. ‘I just think, in light of her previous overdose, that it’s a possibility that can’t be discounted.’

  There was a tense silence and then Ben burst out, ‘Does it matter? So what if the painkillers killed her instead of the cancer? At least she died pain free.’

  Jo couldn’t have agreed more, but it wasn’t a helpful comment in the circumstances.

  ‘It makes a difference to what needs to be on the death certificate.’ The nurse stood firm, sure that she was doing the right thing. It was clear that she was going to stick to her guns, even though everyone else in the room disagreed with her. At least, Jo hoped Hazel disagreed with her.

  ‘Right, I’m going upstairs to examine your mother,’ Hazel told Ben, all no-nonsense practicality, for which Jo could have hugged her. ‘And then I’ll want a quick word with Dr Hughes and then we’ll decide what to do next. Is it right or left at the top of the stairs?’

  As Ben showed Hazel the way to his mother’s room, Jo glared at the nurse.

  ‘You can’t be too careful these days,’ the nurse said defensively. ‘Not since Shipman. I’d be the last person to want someone to die in pain, but you have to cover yourself in case any other relatives come out of the woodwork and complain that we’ve hurried things along.’

  ‘She was going to die in the next few days, anyway.’ Jo was scarcely able to control her anger, but she knew that being angry with the nurse would only make her dig her heels in further. ‘And it’s not as if she had great stores of drugs. I prescribed small amounts, you know that because a member of your team rang and complained that I wasn’t prescribing enough and they were having to fetch more from the pharmacy too often.’

  ‘And you or your colleagues didn’t do any extras we don’t know about, did you?’ the nurse asked her.

  ‘No. Are you suggesting I colluded?’ Jo was horrified, but her obvi- ous anger made the nurse back down.

  ‘You wouldn’t be the first doctor to help a patient on her way, but she could have stockpiled them herself. That’s what she did before. I’ll accept that she did seem to be in more pain than expected so perhaps that was because she wasn’t actually taking her medication but was storing it up.’

  Hazel stomped back down the stairs and handed Jo an open pharmacy box.

  ‘These will need to be destroyed.’ She turned to the nurse. ‘There weren’t any more empty boxes up there.’

  Jo checked the box. Of the opioid painkiller she was prescribing Mrs Springfield, there were only two tablets left, which was a few less than she would have expected if her patient had been taking them reg- ularly, but probably not enough to kill her. Jo knew there was another box ready and waiting at the pharmacy and she would have to let them know it was no longer needed.

  ‘I stand by what I said. I think she’s taken an overdose,’ the nurse reiterated. Jo and Hazel exchanged a look.

  ‘This is just stupid.’ Ben was seriously angry, and no wonder. ‘You’re just trying to stop me laying my mother to rest, you evil witch!’ ‘It’s okay,’ Jo cut in before the nurse could respond and make mat- ters even worse. ‘I am sure we can sort this quickly and easily.’ Hazel looked surprised; she certainly didn’t seem to think a resolution was likely to be either of those. ‘I am going to suggest that the three of us,’ she indicated Hazel and the nurse, ‘go elsewhere and discuss this.’

  ‘Absolutely right,’ Hazel supported her, and the nurse reluctantly nodded.

  As the two women left, Jo stayed behind with Ben for a moment. ‘I’ll come back as soon as I’ve sorted this out. Okay?’ she said qui-

  etly.

  He nodded and she hurriedly followed the others out. Jo often worked with the families of the dying and the dead, but the experiences were very different with her two jobs. There were the violent or un- expected deaths where loved ones were shocked and bewildered and once the news had sunk in, angry and looking for someone to blame. Where it might take years for them to accept what had happened. And there were the expected deaths among the elderly and the terminally ill, where it was so important for the family to come to terms with what was going to happen. If they did, then the death could be peaceful and loving, with the family round the bed and the actual death a gentle letting go of life. Having got Ben to the place where she hoped he had accepted his mother’s death, whether he helped her die or not, the last thing she wanted was for it to be ruined by an over-zealous nurse.

  Once on the doorstep, the question of where to talk was resolved by the fact that the only place near enough to go without getting drenched was the First In Last Out pub, just across the road.

  Once settled in one of the high-sided booths, well out of other peo- ple’s hearing and with coffees on the table in front of them, Hazel took the lead and turned to the nurse.

  ‘I take it you have no proof of what you are suggesting?’

  ‘No, but a PM will show what she really died of.’ Jo inwardly groaned, the last thing they wanted was a PM, just in case it did show she died of an overdose.

  ‘And would delay the funeral and upset the family,’ Jo told her. ‘And for what? She was dying anyway, and if she stockpiled her drugs so she could take them all in one go, does it matter?’

  ‘It does if her son helped her do it,’ she replied, ‘or if you did. As- sisting a suicide is illegal.’

  Jo was so angry that the nurse had reiterated her accusation that she didn’t reply. Fortunately Hazel decided to intervene at this point.

  ‘Look, I haven’t got time to do this now.’ She stood up and started putting her coat back on. ‘I am quite sure that Dr Hughes was not involved here,’ she told the nurse firmly, ‘and you should think very carefully before repeating such a defamatory comment with no evi- dence to back it up.’

  Nurse Cockroft went beetroot red. />
  ‘Of course, I didn’t mean -’ she blustered before being interrupted by Hazel.

  ‘I suggest I contact the Coroner and detail your concerns, and see what he suggests we do next. He may want to speak to you both as well,’ Hazel told them and the nurse looked pleased that she was being taken seriously.

  ‘Thank you, Dr Johnson.’ She glared at Jo, quite clearly believing that the doctor had ‘helped her patient on her way’ as she had put it. Pre-Shipman, most people would have accepted helping dying pa- tients to do so painlessly was what a good doctor did. Now, you risked accusations of euthanasia or even murder.

  Rather than say anything further, Jo stood up and put on her coat, following Hazel’s lead.

  ‘That’s an excellent idea.’

  ‘I’ll speak to you as soon as I’ve had a word with the Coroner,’ Ha- zel said to Jo and they headed for the door, leaving the nurse finishing her coffee, flushed with the sudden sense of her own importance.

  ‘Whatever happens, make sure you don’t mention to anyone that you think your mother may have taken an overdose,’ Jo told Ben.

  ‘But -’

  ‘And in particular, don’t tell me that you helped her do it.’ Ben sat there in silence, guilt etched all over his face.

  ‘I know it’s hard, but I am not the person to discuss this with. If you were to tell me that you helped your mother take her own life, I would have to report it and the police would have to be involved. It is still illegal to assist a suicide, even under these circumstances. There would be a trial and you would be found guilty, although you probably wouldn’t go to jail. Do you understand?’

  He nodded.

  ‘Good. Dr Johnson is going to contact the Coroner and ask his advice. He will want to see your mother’s medical records, he might want to talk to her palliative care consultant and to me and he might also want to speak to you, okay?’

  ‘But what do I tell him, then?’

  ‘That your mother was in a lot of pain and she was the one who was in control of her own medication. You are not sure but it’s possible she might have got confused and taken more than one dose. You do not say she had saved them up, or that she took loads and you certainly don’t say that you helped her. Okay?’

  He nodded.

  ‘And we never had this conversation, right?’ He nodded again and then sighed.

  ‘In some ways I wish I’d not persuaded her to go into hospital the last time,’ he said quietly. ‘But then, the last few days, we’ve talked more than we have in years. About important stuff and nothing.’ He looked at Jo intently. ‘And I’m glad we had that time.’

  Jo touched his arm in sympathy. She was glad he had been able to make his peace with his mother. She just hoped it didn’t end up causing too much trouble for them all.

  Chapter 25

  Armed with the electoral roll disk that she had picked up from Kate on her way into work, Jo got in bright and early, hoping to catch Dr Grantham before morning surgery. She walked into the doctor’s of- fice, a mug of freshly brewed coffee in one hand and Linda’s emergency supply of chocolate digestives in the other.

  Dr Grantham sighed.

  ‘It must be serious,’ he said as he took the coffee and a biscuit from her.

  ‘Potentially,’ she admitted and proceeded to tell him all that had happened with Mrs Springfield.

  ‘The palliative care consultant’s opinion on her prognosis supports the fact that she had only a short time to live?’ he asked.

  ‘He last saw her a month ago, but he said then that she only had a short time longer in his opinion, and he involved the palliative nurse team and prescribed Tramadol for her pain. I have simply continued his regime.’

  ‘And both your records and the pharmacist’s will support that?’ She nodded.

  ‘If she did kill herself, and I agree it seems possible, I’m pretty sure she cut her dose in order to stockpile enough. Her son might not even have known she did it.’

  ‘Then you have absolutely nothing to worry about.’ He paused. ‘Apart from an over-conscientious nurse, who is, of course, a concern for all of us if she is going to accuse us of hastening a patient’s death whenever we prescribe enough medication to ensure a pain-free one.’ He put down his coffee and collected his things ready for surgery. ‘Simon Rickard is an eminently reasonable man. If you can get your notes in order and have all the relevant information ready, I’m sure he’ll be able to smooth things over. I’ll have a word with him in any case.’

  Jo had to be content to wait and see what would happen next, but at least she didn’t have to wait long. This fell under Mike Parton’s re- mit, and he had collected the documentation before Jo had even taken a coffee break, so she knew that Hazel must have been in touch with him first thing. A short while later she got a message to call the Cor- oner after morning surgery. As soon as her final patient had left, Jo picked up the phone and braced herself.

  ‘Hello Mr Rickard, it’s Dr Hughes,’ Jo introduced herself when the Coroner answered his phone.

  ‘Dr Hughes, how kind of you to return my call so promptly. Now, about this little problem that’s come up. Can you tell me your thoughts on the cause of Mrs Springfield’s death?’

  Jo told him that as far as she was concerned, Mrs Springfield had been seen regularly since her diagnosis of terminal cancer of the head of pancreas, and that she had been deteriorating steadily over the past few weeks. Jo had prescribed Tramadol as per the palliative care con- sultant’s letter to her and, at the request of the community nursing team, was planning to change that and put up a syringe driver so that the patient could control her own pain better, but she had died before that had been done.

  ‘I see,’ the Coroner said. ‘And this previous suicide attempt?’

  ‘It was a mix of all sorts of painkillers and other things, mostly over- the-counter medication. It was her son who found her and persuaded her to go into hospital. That was when her prescription was changed to Tramadol, as it was thought that if the pain was kept well-controlled she would be unlikely to feel the need to take another overdose.’

  ‘Precisely,’ the Coroner agreed. ‘And did it control the pain?’

  ‘Yes, for a while, but her pain had been noted as increasing by the nurses, which was why we increased the dose and discussed a change to the syringe driver.

  ‘And, like the nurse – erm, Nurse Anne Cockcroft – are you sur- prised by the suddenness of her death?’

  ‘Not at all. If there’s one thing I have learned over the years, it is that patients don’t necessarily conform to set pathways. The will to live makes such a difference to expected prognoses.’

  ‘And if she had lost that will -’

  ‘Exactly,’ Jo emphasised.

  ‘Yes. Quite so.’ The Coroner cleared his throat. ‘That all seems to be in order. I shall speak to the nurse, and to the son, um – Ben. And then I shall get back to you, Dr Hughes.’

  ‘Thank you.’

  ‘And don’t worry. I’m sure this is all just a misunderstanding and I’ll be able to sort it out and get back to you later today.’

  Despite his reassurances, Jo spent most of the afternoon worrying. She threw herself into her work, and even managed to fit in a short visit to see Billy, who was as reassuring as ever.

  ‘I hope the Coroner does get it sorted. The last thing I want is to have to do a PM on every old biddy the district nurses aren’t sure tech- nically died of their terminal illnesses or the medication they’ve been given.’

  ‘But part of me can see her point, particularly after the latest scan- dal in Gosport. Sometimes we doctors do hurry things along a bit too quickly, and sometimes not for the best of reasons.’

  ‘Yes, but no one is suggesting this is a case of getting rid of large numbers of bed-blockers who are nowhere near death. This is a dying patient who may, or may not, have died a matter of a few days early.’

  Despite Billy’s calm words, she was still feeling restless with anxi- ety, and as it was still too early for
evening surgery and having flown through all her visits, Jo hurried back to the surgery, arriving damp and windswept, cheeks rosy with the exertion of getting back in time to see her first patient and a look of relief on the receptionist’s face. Jo knew she was often late starting her clinics and it was the reception staff who took the brunt of the waiting patients’ anger. Little did the receptionist know that Jo had something to do before she started see- ing patients. She took out the disk Kate had given her, and despite the computer’s best efforts to stop her reading what was on it, she man- aged to bypass the security and look. Result! Although the information on the disk was about five years out of date. Not only did she find Mervyn Bartlett’s home address, she also found an address for Fiona Hutchins.

  Surprisingly, she was still running on time about half way through surgery and managed to call Ben between patients. He told her that the Coroner had called and spoken to him, and had also told him it would be fine for the undertakers to come and take the body. Jo began to feel the tight knot in her stomach begin to unravel at last, as she was sure he wouldn’t have said that if he was going to ask for a post mortem.

  But it was not until well after evening surgery, as Jo was just finish- ing up her paperwork, that the Coroner called back.

  ‘I spoke with the nurse and her manager and explained my view once I had heard her, um, her concerns. I told them that while it’s im- portant to keep a close eye on the numbers of deaths and prevent any future problems like Shipman, we had to remember the poor woman was dying and that without adequate analgesia it would have been a far more cruel event. The last thing we want is for doctors to be too frightened to prescribe proper amounts of painkillers. She seemed to accept it. Her manager certainly did, and it’s possible she had had sec- ond thoughts overnight anyway.’

  ‘Thank you, Mr Rickard. That’s very good news.’ He or the manager must have been very persuasive to change Nurse Cockcroft’s small mind, Jo thought.

  There was a moment’s silence and then she heard the Coroner shuffling paper.

  ‘Well, I have to say everything seems to be in order. I see that on part one you have put cause of death as carcinomatosis secondary to cancer of the head of pancreas, and Dr Johnson is also happy to sign part two to that effect, so I see no reason for there to be any further investigation.’