Bridget Stirling’s 71-year-old father, Ian Stirling, died on July 21 at a general practice clinic at Edmonton’s Royal Alexandra Hospital, where he had been admitted 16 days earlier.
His family would later learn that the cancer had spread from his lungs to his liver. A mass in his chest, below his collarbone, had grown to the size of a fist.
The family wasn’t told their father’s condition was critical until two days before his death, she says. Her father was robbed of his dignity, while his family lost precious time to share a meaningful goodbye.
We’ve lost that time and we’ll never get it back.- Bridget Sterling
“No one told us that he had advanced cancer and that his liver and kidneys had failed and that he had days to live,” she said.
“We lost that time and we’ll never get it back.”
Stirling said her father’s time in hospital was a nightmare of failed communication. It fell through the cracks of a health care system in crisis, he said.
He said it shouldn’t take a family weeks for their loved one to receive adequate care or clear answers about a prognosis.
She has filed a formal complaint with Alberta Health Services, detailing how her father’s debilitating pain was treated for days with only Tylenol and how he was found in soiled sheets.
Medical experts say Stirling’s complaint is an example of the lingering pressures of the COVID-19 pandemic on Alberta hospitals, the lack of access to timely end-of-life care and the need for improved training to ensure medical staff are informed patients and their families when death is near.
Stirling said one morning, after her father could no longer walk without help, the family found him in a dirty hospital bed. He was unable to reach the toilet during the night and appeared to be in that condition for hours, she said.
“It was like no one was checking him,” he said.
“I just want to know why no one told us and why my father was left in such pain.”
An AHS spokesman would not comment on the details of this case due to patient privacy, but said staff would meet with the Stirling family and the complaint would be “monitored and managed as appropriate.”
Bridget Stirling holds a photo of herself and her late father, Ian Stirling. She has filed a formal complaint with Alberta Health Services about the care she received at an Edmonton hospital. (Travis McEwan/CBC)
Stirling’s father, who lived alone and worked full-time at a local graphics company, was hospitalized on July 5 after visiting the emergency department at Strathcona Community Hospital in Sherwood Park.
After an initial CT scan showed spots on his lungs and possible tumors in his liver, he was taken to the Royal Alex where an MRI and biopsy were performed, Stirling said.
She said a doctor told the family that after the results came back – within five to 10 working days – her father would be referred to the Cross Cancer Institute for treatment.
He was tossing and turning in his bed and moaning and crying and begging. I will never be able to stop listening to this.- Bridget Sterling
His condition quickly deteriorated, Stirling said. He stopped eating and developed jaundice, which turned his skin and eyes yellow.
Her father was moaning in pain and no longer lucid, but was only given Tylenol until Stirling begged a nurse to get him something stronger, she said.
He took morphine on July 10, but it was administered inconsistently for four days, he said.
“He was tossing and turning in his bed and moaning and crying and begging. I’ll never be able to stop hearing that.”
Ian Stirling, pictured above in this family photo, died on July 21. His end-of-life care is now being reviewed by Alberta Health Services, following a complaint by his daughter. (Travis McEwan/CBC)
On July 15, a hospital pharmacist spoke to Stirling about the medications he would need after he returned home.
Four days later, Stirling said the family had an initial consultation with a palliative care doctor. Then they learned that her father’s death was imminent.
He died two days later in a shared room in a hospital acute care ward.
Until hours before his death, hospital staff were trying to get him to sit up in bed to eat, even though it was causing him severe pain, he said.
Her father’s previous doctor had not told the family that his illness was terminal, Stirling said.
“We kept asking [the biopsy] and the doctor kept saying, “It’s okay, we’ll just wait and everything will be fine.”
Rules regarding patient disclosure
Alberta Health Services protocols say patients must be well informed about their diagnosis to ensure they can make informed decisions about treatment. AHS said that even without the patient’s consent, doctors can tell their families about a prognosis.
“It is important to recognize that some diseases are difficult and difficult to predict, and at the end of life, a patient’s disease course can change rapidly,” AHS said.
AHS protocols also recommend checking all patients at least once every two hours, more often if the patient’s condition warrants.
In general medicine units at the Royal Alex, patients are checked at least every four hours via “comfort rounds”, which address a patient’s “pain, position, toilet and belongings”, AHS said.
“Pain assessments are done with all routine patient assessments, during comfort rounds, after analgesia is given, and when patients report pain.”
Comfort rounds are in addition to patient checks during routine medical rounds, scheduled medication administration, meal deliveries or room cleanings, AHS noted.
AHS said each zone has designated palliative care and end-of-life care beds. Waiting lists for hospice beds vary according to patient demand.
People who die in large, busy hospitals often don’t tend to get excellent end-of-life care.— Donna Wilson.
Stirling’s case is a sign that Alberta hospitals remain “in a state of shock” from the pandemic, said Donna Wilson, a professor in the University of Alberta’s nursing school.
“People who die in large, busy hospitals often don’t tend to get excellent end-of-life care,” Wilson said.
“I think it’s probably worse now than it’s been in many years because of COVID.”
Leaving a patient on soiled sheets is unacceptable and a “red flag” for potential staffing issues, Wilson said. Sterling said the staff on her father’s ward seemed overworked and burnt out.
Wilson said hourly patient checks should be the standard in every hospital.
He said the case highlights the lack of access to end-of-life care in Alberta, along with the chronic challenges acute care wards face in meeting the needs of all patients.
“The dying have, for several decades, not done well in large acute care hospitals because, again, all the emphasis there is on diagnosis, treatment and cure.”
Wilson said when a patient’s death is imminent, a lack of communication with families is all too common.
Sometimes information is withheld because of confidentiality rules or withheld because of the time it takes to reach a diagnosis. Other times, information isn’t shared because of a “lack of responsible physicians” willing to take the time to have difficult conversations, he said.
Maintaining dignity
Stirling’s case also points to the need for improved training in palliative care, said Dr. Harvey Chosinoff, a professor of psychiatry at the University of Manitoba and senior scientist at the CancerCare Manitoba Research Institute. Chochinov, who served as Canada’s first research chair in palliative care, said every medical worker should have training in caring for dying patients, particularly in pain management. Difficult conversations are necessary, and a doctor’s personal discomfort should never get in the way of maintaining a patient’s dignity, he said. “There will never be enough palliative care beds to accommodate all patients who have a life-threatening or life-limiting condition,” Chochinov said. “Therefore, all of us who practice medicine must be well aware of a palliative approach… And in the face of impending death, patients and families must be informed.”
