What happens if a patient cannot feed themselves?

What happens if a patient cannot feed themselves? That’s the question I found myself asking the patient services manager after my late father spent 10 miserable days in one of Ireland’s biggest hospitals, unable to feed himself and under the care of a nurse who made it as difficult as she could for us to look after him.

My father died a year ago. It still hurts to talk of him in the past tense.

He was 89, an affectionate and genial man who was loved by a large, extended family of four generations. The last year of his life was one of sickness and pain, but, with the help of the hospice homecare team, we were able to nurse him at home.

When he was diagnosed with prostate cancer in January 2018, Dad decided to cure himself with food and my siblings and I took great pleasure in providing him with whatever he wanted, whenever he wanted it. He was an Irish mammy’s dream, washing down his meals with glasses of milk and topping everything off with the nursery food of his childhood – rice, semolina, tapioca or custard accompanied by stewed apples and a generous dollop of jam.

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Treatment

In November 2018, Dad spent 10 days in hospital.

Had he known that he had less than a month of life left at that stage, he might not have opted for that last bout of treatment, but, both he and his doctor hoped that a blast of radiotherapy would shrink the tumour on his spine and get him moving again.

One of my brothers went with him in the ambulance and, many hours later, Dad was given a bed in a ward. Exhaustion, plus his already weakened state and the fact that one of his hearing aids was broken, resulted in Dad – until then the most sensible man in the world – rapidly losing the plot.

The night staff were agreeable to my brother staying, but advised him to leave before 8am when a boss of the ward came on duty. But, in the morning, Dad was very weak so my brother stayed on to help him with his breakfast. They were in the middle of the porridge when the nurse materialised beside them. She told my brother to make himself scarce.

Skulking in the corridor, he texted an SOS for semolina and apples for a hungry man, and a strict warning to pussy-foot round the nurse who was inconvenienced by the presence of a very ill patient who could not feed himself.

I arrived in the evening and found Dad crying like a lost child. His tea was delivered to a trolley at the end of his bed, but the trolley was too high, and the food was too hot. Dad couldn’t sit up and his arms wouldn’t work. It was too much for him and he said he wasn’t hungry. The trolley with the untouched food was removed without comment.

Dad then remembered that my sister had left a container of rice in his locker and, as I was spooning this into him, the nurse shouted that there were no visitors allowed at teatime. I told her that my father couldn’t feed himself and she retorted that it wasn’t fair on the other patients that Dad had someone to help him.

Later that night, I emailed the patient services manager describing how my father was being treated. For the next 10 days, we slipped in at mealtimes and helped him to eat. He couldn’t manage the hospital food so we brought him containers with rice, semolina, tapioca and fruit. As his hearing aid was still being repaired, we felt it was crucial to be there when the doctors did their rounds. We came one at a time, melting into the shadows, staying in the background and got in nobody’s way.

Hostile attitude

The other nurses didn’t mind us being there to look after Dad – except for the nurse who maintained her hostile attitude. We watched other members of staff roll their eyes behind her back and wondered why her behaviour was tolerated by her colleagues.

Sadly, the radiotherapy had no effect on Dad’s tumour but we were able to get him home for the last couple of weeks of his life. Back in his comfort zone, Dad was able to feed himself again. He stayed in bed, sleeping most of the time, waking to chat with our mother who sat at his bedside.

Eventually, he stayed asleep and passed away peacefully.

A month later I met the patient services manager in the hospital to ask who is responsible for the nutritional needs of patients who cannot feed themselves. I complained about the nurse who had made it difficult for us to look after our father and how her appalling behaviour was tolerated and was not challenged by her colleagues.

She sent my concerns and complaints to the director of nursing and, eventually, the director’s response was sent back to me. The director assured me that “attending to patients’ nutritional needs is part of the nurses’ everyday workload and it is recognised as an integral component of their role” and “if a family member is available to feed their loved one at mealtimes, it is largely welcomed by nursing staff”.

There was also an apology for the “upset” that we had felt, but there was no apology for how my father had been treated.

Perhaps my father was just unlucky to have come across a nurse who, far from welcoming us, made it as difficult as possible for us to look after him when there was neither carer nor nurse available to do so, but his experience does not seem to have been unique. There is anecdotal evidence of adult children arriving in hospital at mealtimes to find that their old folks have either been asleep or showed no interest in eating and have missed their meal again.

My siblings and I are quite certain that, had we not persisted in turning up at mealtimes, our father would not have survived his sojourn in hospital.