Timely Discharge Series: “Where’s Lammy?! I want to go HOME!”

Dr David Attwood is Honorary Secretary of the BGS and a GP with a specialist interest in Older People, particularly in change management surrounding their proactive and unplanned care. His experience in working in primary care, secondary care, and intermediate care, has led to a deep appreciation of the need for novel solutions, transcending all health providers, built around the needs of older people. He tweets @DavidAttwood12

This is the second blog in the BGS’s ‘Timely Discharge’ series. We aim to raise awareness of the detrimental effects on older people of being stuck in hospital when they are 'medically fit for discharge'. Our blog series explores the causes of delayed discharges, the knock-on effects to the wider health and social care system, and what needs to change.

“He’ll be here shortly, Emily.” I answered, praying that he would be soon. I turned around and there he was. Lawrence (or Lammy, as he was called by his wife, Emily) had arrived. He saw the look of relief on my face, then smiled at his beloved. “Hello my love. Of course you can come home. I promise we will get you home as soon as we can get some carers.” Then changing the subject “Look, I have brought you some strawberries and today a photo album of our time in the Galapagos!”

Lammy and Emily had been married for fifty-two years. They met at university studying Biology and immediately fell in love and married, both aged twenty-one. Emily was always the more free-spirited of the pair and shortly after their wedding, they emigrated to Uganda, where they became Biology teachers at Makerere University in Kampala.

The Idi Amin years were brutal and following some  state-sponsored killings at the university, Emily and Lawrence fled to Kenya, before moving to the UK to work as Biology lecturers.  

They never had children, preferring instead to go travelling, doing Biology research in remote locations. About three years ago, whilst on a cruise in the Greek islands, Lawrence started to notice issues with Emily’s memory; she started forgetting locations and the names of the people she met on the ship.

As the months passed, Emily’s behaviour changed; she lost her “free-spiritedness” and Lammy started booking the holidays and doing more of the housework. A year later, Emily was diagnosed with Alzheimer’s dementia and Lawrence became her carer. That year they celebrated their golden wedding anniversary in Sicily, drinking wine whilst watching the sun set at the temple in Agrigento. It would be the last holiday they would go on together.

A month ago, Lawrence was woken with a thud and cry of pain. Emily had fallen and fractured her hip. She was rushed into hospital and operated on. She became confused in the aftermath and was no longer able to walk, crying out “Lammy, where are you? I want to go home!”

She was discharged to a community hospital, ostensibly for rehab but in truth because there were no care packages available. In yet another unfamiliar environment, her behaviour worsened. We allowed Lammy unrestricted visiting rights as his presence had a calming impact on her. He was totally devoted and every day would arrive with a new photo album or show us some videos of the pair on holiday. I found myself deliberately organising my ward round around Emily so it would coincide with Lammy’s arrival. Story-telling was his gift and when he talked, we found ourselves transported back in time, a silent witness to their amazing lives and depth of feeling for one another. Today I would hear about their journey to the Galapagos…

The days went by and it was becoming increasingly apparent that Emily was not going to be able to walk again. She was no longer able to make decisions surrounding her health and care needs and Lammy agreed he needed help to support her at home. Every day we awaited news of a package of care so that she could be discharged. Every day no news returned.

We followed our processes of escalating the situation and she moved from green, to amber, to red for a delayed discharge. The only thing that changed, aside from the colours, was Emily’s behaviour. As time went by, she became more withdrawn and her memory worsened. I walked in to find Lammy in tears one ward round. He showed me the photo of them celebrating their 50^th wedding anniversary at the Temple in Sicily, watching the sun set. Then he asked his wife. “Emily, where is this? Can you remember?”

She looked at him blankly. Then shook her head and said in a feeble voice “Lammy, I want to go home.”

He looked at me imploringly. He and I could both see that the free-spirited Emily of yesteryear was losing her battle with Alzheimer’s. This was Emily’s final wish, her last adventure.

The team tried everything that day to get Emily home as we knew the days now mattered. We phoned every domiciliary care agency, escalated to every line manager, we even asked the hospice if they could support. There was nothing available.

That night Emily deteriorated and her breathing became more laboured. She was diagnosed with pneumonia and started on antibiotics. Lammy was called in and told how dire her situation was. On my ward round the next day, it was clear to both of us that she was dying and was in distress with her breathing. I explained to Lammy that we needed to give her some medications to improve her symptoms. He looked through me to her, shook his head and started crying. “You remember when I brought in the photo album of the Galapagos?” I nodded. “I promised her I would get her home. That was the first promise I have ever broken in 52 years.”

Despite ongoing efforts to get her home, Emily never went home.

There were simply no carers.

She died peacefully in Side Room 4 of our hospital with Lammy present. I spoke to Emily’s GP and asked if they could make contact with Lammy, as they had always looked to each other for support and now that chain was broken, I feared for his health.

A week later Lammy was admitted to hospital with breathlessness and chest pain. He was diagnosed with Takotsubo Cardiomyopathy, also called “Broken Heart Syndrome.” Twenty-four hours later, he passed away. I like to hope that during his last moments, someone was with him, holding his hand as his final breath became air. Finally, he would be reunited with Emily, his free-spirited wife, who forgave him his one broken promise.

For in truth, he never broke any promise. He believed that the state would support them and they were both let down. I hope that in my lifetime we secure a brighter future for social care and in particular its invaluable workforce. There are people counting on us to make this happen.