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There must be a better way

BMJ 1998; 316 doi: (Published 27 June 1998) Cite this as: BMJ 1998;316:1989
  1. Jonathan Koffman, research fellow in palliative care
  1. London

    Some years ago I became the custodian for my grandmother's care, a woman with progressive multi-infarct dementia, congestive cardiac failure, and a litany of other medical problems, the common currency of older people. Remarkably, she coped at home, with the help of a sympathetic and pragmatic community psychiatric nurse who visited her regularly. She rarely ventured out of her second floor flat, although by all accounts residential care with regular day care sessions in the local community hospital would have been better for her. But she was stubborn and independent, and among many other more amenable qualities were the reasons we loved her.

    Recently my grandmother fell while trying to negotiate her way to the bathroom. I called for her general practitioner to attend, and he organised for her to be admitted to a local teaching hospital. It quickly became clear, while we waited in the accident and emergency department, that her condition was far more serious than I had previously imagined. She had sustained a bad fracture to her right neck of femur (no doubt as a …

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