Looking for answers: What hospitals can do to improve supports available to traumatised next of kin

Tony Twomey’s family felt abandoned by hospital staff in the wake his sudden death. They spoke to Catherine Shanahan in the hope of generating a debate about what hospitals can do to improve the supports available to traumatised next of kin

Eleanor, Maria, and Tony Twomey with baby Mia.

On May 28 last, Eleanor Twomey picked up a copy of the Irish Examiner and the headline hit her like a hammer.

“Desperate for the Truth: Family seek answers after daughter, 20, died in hospital A&E,” it read.

“I read the story and I was right back there with that poor girl’s mother,” Eleanor says.

The article related to the death of Denisse Kyle Dasco (right) , a third year forensic science student at University College Cork (UCC) who died within 12 hours of presenting at the emergency department (ED) of the Mercy University Hospital (MUH) on April 21.

She had gone in that morning by ambulance with a severe pain in her back and was dead by the time her mother arrived from Limerick just before 10pm that night.

Her family, who await an inquest into their daughter’s death, have no idea why she died. The hospital has not supplied answers and the Dascos have been advised they must address any queries to the coroner.

This is the procedure, but the family is devastated. More than nine weeks have passed. Their solicitor, Denis O’Sullivan, has told the Irish Examiner that “where the death of a child occurs, the hospital has an ethical and moral duty to inform the child’s parents of what it knows concerning the death of their child while in its care”.

Eleanor Twomey, from Blackrock, Cork, says she can relate fully to the Dasco family experience.

On March 19, 2016, her beloved husband Tony Twomey passed away, also in the ED at MUH. While his death has since been explained via inquest, the trauma that Eleanor and her family felt in the immediate aftermath of his passing was considerably magnified by a sense of abandonment.

Tony Twomey with daughter Maria at Cheltenham the week that he died.

Aileen Twomey, Tony’s eldest daughter, says the legacy they are left with is a sense that the hospital failed them on the night, not because staff couldn’t save their Dad, but because of the information vacuum and general lack of support.

“It felt like we were shut out and they shut down,” Aileen says.

Just days before he died, Tony was walking the course in Cheltenham.

“In his hat and coat, you’d mistake him for an owner,” Aileen says.

He’d travelled over with his youngest daughter, Maria. Her husband’s family has a racehorse and they had owner’s passes. Tony was in his element.

He returned from Cheltenham the day before St Patrick’s Day. Two days later, he felt unwell. He woke feeling nauseous. He started vomiting and had diarrhoea. His family thought maybe he’d eaten something in Cheltenham that hadn’t agreed with him.

Later in the morning, Eleanor rang the doctor and the winter vomiting bug was thought the likely cause of Tony’s illness. Motilium and Dioralyte followed.

Tony didn’t improve. Aileen came to the family home shortly after 5pm. Her father had begun to complain of shallow breathing.

“I can’t catch my breath,” he said.

SouthDoc was called. The winter vomiting bug was reaffirmed and a referral letter for the MUH was supplied in the event the family felt it necessary to bring him to the ED.

Later in the evening, Tony had a fall in the bathroom. An ambulance was called. The ambulance crew assessed Tony’s head injury and had no concerns about it. However, his blood pressure was low and they advised taking him to MUH.

At MUH, Eleanor, Maria, and Aileen waited more than an hour in the ambulance bay with Tony on a gurney before he was handed over to a nurse and put on another trolley in a corridor of the ED. The Twomeys were moved to a waiting room.

“Nobody had approached us at that point,” Eleanor says.

Aileen says they were not worried: “Because you have handed him over and I suppose you expect or you assume that they know what they are doing and that they are actively doing something.

“And I think at that stage, I was annoyed with the wait, but it was more like ‘for God sake, can you not just make him better and we can go home’.”

When Eleanor next saw her husband, he was in a bay near the nurse’s station. A doctor asked about the head injury. Aileen explained she felt his stomach was the problem but she felt the doctor was more focused on her father’s head.

She went to speak with her father, who was by now crying with the pain in his stomach. A nurse came to turn him on his side in an effort to alleviate the pain. Tony’s colour seemed to improve.

“I breathed a sigh of relief,” Aileen says, but it was short lived. “Everything started beeping and people started moving. And that’s when I started panicking.”

The decision was taken to bring Tony for a CAT scan. A doctor started asking questions about Tony’s medical history. Maria went with the nurse and porter who were taking her father to another building for the CAT scan.

“We left the ED, into a lift, across a big corridor, into another lift in the older building and down a hall. They took Dad into the CAT scan room and I waited outside,” Maria says.

Back at the ED, a doctor, having listened to Aileen and Eleanor’s description of Tony’s condition, mentioned the word “ischemia”.

Meanwhile, Maria could overhear the nurse in the CAT scan room calling her father’s name.

“I was thinking ‘What’s after happening?’ And then she came out the door and said ‘We need to go back to the ED’ and we started off with Dad on the trolley and she said ‘run’ and we started running, and another nurse ran ahead to hold the lifts and we went into the lift and I just went mute and held Dad’s hand.

“His eyes were dilated and there was no movement. He had crashed inside in the CAT scan room.”

Maria says the journey back to the ED felt like a lifetime, another nurse holding the second lift while the nurse pushing the trolley called ‘Code Red, Code Red’.

“And I just kept saying ‘Dad, Dad, Dad, I’m here’. And I just held his hand even though I knew he was dead. I just knew it. They never said one word to me. Not one word,” Maria says.

“I suppose you sort of expect something like ER or Grey’s Anatomy where they are with you, but I was just mute holding his hand.

“And then on the way back to the ED, we were trying to get through the corridors, but Dad’s trolley kept getting stuck in between the other trolleys that were in the way.

“The corridors weren’t wide enough, so they were trying to get wheels off, trying to get people to move and they ran into the resus [resuscitation] room — which was in the corridor where we’d been waiting earlier with the ambulance lads.”

During this dash, the trolley was pushed past Aileen and Eleanor, hitting one of them in the thigh. They followed to the resus room and one of the medical staff told them he would be put on a ventilator and they were doing all they could. She said the situation was not good. More staff came. They saw a priest go in. Aileen started to cry.

“That was the moment that I realised ‘Oh Jesus, this is not good. This is bad’,” says Aileen. “I think I looked at Maria’s eyes and I thought ‘Oh ya, this is bad’. And I didn’t know what bad was but I knew we mightn’t be coming back from this.”

Shortly afterwards, at approximately 12.30am, two staff members came out of the resus room and broke the bad news. Their father had gone into cardiac arrest and despite their best efforts to save him, Tony, husband and father, had died.

Tony Twomey with granddaughter Mia.

Eleanor recalls the scene after that news was broken.

“All I remember is standing there and a battalion of medical staff came out. And they all veered left. And we were standing there. No one came over. I can remember us looking at each other going — are any of them going to talk to us? Thinking in my head: ‘They’ll be back in a minute. They’re giving us a minute to get it together.’ ”

Aileen continues: “And I know it must be a horrible experience for the medical profession to have to deal with that, but they don’t have to face us exactly, but somebody from the hospital should.”

A porter brought them to a family room in the old hospital building where they waited while their father was taken to the mortuary.

“We were left in that room on our own for I don’t know how long, an hour, I’m not sure,” Aileen says. “It was five or six in the morning when we left, we had to wait for Conor, our brother, who was travelling down from Dublin.”

In the aftermath, the quest for answers began. They were told to get in contact with the coroner.

“We just needed to know what happened, roughly even,” Aileen says. “Our biggest fear going into the inquest was if they said ‘had he been there earlier, had he been treated earlier, had we not slipped up, he could have been saved’, but that was not the case.”

Their questions to the coroner had to be in writing. Aileen says she almost earned “a mini PhD in inquests and coroners” given the level of research she engaged in. They had their day. The coroner, they say, pulled all the strands together beautifully.

“People said to me: ‘You’ll get nothing from the inquest.’ But they were wrong. The coroner answered all of our questions,” Aileen says.

At the inquest, their father was described by a representative of MUH as “elderly” and “confused”. This was the ultimate insult, Eleanor says.

“He was 74 and he was not confused. He was dying,” she says.

The inquest found that Tony Twomey died from “acute congestive failure due to a dilated cardiomyopathy associated with ischemic colitis on a background of hypertension”.

Aileen says that, in layman’s terms, the blood supply in a part of his bowel got blocked “and became necrotic and basically died”.

“It allowed leakage out of the bowel which, once it gets into your system, it becomes toxic — that would have then presented as vomiting, diarrhoea. And as the sepsis goes through the system, the organs begin to shut down,” Aileen says.

The Twomeys are grateful to the coroner but feel badly let down by the hospital. They rang the MUH risk manager after the inquest and were invited to meet with the hospital and to submit their questions in advance.

“They had our questions from the coroner and we came to the point where we felt we could not sit across the table from these people now. It’s too late,” Aileen says.

“We were in a state of trauma the night Dad died. We were nearly patients ourselves at the end of it. Everyone who was involved, who could have just given us a minute or two, left.

“And it was like once the event happened, they are programmed to reset. That’s what it felt like.

“I felt looking back that there is nobody to liaise with the family. And I know things can go wrong really really quickly, which they did.

“But surely there is a role for someone who steps in to be that kind of bridge between a family and the medical staff? I appreciate the medical staff are going through a trauma as well, they don’t want patients to die, but you can’t leave a family, just give them the bad news and then turn away and leave.

“That’s not a First World approach. You can’t blame resources on that. That’s just humanity, that’s just people.

“I think the trauma could have been lessened if they’d looked after us a little bit more. Just a little bit more care.”


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