By Professor Andrew Elder

EIGHTEEN months ago, I spent my first night in a care home. So far, it has been my only night.

My mother, Ivy, had spent almost a thousand nights there. Widowed 25 years earlier, she had lived a full life from her sixties to her early eighties. But come her 85th birthday things had changed. The combination of declining mobility, a series of falls, and the relentless loneliness of life in a small sheltered house provoked her decision to move to a care home.

She weathered multiple minor medical ups and downs, but their collective effect caused gradual, stepwise decline. Inevitably, more serious illness came. A cold became a fever. Antibiotics did not help. It was pneumonia. Her GP spoke with my sister and me. Our mum was too drowsy to be involved. There was a choice – go up to hospital for more intensive treatment or be cared for here. We were agreed. Our mum should stay here, surrounded by the kent faces and voices of the carers who now knew her so well. Her capacity to benefit from anything that hospital could offer was far too small. Moving her gave no realistic prospect of prolonging her life but might well prolong her death.

Conversations like this were a very familiar part of my professional life. As a geriatrician I had stood in the same shoes as my mum’s GP on many occasions – sometimes speaking to a patient, sometimes to their family, often to both.

These are deeply personal conversations, always different, always individual. Two people who might outwardly appear just the same, might have entirely different perspectives. One might choose less, the other all that can be offered. The only way to know is to talk about it. And – ideally – to talk about it before the need arises. A sick patient often cannot communicate their views. But if they have had the conversation with family in the past, that helps doctors make the decision that is best.

Our conversation with our mum’s GP was perhaps easier because of my professional experience. But what really made it easy was our confidence that we knew our mum’s wishes. She had made clear that she would never want to have her life prolonged unless it was a meaningful life. She couldn’t now speak for herself, but we could and so we followed her wishes. And as a result, I was able to spend that night – my first and my mother’s last – in her care home room. Surrounded by pictures of her husband, her children, grandchildren and great-grandchildren – not drips, oxygen tubes, or masks. Her favourite music playing – not the noises of a busy hospital ward. She died in the early hours, able to have the kind of death she wanted because she had spoken to her family in the past and we had spoken to her doctor.

Conversations like these, now known as “anticipatory care planning”, are not the product of the arrival of a new virus, and the disease it causes, Covid-19. They have existed for as long as patients, families and doctors have come together to think about what is best for the people they care for. They are a marker of good care, of humanity, and of respect for individuality. We all need to have these conversations.

Professor Andrew Elder is President of the Royal College of Physicians of Edinburgh, a consultant geriatrician in NHS Fife, Honorary Professor at Edinburgh Medical School and Presence Scholar at Stanford Medicine, California, USA.