Station 18 · Care home call

Persona and manner

• Distressed, insistent, uses medical words from the internet; feels guilty about the distance; suspicious that the home 'is giving up' and that the doctor 'is saving money'.
• He softens only when his guilt and his father's own words are acknowledged.

Opening line — say this verbatim

• "It's about my dad, Ernest Cole — the home says he's stopped eating and they're just going to 'keep him comfortable'. That's not good enough. He needs a feeding tube — a PEG — and I want him in hospital where they can actually do something."

Volunteer freely if given the space

• 'They're giving up on him.' 'The DNACPR was never explained to me.' 'My sister's too soft.'

Only if asked

• Ernest did not recognise Martin at the last visit; 'he squeezed my hand'.
• Martin has read that 'PEG feeding keeps people alive'. He has not spoken to the SALT or the home's nurse.
• His father's previous wishes: if asked well, he recalls Ernest saying after his wife's death, 'don't let me end up like that'. Susan 'says Dad would hate this'.
• He is frightened of 'letting him starve'; he asks whether the doctor 'is just saving money'; he wants 'a second opinion'.
• He lives in Newcastle; work is 'relentless'; he has not been able to visit; he cries if this is acknowledged.

Ideas, concerns and expectations

• Idea: 'starving to death, and a tube would fix it'.
• Concern: guilt at living far away; 'letting Dad die'; the sister and the home deciding without him.
• Expectation: a PEG, admission, 'everything done'.

Cues to deliver, timed

• Minute 1: 'giving up on him.'
• Minute 3: 'he squeezed my hand.'
• Minute 5: 'don't let me end up like that' — only if asked what his father would have wanted.

How to respond to the doctor's plan

• If the doctor listens, acknowledges the guilt and the distance without judgement, establishes that Ernest lacks capacity for this decision, explains best-interests decision-making under the Mental Capacity Act (family consulted, known wishes weighed, burdens and benefits), explains honestly why a PEG is not recommended in advanced dementia (does not prolong life or prevent aspiration; adds burdens) and what comfort feeding actually involves, reframes 'starving' (reduced intake is part of dying in advanced dementia), reviews the ReSPECT decision with him, offers a best-interests meeting with the home, SALT, Susan and Martin (video), palliative care involvement, a second opinion if he still wishes, and a clear communication plan: Martin is tearful — 'so he won't be in pain? And I can still come and feed him myself?'
• If the doctor concedes an admission or a PEG referral to end the call: 'fine' — the examiner will not be.
• If the doctor refuses without explanation: 'You're not listening. I'll go to the papers.'

Background you can draw on if asked

• Ernest was a bus driver; 'a big man'; 'never ill a day in his life' until the stroke at 78; the dementia 'took him fast after Mum'.
• The last admission: Martin was not told until discharge; he found out from Susan; he feels 'cut out'.
• He has looked at the CQC report for the home and found 'requires improvement' for 2023 — he will use this if the doctor is defensive.
• He asks, if given the opening: 'if it was your dad, what would you do?' — and listens to the answer.

Do not

• Volunteer his father's words unless asked what Ernest would have wanted.
• Accept comfort feeding until it has been explained as care, not neglect.