Part 2

Dr Dawson feels that Mr Singh’s swallowing difficulties need specialist assessment and she needs some further advice about how to best manage his care at home given what she knows about Mr Singh’s wishes. She asks Dr Garcia, a Palliative Care consultant, and her team to assess Mr Singh at home.

The team do not find any reversible cause, such as mouth ulcers, which might be causing Mr Singh’s swallowing difficulties.

They recognise that Mr Singh has been very well cared for by his family and that, up until now, his nutrition and hydration needs have been met by the food and fluids that they have been providing. However, Dr Garcia is concerned that Mr Singh’s swallowing difficulties mean that he may not get sufficient nutrition and hydration by mouth and there are some indications that he is dehydrated. 

Dr Garcia and her team conclude that to meet Mr Singh’s hydration needs, the use of a drip would be clinically appropriate in the short term and it might be possible, though difficult and risky, to continue to meet his nutrition and hydration needs at home by careful oral feeding.

Mr Singh’s family clearly wish to continue to care for him at home, and reaffirm that he also expressed this wish when he was still able to communicate. They are very concerned that if he goes into hospital he will not be able to come back home.

They stress to Dr Garcia that despite their father’s difficulties swallowing, he can still take some soft food and fluids and they believe they could manage the risks at home with advice and support from the palliative care nurses.