A few things have changed in medicine over the last few decades. Okay, a lot has changed, and most of it good. But along with the improvements in patient care there has been an exponential increase in expectations. We’ve somehow gone from “your loved one has a life threatening illness and we will do what we can to treat it and in the meantime ensure they don’t suffer” to “your loved one has a life threatening illness that we have the capacity to cure, and if we don’t we will have done something wrong.”
The problem is, last I checked, everyone dies. Let me say that again for good measure. Everyone. Dies. The problem is not with that truth alone, but with the fact that patients with terminal illnesses – and their caregivers – rarely understand their mortality. And when patients and families have unrealistic expectations about what their doctors can accomplish, many people die in a way they never planned for or wanted: in the hospital, dependent on strangers for the basics such as eating and bathing, and often hooked up to machines.
If that makes you feel hopeless, you’re not alone. Many doctors and other healthcare professionals I work with feel that way, too. In the hospital, your code status – whether you want to be resuscitated or not when your heart stops – has become a sort of surrogate for determining whether you really understand your prognosis. Of course, it’s not quite that simple. We know there are other considerations, such as deeply ingrained core values and past experiences with death – good or bad – that play into a patient’s wishes about their death. But the hospital is often the worst place to begin to have these important conversations. Patients in the hospital are sick, they’re scared, and they usually have no prior relationship with the physician who is trying to paint a realistic picture of their condition.
Everyone in healthcare – assuming they don’t have their head in the sand – knows that the system, especially regarding end of life care, is terribly broken. While I believe we are on the path to improving this (within the last year, Medicare approved payment for voluntary end-of-life counseling), we still have a long way to go. But there are things patients can do to take back control of their health and the health of their loved ones.
1. Understand What Resuscitation Is: It almost uniformly involves chest compressions, intravenous medications, mechanical ventilation, and defibrillation. Currently, resuscitation is performed unless a patient has “opted out” in the form of a DNAR order (Do Not Attempt Resuscitation). Many people in healthcare feel that resuscitation should be approached like any other procedure in medicine, requiring consent from a patient to initiate it in the first place. And in the case of resuscitation – when the patient and family goal is not only survival, but a return to prior level of functioning – the chances of success are alarmingly low. After all, if a doctor offered you a surgery that had a 1.7% chance of improving your condition, was painful and distressing, and had to be done without sedation or pain control of any kind, you may just choose not to proceed.
Patients and their family members are often presented with the ever-important “code conversation” in the following way: “If your heart stops or you stop breathing, do you want us to do everything?” For a doctor, it’s a lazy way of asking “Would you want to be
resuscitated?” without explaining exactly what that entails. But what patients often hear is: “Do you want us to do everything or nothing?” or, worse: “I think you might die during this hospitalization.”
Of course, neither of those things is what the physician is really trying to convey with this question. First, there is a lot we can offer in the way of treatment short of resuscitation. Many times, our treatments are able to circumvent the need for resuscitation altogether. And, even if death is unavoidable, there is so much we can offer patients and families to reduce suffering and provide support. We, as a society, often equate doing “everything” will showing our love. (“I will never let mom die.”) Many times, nothing could be farther from the truth. As people age and their chronic illnesses progress, quality of life – rather than quantity of time – should be the central focus. But, as we see too often, it rarely is. Second, we are almost never implying that death is imminent with this question. We try to bring up the issue of code status with every admission. Since we don’t have a crystal ball, we can’t always predict a medical emergency (sometimes, yes, we pretty much know it’s coming). But regardless, we want to be prepared to act, at a moment’s notice if necessary, in a way that respects your wishes.
We, as doctors, as a healthcare system, cannot afford to be poor communicators about this issue. But patients and families, for their parts, cannot afford to be uninformed.
2. Understand What Resuscitation Is Not: It is not a guarantee of survival, and it’s certainly not a guarantee of survival with the same quality of life you enjoyed previously (or even a quality of life you deem acceptable). We’ll talk about this concept a little more below.
Codes are not what Hollywood would have you believe. One study in which the researchers watched 97 episodes of popular medical dramas in the 1990s reported a 75% survival rate for fictional patients immediately after resuscitation and 67% survival rate to hospital discharge. In stark contrast, an article in the Journal of the American Medical Association published in 2013 studied a prediction tool for survival after in-hospital resuscitation. In it, they used four branch points to stratify patients’ chance of survival with a meaningful quality of life: very low (<1%), low (1-3%), average (>3-15%) and higher than average (>15%). That bears repeating. A higher than average success rate for resuscitation was >15%.
Presented another way, the average chance of successfully resuscitating a young, healthy person (when success means the patient is neurologically intact, i.e. not physically or mentally dependent on others) is only 30%. The average success rate of resuscitation in an elderly nursing home resident with several chronic medical issues (who may have even been going along just fine prior to their illness) is 1-3%. For some patients, the success rate approaches zero.
3. Understand Your Health: A young, previously healthy person with a treatable (i.e. fixable) condition is the poster child for resuscitation. Nearly everyone else is not. That’s not to say we should never try CPR in the hospital, but there are many cases when it is clearly the wrong thing to do. In the end, it is an individual decision that each person should make with the help of their doctors and other healthcare professionals. But patients should be aware that many chronic medical conditions, such as dementia and COPD, negatively affect their chance of surviving an in-hospital cardiac arrest, and patients should know what they are getting into. Complications such as kidney damage, liver damage, low blood pressure, and mental status changes also worsen your chances of surviving. Increasing age, as you might imagine, does, too. This is not the only thing to consider when deciding or updating your code status, but you cannot make an informed decision without this knowledge.
4. Understand the Risks of Resuscitation: The risks? Wait, I thought resuscitation was good, that it was supposed to save lives. Sure, it is and it does…sometimes. But all medical treatments have risks or side effects associated with them. It’s the inherent nature of the practice of medicine.
Long term, patients can end up with poor neurologic function, dependent on ventilators which breathe for them and which they have no hope of coming 
off of because of their previous lung disease or other complicating medical issues. Even if not dependent on a ventilator, they may require feeding through tubes introduced into their gut because they aren’t able to swallow. They can be bedbound and develop ulcers on the dependent areas of their bodies. These ulcers can become infected. They are often tied down to keep them from pulling at their numerous tubes due to their delirium. They get urinary tract infections because they require a foley catheter or are incontinent.
Many families feel trapped after their loved one has “beaten the odds” and survived a cardiac arrest just to be in a situation similar to the one described above. It is important to mention that it’s never too late to withdraw care in these situations. This is not equivalent to causing death, as the underlying illness is doing that. It is simply removing the artificial means of keeping the patient alive.
Death is an inevitability. Modern medicine is amazing in that we can often treat the complications of terminal disease. But we cannot change the terminal nature of those diseases. And when the treatment starts to cause more harm than good, we need to take a step back and re-evaluate our goals. One of the most amazing things about medicine, one of the reasons I love practicing, is the experience we gain over the years. We can counsel a patient who may be experiencing illness for the first time on what to expect – because we’ve seen it. No, we can’t tell them the day and the hour of their death, but we can give them an idea of how things are going to go, so they can decide on their own terms when enough is enough.
And it’s different for every person. We know that. And we respect that.
5. Fill out a Five Wishes or MOST Form and Talk About Your Wishes with Your Loved Ones: Close your eyes and picture how you imagine your death. 
Is it surrounded by family members in your own home? Is it on a tropical island with a Mai Tai in your hand? Is your pastor at your bedside saying a prayer over you? Chances are, it’s not tied to a bed in a cold hospital room, sedated and unaware.
Of course, many people don’t get to control how they die. They die in car accidents or of a heart attack in the middle of the night. They aren’t even aware that life is passing from them during their final moments. But if you are blessed enough to have time to ponder your mortality and the ability to dictate the terms of your death –wouldn’t you want to take advantage of 
that? A Five Wishes (https://agingwithdignity.org/docs/default-source/default-document-library/product-samples/fwsample.pdf?sfvrsn=2) or MOST form (http://www.polst.org/wp-content/uploads/2012/12/NC-MOST-Form.pdf) tells those who will care for you and who will make 
decisions for you what those decisions should be. Gift your family with your wishes so they know how to take care of you in the way you envision.
Too often, caregivers are placed in the impossible situation of guessing what their loved ones would have wanted. Though they come from a well meaning place, they usually do everything to keep their family member alive, even if it prolongs a quality of life inconsistent with who they were in life (and one they would never want for themselves). Take the time to speak with your family and document your wishes – and you just may end up with that Mai Tai, after all.
The end of life is a part of life. It should be part of our legacy, not a desperate last-ditch effort to escape the inescapable. Talk to your family and your doctor now and on a regular basis as your condition changes. Take control of your legacy.
***
The information for this article was obtained from review of the articles below and conversations with Alisha Benner, MD, who has conducted research regarding end-of-life care.
http://www.cnn.com/2013/07/10/health/cpr-lifesaving-stats/
http://www.theguardian.com/society/2012/feb/08/how-doctors-choose-die
http://archinte.jamanetwork.com/article.aspx?articleid=1735894
http://www.hhnmag.com/articles/3656-health-care-costs-and-choices-in-the-last-years-of-life
http://www.cbsnews.com/news/the-cost-of-dying-end-of-life-care/
http://www.medscape.com/viewarticle/853541
K.V. Scruggs 
Dr. Scruggs:
I worked with you as an RN and I was always impressed with your care.
This blog really resonates with me. I am passionate about people being given the chance to die a “good death” – almost go to point of freaking people out with my enthusiasm for the topic.
I got into nursing because of my FIL. He was diagnosed with Creutzfeldt-Jakob Disease. When he talked with the doctors and learned it was a terminal disease with no treatments available, he said, “So I have no need to ever be in a hospital again, right?”…and he never was. He had three months of home hospice care (which was amazing) and died in his living room, surrounded by 20+ friends and family. He died peacefully, holding my MIL’s hand. It was actually the most beautiful thing I’ve ever experienced. His death motivates me in my care every day.
Thank you for writing this. And thank you for being a great physician who is willing to have those hard conversations. It was a pleasure working with you!
LikeLiked by 3 people
Hi, Amber! Thank you so much for sharing your family’s story. I think that’s the kind of death most of us want.
LikeLiked by 1 person
No one ever gets better after resuscitation! If you are young and otherwise healthy, we have a chance to save you, and give a good outcome. If not, in case of CHF, cancer, brain damage etc, we will only prolong and exacerbate your suffering. Please everyone, discuss your wishes with your doctor! Do not resuscitate doesn’t mean we don’t treat, just we don’t try to bring you back to suffer more!
LikeLiked by 1 person
I must tell you about this remarkable woman, Betty, who had surgery for a large (football size) benign tumor in her abdomen. She “died” on the table, was resuscitated and spent two months in the ICU on a vent. She was weaned off the vent, regained consciousness, and went into rehab where she had to learn to walk again. She was 74 at the time. A retired high school guidance counselor, she continued to mentor young people and was active in our church. That was 9 years ago! Betty was much beloved by many in our county. We had her funeral yesterday after she succumbed to pancreatic cancer (which she had fought for almost two years). Betty had a strong will to survive and it was that will and the grace of God that gave her 9 more years with us.
LikeLike
Resusitation is appropriate in the right situation with the right patient. “Dying” on the table is the ideal situation to attempt resusitation. The docs know exactly when the heart stopped and the needed equipment is right there. Most victims of cardiac arrest are not that lucky.
LikeLiked by 1 person
That is an anecdote. It is far from the typical outcome. By the grace of medical science she lived 9 more years.
LikeLike
As far as I know if you are in surgery all DNR orders are not recognized because your intention to come out of surgery is implied.
LikeLike
thanks for the article… I know someone in this situation and he feels utterly hopeless … I got some inspiration from this article thank you
LikeLike
What an arrogant view of life and death. Makes me very glad I know all the men and women I have worked with in hospitals over the years don’t all share your view and no doubt your practices.
LikeLike
Why is it arrogant???
LikeLiked by 1 person
You are apparently inexperienced with ventilators, tracheostomies, PEG tubes, pressure ulcers, severe debilitating strokes, and anoxic brain injuries. Spend lots of time on a busy icu unit, better yet a neuro icu. I also want you to put yourself in the place of a person who can’t even change their own position in bed let alone the tv channel. Be the person who can’t tell someone they are in pain or are lonely because they can’t speak. I think you are the arrogant one, Carolyn, for judging an article that’s sole purpose was to inform and educate. Go gather more education of your own before commenting on an article of which you obviously have no experience.
LikeLiked by 2 people
How was this viewpoint arrogant? I thought it was very compassionate and very patient focused.
LikeLike
Yes, please indulge on why you see this article as arrogant. Give examples and purposes on how you see that there can be a better approach to death. I merely want to explore and understand other alternative approach. Short little jabs dipped in personal opinions doesn’t make it seem plausible or even constructive for others that can relate to this article.
LikeLiked by 2 people
Wow! How is it arrogant? It’s the truth. All he is doing is informing you of the truth and letting you make better decisions. You’re welcome.
LikeLiked by 1 person
Not arrogant. Factual. Talk to any RN, paramedic, doctor. Nearly ALL of them will tell you they never want to be resusciated. It’s almost never a good outcome. TV shows and movies are unrealistic. The ‘survivors’ are often brain damaged or will be in the ICU for what is left of their life.
LikeLiked by 2 people
Interestingly tho, most doctors and nurses rebel against statistically driven directives for the delivery of care. They cling to the outdated methods and procedures they learned decades ago and dismiss data in favor of anecdotes. Homes sign, hypoxic drive, wet to dry dressings, opiods for chronic pain over non-pharma tx’s are all outdated beliefs still being used. So yes, it’s a little arrogant to tell me I should trust your veiws on this issue b/c the data supports it and not expect the same openess to data in return.
LikeLike
I encourage you to do your own research and decide for yourself. And please do not pretend to know me or how I practice medicine.
LikeLike
Please inform the VAST majority of educated medical professionals that are in agreement regarding positive and REALISTIC expectations of end-of-life care. WHY is this arrogant, truthfully?
You are 110% entitled to your opinion, however my colleagues and I will do our BEST to articulate your attempts to relay your feelings; “PLEASE let me die, I can’t, NO MORE, tell my family, I hurt, STOP, I’m ready, etc” or simply a head shake w/ or w/o tears and/or desperation, should YOU ever find yourself in this situation… Many of us experience this EVERY DAY, and we can only hope that our patient’s needs are conveyed to YOUR well-meaning, good-intentioned, and loving family members.
As an RN, it causes me internal grief to witness this, and truly HOPE that in the appropriate situation, I am able to provide this to my patients… This is my calling, and I am quite sure most of “us” are answering our calling because of a GENUINELY pure place, as I witness this EVERY day with my cohorts by my side united. Please take a moment to ponder YOUR own scenario, as we all have as well…
LikeLike
Not arrogant! Realistic!
LikeLike
Carolyn,
i agree with you. The writer needs to rethink this when she gets older. I think her attitude will change.
LikeLike
Carolyn,
I agree with you. This woman will have a different point of view as she gets older.
LikeLiked by 1 person
THANK YOU.THIS ISSPECIALLY RELEVANT IN DEVELOPING COUNTRIES LIKE INDIA,WHERE EMERGENCY MEDICINE AND CRITICAL CARE MEDICINE ARE CONSIDERED AS MONEY SPINNING AVENUES FOR PRIVATE HOSPITALS
LikeLike
I found this article circulating on Facebook, and I’m very thankful to have had the opportunity to read it. My Mother in Law passed away last month. She was 92 years old and got septic from a kidney stone. The infection was successfully treated, however she suffered a stroke, which left her unable to swallow, effectively communicate or move. Fortunately we had a medical directive completed some years ago, and she made it clear that she did not want to be kept alive by artificial means. We honored her wishes and she had a peaceful death. Many family members though had great difficulty accepting the medical directive, and a rift among the family continues to this day. I knew at the time that allowing her to pass peacefully was the best thing to do. It’s never easy. And your article gave me reassurance of that fact. Thank you for sharing your knowledge and perspective.
LikeLike
Thank you for your bravery to honor your loved one’s decision. You were her blessing.
LikeLiked by 1 person
What a sensible approach! I am a paramedic and too often have to ‘go through the motions ‘ of resuscitation when I know the situation is utterly hopeless. This is usually in nursing homes on very elderly residents who have been very ill for a long time. I so often wish the family had made a decision in the best interests of their loved one and had a DNAR put in place to save the suffering, not only of the patient and the family but also for those like me who find the whole process distressing. The pressure to ‘bring back to life’ is enormous and gives a false hope. Being allowed to die with dignity is surely paramount.
Emma Hallissey
Paramedic
LikeLiked by 1 person
I absolutely love this… It should be made into a paphlet and handed out to everyone along with the MOLST form
LikeLiked by 1 person
Everyone needs to read and understand this article. I have been down the road of the loss of a loved one. We had a close relationship with Dr. Gutshall, were advised of what the calendar of death event might look like and it played out pretty much that way. We were well prepared for the ending. Nursing care and hospice were excellent. God blessed us all in his special way.
LikeLike
I loved this blog; thanks so much. I would add one other item: Make CERTAIN the hospital records the DNR for EACH and EVERY admission. In North Carolina, this must be done by the attending physician. At the major medical center caring for my mother, it took SEVEN days for the DNR to be recorded; in the meantime, my mother was resuscitated twice, both times when I was not at the bedside. Once was for over-sedation. Had she been able to drift off peacefully, it would have saved her another six to eight weeks of pain and suffering. I was, thank goodness, able to decline on her behalf yet another surgery, and she died peacefully and comfortably in the same medical center’s incredible inpatient hospice unit.
LikeLiked by 1 person
Response to Carolyn:Are you a Healthcare provider? Or do you work in an ancillary deptartment?
Have you had the horrible experience of feeling an elderly osteoporosis patient’s ribs crack?–yes, it happens even when compressions are done correctly.
LikeLiked by 1 person
Sarah, you are absolutely correct. Compressions performed properly breaks ribs and possibly the sternum every time. It can not be helped. I work a busy ICU and ALWAYS break bones. It is the only way to give high quality CPR.
LikeLiked by 1 person
I cared for my father who developed Dementia at home. I had him fill out the Five Wishes 5 yrs. before we needed them. He wanted things done if he was going to get better and I said of course Dad. He died at home, hospice was involved… I would have liked him to be more comfortable… he was struggling , he would stop breathing and then start again…the look on his face the grimace and clench teeth…I think more pain medicine was in order.
LikeLike
As a RN, I found this article very interesting and agreed with most everything; however, I must tell you about my husband’s experience. On December 1, 2015, he started having chest pain. After checking his BP and Pulse rate (which were elevated), I gave him 2 baby Aspirin. We then proceeded to the ER. He walked into ER, we told them he was having chest pain, and they immediately took him back to assess him. Within 5 minutes, they paged “Code Blue ER” twice. It was my husband. They used CPR, and defibrillation to get him back. He was then transferred to a larger hospital where a cardiologist was waiting. He did a heart cath. and installed 1 stent. They saved his life!!!! No after effects. He did not have a diseased heart. Apparently, plaque had broken loose, and blocked 1 artery which caused a heart attack. If we had not been in the ER, and they had not resuscitated him, he would not be here, with no after effects, today. SO, there are some good reasons to resuscitate. I thank God everyday for that ER team. (One thing I learned is that I should have called EMS instead of taking him by car.)
LikeLiked by 1 person
Great story! It sounds like your husband was a good candidate for resuscitation. I want to stress that I don’t believe everyone across the board should be DNR. There are lots of things that factor in and it’s impossible to cover everything in a 2000 word article. Generally speaking, as patients age and develop chronic medical issues, the success rate goes down. I think most young, healthy people would gladly risk the pain of resuscitation for a chance at recovery. But I believe that patients need to know what they’re getting into and also have a plan for if things don’t go well. My goal was to get people talking about it, and I hope I’ve done that!
LikeLiked by 2 people
I couldn’t agree more–he had an acute issue, and there was a treatment option that had a reasonable chance of resolving the acute issue before a lot of permanent damage occurred. I worked in the ICU long enough to know that: (a) patients and families don’t really understand what’s described in this article, and (b) anxiety and fear make hospital admission–or worse–seeing a loved one about to code–are the worst times to have a clear-headed discussion about resuscitation and end-of-life decisions.
LikeLiked by 2 people
Thank you for this article. Here is my frustration, one of many: My husband and I both have medical directives and Five Wishes documents on file. But, that information is compartmentalized because between HIPAA laws and facilities and files not being connected electronically, that information may not be where it needs to be when it’s need. Our local hospitals are still faxing items back and forth. I have zero faith that the information could be obtained from my PCP unless they call on a weekday during business hours. Of course I keep copies at home, but I don’t always have them with me. Until we can get the medical profession connected so that patient information travels with the patient, I do not have any faith my wishes will be respected.
LikeLiked by 1 person
Would some type of medical bracelet help? Put DNR or no DNR on it? Never thought abt this b4.
LikeLike
Penny,
There are several things you can do to make sure your wishes are fulfilled. You can fill out a POLST, and hang it on your fridge at home. You can make sure your local hospital and doctors offices have a copy of your advanced directive. Do you have a power of attorney for healthcare, if so make sure the hospital and docs office know who that is and have a phone number to reach them. Make sure family is aware of your wishes. And yes you could wear a bracelet. The more prepared you are, the more you won’t have to worry that your wishes will be followed.
LikeLike
One of my greatest regrets is performing CPR on my mother. I wish I had just let get go rather than have her go through what she did.
What was left wasn’t really my mother and was kept “alive” by machines. Fortunately, even the machines couldn’t keep her body alive. I also felt like I watched her die twice.
LikeLike
Great article, it helped me learn more about my own mortality and helped explain a lot of things.
Thanks.
LikeLike
[…] https://kvscruggs.wordpress.com/2016/04/11/the-dirty-secret-about-cpr-in-the-hospital-that-doctors-d… […]
LikeLike
Great article. I find it sad that medicine has become so fragmented that the doctor who knows you best is not around when you are the most ill – in the most need. This makes these situations much harder. As the article mentions, that built in trust is key, and so often, missing.
LikeLike
Excellent and very accurate article. Thank you. There is one part that bothers me however. It is the part that says…”While I believe we are on the path to improving this (within the last year, Medicare approved payment for voluntary end-of-life counseling), we still have a long way to go”. I do realize that it takes time for providers to talk with their patients about such important issues, but why or how has this become “extra” and requires money before it will occur?
As people age, developmental issues change. Take pediatrics for example. Pediatricians talk with parents about developmental phases that a child will go through and that is part of their care for the patient. I’ve never heard of a “beginning of life talk” that required reimbursement. Why is that not just part of the conversation between provider and patient as the patient ages? Why is this dependent on money, in order for it to occur? If it is an ongoing conversation over the years between a patient and their primary care provider, it should not require a special “end of life”talk requiring extra money allocated by Medicare (which, as we all know, is out of all our pockets) should it?
LikeLike
I don’t work in primary care, but I know they work hard to provide comprehensive care to their patients. They have very little time to address multiple medical issues as well as healthcare maintenance. This is a conversation that can’t be rushed. Also, from a strictly financial perspective, I’m guessing if these codes are used in the primary care setting it will result in lower Medicare spending overall.
LikeLiked by 1 person
Talking to and counseling patients is one of the main jobs for doctors in primary care (like pediatricians), and as a result a decent part of that bill your insurance got for your pediatricians visit went to pay for the time the doctor spent talking with you. In pediatrics, the “beginning of life talk” is reimbursed as part of the “Well Child Visit”. If a kid comes in and want to talk about weight gain, there is a separate code for “weight counseling” ICD10:Z71.3 , and each insurance plan decides whether or not they are willing to pay the doctor for it and how much. If medicare decides it won’t reimburse doctors that spend time talking about end of life issues, then the hospital bosses will discourage doctors from doing it. The sad truth is that while ideally that conversation would happen over time and multiple visits with your family doctor, it most often ends up falling to hospital doctors that have never met the patient before, and have to budget their time to meet hospital patient quotas.
LikeLiked by 1 person
DR. Scruggs-
I have been a medic/firefighter since 1973, and I believe this to be absolutely one of the top 5 articles on medicine in general, and CPR in particular ever written. How professionally and compassionately you wrote this is testament to the fact you are as beautiful a person on the inside as you are on the outside. Please stay safe and healthy for many years to come. May God Bless you and your families.
Denny
LikeLiked by 1 person
thank you for your service to people in times of need. First responders are the greatest!
LikeLike
Wonderful article! Thank you so much for describing one of the central dilemmas of modern medicine so clearly and succinctly. One small thing, because the words we use are so important: “It is important to mention that it’s never too late to withdraw care in these situations.” The mention of withdrawing care often sounds like your example of doing everything vs doing nothing. As healthcare providers, we never stop providing care, but we may choose to withdraw technology, artificial life support… pick your phrase, but choose it well and consider the impact of those words.
LikeLiked by 1 person
This article should be put in every newspaper and publication as well as discussed on all the news programs. Such an important issue that still is seldom discussed.
LikeLiked by 1 person
As a healthcare provider and more importantly a human being I see this as a vital discussion to have . What better place than Facebook . The goal is to reach out and pass the word.
Many families have said after the endless battle to infuse life when there are more risks than benefits the decisions would have been different.
Unfortunately it’s experience that teaches us this. As health care providers we have this experience. We have an obligation to continue to provide truly informed consent on a humanistic level.
LikeLike
My grandmother passed on Thanksgiving day in 2007. She was 85. Over the previous year, she had been in and out of the hospital and rehab multiple times. It was actually in February that she nearly died and came to terms with the transition. I also had the blessing of those 10 months to say goodbye, to grieve, to prepare. We had plenty of time to discuss what efforts she wanted/didn’t want to prolong her life. She was very much at peace with dying.
When the nursing home called my mom and said that my grandmother was being transported to the ER (CHF, diabetes, renal failure), my mom went into crisis management mode. As the interventions became more and more invasive, I was able to step up and calmly remind my mom (and the ER) that my grandmother had a DNR and her advanced directives specified that she didn’t want extraordinary measures or medications to prevent the inevitable. It was time to make her as comfortable as possible and let the cycle happen. My mom took great comfort in my calm and informed counsel and we got my grandmother (who I believe was already gone at that point and her body just needed to finish shutting down) settled and on morphine. Her final breaths were taken about 6 hours later, with my mom and I at her side holding her hands. It was one of the most beautiful, spiritual moments of my life.
My grandmother said 3 things to me that day. To live my life for my happiness. To take care of my mother. And the last thing was, as they were giving her Lasix and other meds, “You know. It’s time. You know.”
It was at that point that I knew I wanted to help others with the preparation for end of life. I have been studying on and preparing for certification as a Death Midwife. I plan to keep this article and reference it and share it with others who need it. Thank you for saying what needs to be said and for doing so in a very approachable manner.
LikeLiked by 1 person
I am a 26 year old woman from Texas. Recently I became septic from an infection I got from a cut on my leg. My kidneys shut down, I was in respiratory failure and was bleeding awful from the doctors think was an ulcer. After 12 days in ICU, and another week in a regular room, I coded because of a doctors error. I am overweight and was malnourished when I reached the hospital. I only had a hemoglobin level of around 6. I coded for 28 minutes on Dec. 23, 2016, and I lived. With my mother being a nurse, I know a person living after coding for 28 minutes is unthinkable. I’m truly blessed and saved by a higher power. I don’t live in a big city so these are small time hospitals. No special equipment. Today I’m fully functional, better than before with quite a story to tell.
LikeLike
One of many “dark” jokes, when I worked as RN, was “Do you want to see my tattoo on my chest
It says DNR so they can’t miss it.
LikeLike
A very important and pertinent article. As a paramedic for 35 years and an EMT for 10 before that, I have seen the effects of the useless Code again and again. I have been thrown around in the back of the ambulance as I attempted to do CPR, give meds, and ventilate a patient while going 80 miles an hour to a hospital with a dead body that I was abusing all the way. Not to mention the bruises I suffered from hitting the wall every time we came to a stop or went around a corner.
My mother died of ovarian cancer, and we were lied to by the doctors at every turn. She was terminal when diagnosed: Ascites was present. Instead of being honest with us and her, her doctors did useless surgery on her. I remember the surgeon’s little “talk” to us when he came out of the OR. “Well, we got most of it. There was some that we couldn’t get, but we think the chemo will work with that. She’ll be back at work in a few weeks.” All this was a lie. The chemo did nothing but make her life miserable. She had metastatic carcinoma that had already invaded her liver, hence the ascites, and soon enough, her lungs. She underwent horrible chemo and radiation that literally burned her up, and she died 6 momths from the day she was diagnosed. Never, once, did her doctors level with us and her. Now, this all happened in the late 1970’s, so I hope some things have changed, but I fear not enough.
I hated doctors for a long time after that. I am very lucky, at 78 years, to have wonderful doctors who have great communications skills and spend time with me talking about my problems, but sadly, I have many friends who tell me that their doctors do not listen to them, do not talk to them, and they feel that they are simply an item in that day’s billings.
As a paramedic I have absolute understanding of my mortality and the realities of life as I age, but so many people do not. And, sadly, I think the medical profession as a whole does a very poor job of communicating the realities of dying to patients.
Couple this with the insane resistance by so-called evangelical Christians to allowing any sort of end-of-life discussions to be paid for by medical insurance, and we have the present situation where many people are not prepared to die.
LikeLiked by 2 people
Finally a Dr who talks to patients/families/individuals in a language they can understand! In the healthcare industry for 35 yrs, I have seen many individuals, healthcare and non healthcare, explain end of life care and “what happens during a code”, most (including Dr’s) miss the mark on providing a complete “delicate” explanation so that the families/patient’s understand what is exactly going to happen and could potentially be the outcome of the actions. Well written article, the world needs more Dr’s like you, REAL!
LikeLiked by 1 person
[…] Read More […]
LikeLike
Reblogged this on Safety un-Limited and commented:
Long, but well worth reading
LikeLike
[…] Read More […]
LikeLike
Reblogged this on rosebleue9 and commented:
Insightful article about possible end of life care and choices
LikeLike
Great article — thank you for taking the time to write this. Patients and families also need to understand that in many states, they may need a specific EMS Do-Not-Resucitate order for EMS providers to withhold resuscitation efforts.
LikeLike
So, should CPR still be taught in first aid classes?
LikeLike
Of course! There is a definite role for CPR. It is very dependent on the situation. I am just encouraging readers to take ownership of their health and make their own decisions about their wishes when they are able to.
LikeLike
Maybe you need to write an article clarifying your position, because this entire article sounds like you’re advising against CPR under nearly every circumstance!
LikeLike
Bkarp23, the article was meant to provide objective information so that patients can have a meaningful discussion with their doctors and families, not to give advice. Perhaps I should clarify that I consider 30% an acceptable success rate to initiate CPR for myself, personally. I think most people would agree with that. But it’s a personal decision, not one that someone else should make for you.
LikeLiked by 1 person
Maybe it would be good to make that clear in a post rather than a comment? If I read it as advice, I’m certain others did as well. Thank you for your response.
LikeLike
[…] Source: The Dirty Secret about CPR in the Hospital (That Doctors Desperately Want You to Know) […]
LikeLike
Great article. Honest and informative for those that are not in the medical field by trade. For those of us who are in the medical field or are first responders, this article is spot on. Carolyn clearly is not in the medical field/has not experienced what happens in a code. Aging will not change the minds of those of us who live this, experience this, have medical degrees, and work these codes on a daily, weekly, or monthly basis in our professions. We know that this article paints a small piece of the real picture of a code, not the codes people see on TV. This article was obviously to inform others of what they obviously know nothing of. To help others be able to better make decisions for loved ones or themselves. To understand that sometimes, and in many cases, CPR/resuscitation is not the best choice. Thank you, Dr. Scruggs
Kimberly, RN Charleston/MUSC
LikeLike