A couple weeks ago a nurse made international headlines when she refused to perform CPR on an elderly, dying woman in Bakersfield, California. The tape of the frantic 911 dispatcher was played over and over again. Newscasters spoke of the need to expand “good Samaritan” laws. The country was outraged.
Somewhat surprisingly, the woman’s family declined to sue, saying she had wanted no extreme measures to prolong her life.
Extreme measures? It’s just CPR, right?
Maybe not. In some cases, denying CPR may be the most humane option.
The following is a quote from the horrendously enlightening article, How Doctors Die by Dr. Ken Murray. I read it a year ago but it was so profound, it stayed with me. I’ll never forget this:
Some doctors are so afraid of having their Do Not Resuscitate orders ignored that they have NO CODE tattooed on their chests.
What could cause doctors to fear life-saving measures? Here’s an excerpt of one doctor describing resuscitation measures:
The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the intensive care unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist.
Did you know CPR often breaks ribs? I didn’t either. Here’s more:
Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming.
This article in Forbes laments the fact that there was no “Do Not Resuscitate” order on file at the home, and I agree. However, even if you have such an order on file with the facility, over-zealous or lawsuit-shy staff may completely disregard them. “Jack,” who had such orders on file only to have them ignored, was lucky enough to be removed from life support by the doctor who wrote this article. The doctor said:
Although he had thoroughly documented his wishes, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my actions (i.e. complying with Jack’s DNR orders) as a possible homicide.
It’s difficult to imaging leaving a patient to die without taking measures to revive her. However, I read the Murray article before the Bakersfield incident occurred, and thus my first thought was that the nurse was a hero, courageous enough to honor the patient’s wishes. It’s apparent that the family felt the same way.
But I still kind of feel like getting a tattoo.
Reblogged this on Dying with Dignity: Education and Legislation and commented:
People want change! People want choice! Stay informed and keep others informed!
Hi there – I’ve started a blog for my Aging Policy class discussing the Death with Dignity Acts across the nation and how we’re in need of national laws for those who make the choice to end their pain. Is it OK if I reblog your post (I just wanted to ask before I did)?
Only if you promise to visit now and then. Seriously, I’m honored. Reblog away.
Thanks so much!
The “system” should never intervene with the right to die a with dignity. Thank you on behalf of humanity for writing this post!
If it saves just one person…
Lynne, I am so glad you brought this up. Throughout all the media hype about the nurse refusing CPR, due to my health care background, I was initially appalled at her refusal. We are programmed to save lives, especially if there are no clear directions to do otherwise. But underlying my initial reaction was the nagging sensation that at her age,she should go in peace. This is why having a living will is so important. Making your wishes known ahead of time saves a lot of confusion and unnecessary heroics- which for an elderly person can mean further complications,i.e. fractured ribs, perforated liver, lungs or spleen,etc. The fact that the family did not sue further supports the notion that the nurse was right.
Exactly, Kathy. It really bothered me to see the people on the news shows declaring the nurse was immoral and incompetent. Maybe she was a hero.
When my grandmother was dying, my Dad called her doctor and asked if she should be brought to the hospital. The doctor said why? It’s her time to go, let her do it at home. And she did, sleeping peacefully until the end. I don’t know what my Dad was thinking – he must not have asked my aunt her opinion either. I don’t think she would have let him do it.
Grandma was in her late 80’s and had a very limited life for a long time due to a series of strokes that took everything way from her. I hated losing her, but I was glad she was finally free.
Nancy
Nancy, that’s how most of us want to go. Nice that her doctor didn’t care about racking up wads of cash for himself at the expense of your poor granny, may she rest in peace.
Hmmm- I’ve always wanted a tattoo…
Uh huh. So now it’ll be you, me, and Sorta. I’m thinking a red, white and blue arrangement.
Great post, beautifully done, especially your choice of quotes. I’ve forwarded this post to my sister, who is a hospice nurse.
See you at the tatoo parlor!
Ain’t that the truth, Sorta. Do you think it will hurt?
… ummm … already have such a tattoo (No Code Blue).
Have had it for ~ 25 years. It’s an effort to “bubba-proof” my end.
An old (now) ICU nurse.
Really! Wow, Jon, you’re so ahead of your time! Where is it? On your chest? Arm? Very smart.
Lynne, your post is the first truly rational account I’ve read of this tragic situation, so I thank you. Vonnie brings up a good point, too — why does the media insist on interjecting itself in what should be a private, family matter?
My late dad had COPD and was terrified of not being able to breathe. Early on the morning he was to die, he had “an episode,” we called 9-1-1, they inserted a breathing tube, and they took him to the hospital. Little did we know that removing the tube wasn’t an option because it would cause him to die. He spent his last hours of life attached to machines, unable to speak with his family, unable to communicate. I know he wouldn’t have wanted that. Yes, the tube prolonged his existence, but at what cost??
Oh gosh I’m so sorry Debbie. I remember when you and I first met, we have so much in common it was uncanny. Well here’s another thing: the way that our fathers died. You just have to try to forget that part and remember all the good stuff right? I wish I could say more but I am sitting in the San Diego Airport and my battery is dying. To you and to all of my friends to have made such heartfelt comments this morning, I will get back with you around mid day. Until then.
I’m thinking if a tattoo, too. Thanks for posting this. A good reminder to seek out both sides if an issue.
Yeah, Susan, it pained me to see the rush to judgment. Also proved most of us aren’t really prepared for what could happen.
Wow, it’s so good of you to share this! My mother has no-resusitate instructions, and I never dreamed some health care giver might ignore them. Hopefully I’ll be around when the time comes to demand that they follow her wishes because I doubt my 94 year old mom would go for the tattoo.
Ha ha, Kathryn, no, you’re wrong. Your mom would probably LOVE a tattoo. But it would be an all-time winning word on Scrabble, not DNR.
I’m sure most people who’ve had to deal with a parent in a nursing home understood why the poor nurse couldn’t perform CPR on the resident. When you admit a loved one to the facility, the staff explains to the family the services they will and will not perform, when an ambulance will be called and when the family will be called to make a decision. When my dad was suffering congestive heart failure at 84 and otherwise merely exsisting at the home, the head nurse called my sister and me and asked whether we wanted him taken to the hospital or to receive comfort care at the home. She also made clear of the outcome of either choice. We appreciated that.
I also understand why the dispatcher would be upset, but should have abided by the nurse’s wishes. For this to be considered national news justifies my opinion that the networks will do anything to stir up twitter traffic. In the meantime, the poor family and the humilated nurse are left to question themselves. The last thing you need in that situation is to have the media involved in these private matters.
Great post Lynne. 🙂
All true, Vonnie, except in this case I probably am part of the media in a sense. But it was interesting that the woman chose that home due to its LACK of high-level medical services. She wanted a place to die naturally. BTW thanks for sharing your dad’s story. Best wishes.
Mom had a DNR on her refrigerator for years and although I didn’t realize how damaging CPR could be, I know she didn’t want heroic measures to keep her alive. As it was, it was her own heroic self that kept her alive until she died at nearly 102. No CPR for that gal. As for me, this got me thinking about having a DNR for myself…or a tattoo!
Martha, you should definitely have something somewhere. In California, you can register your wishes on a form filed with the Secretary of State. Don’t know where you live but keep it somewhere http://www.sos.ca.gov/ahcdr/
This is such an important subject, and such a difficult one to approach for many people. Thanks for your thoughtful comments, and the links.
It’s difficult to think things can go so wrong even if you plan ahead and have all the right conversations, Sheila. But apparently we have to fight even that.
I agree with you. My mother was a geriatric nurse, so, for 6 months, I actually lived at an apartment at a nursing home and later, I worked in a kitchen at a Ohio facility that housed seniors that was part of the old “poor house” system. The people who are SO outraged are probably the family members who promised to bring them home for Thanksgiving and never showed. I remember hugging an elderly retarded woman and telling her that I loved her and that her family must have had a problem — because the never could have forgotten her…
Heartbreaking story, Sharon. Thank you for loving her, and for sharing your positive energy in that setting.