I am living in a world I will never understand...

[MikeAurelius]

Well said. If you spend time with many (not all!) elderly folks you'll here their greatest fear is coming out of a situation like this attached to a respirator and unable to enjoy any quality of life.

There's a new show on TNT called "Monday Mornings". It's about the M&M meetings at a major teaching hospital and something like what you wrote was the topic of one of those meetings. Patient had a DNR and needed surgery, and was brain dead on the table. Doctor did not ask about a DNR and left the patient attached to the apparatus, leaving the widow to make the decision.

(M&M if you don't know is "Morbidity and Mortality" aka the "how come the patient died" meeting)

[Uncle Fester]

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CPR more often prolongs seniors' suffering than saves lives

In Bakersfield, California, a nurse is under scrutiny for refusing to perform CPR on an elderly woman. But life is not 'Rescue 911'

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  • Paul C McLean
    
  • guardian.co.uk, Tuesday 5 March 2013 14.13 EST
  • Jump to comments (3)

TV medical dramas have radically raised expectations of the success of CPR. In reality, it only works, at best, in 30% of cases; and for the elderly, the rate of success is as low as 5%. Photograph: Getty

I seem to have misplaced my outrage.
In Bakersfield, California, an 87-year-old woman collapsed in a senior residence and was allowed to die by a nurse who was following company policy against staff performing cardiopulmonary resuscitation. In a recording of her seven-minute conversation with the 911 dispatcher, the nurse's affect was, to my ear, one of indifference.
Unedited 911 recording showing a nurse's refusal to perform CPR, via BakersfieldNow.com Not so the exasperated dispatcher who perceived, by phone, that a life-saving opportunity was passing and pleaded with the nurse to resuscitate the woman, or to get someone else to do it. But resuscitation was delayed until the ambulance arrived, and a short time later, at the hospital, the woman was declared dead.
Still, my outrage is missing.
Oh, here it is. I found it in the story that wasn't covered – but which played out countless times on countless senior citizens that same day.
In this story, CPR was dutifully performed, without regard for whether it might do more harm than good, followed by urgent races to the ER where holes were cut in throats to accommodate tubes, arteries were probed and accessed to provide antibiotics, fluids and perhaps opiates, and ventilators were cranked up to deliver to elderly humans what they no longer were capable of accessing on their own: the breath of life.
Except for a lucky few – roughly, one in five – these patients will not resume life as before. They will not eat for themselves, drink for themselves, clean themselves, or possibly ever feel another thing except maybe when their dressing is changed or feeding tube suctioned, when they'll grimace or moan. Maybe the heart will stop and CPR will be performed again. This will go on for days, weeks, maybe months.
Just another heroic episode of CPR at the end of life.
We want to die at home but increasingly, we die in hospitals. We want good deaths. We tell pollsters this all the time. But we seem to want only the good part, not the death part. We fear death. We fear everything about it – pain, grief, lawsuits, God's judgment. Our fear is systemic, undermining everything from dialogue between doctor and patient to a family's determination of what is best for a loved one existing in a terminal and interminable state in intensive care.
I'm not sure what the Bakersfield nurse was thinking, though it must be a strange thing to be a nurse working for a company that restricts how you assist residents. And I'm not sure what truly was in the best interest of Lorraine Bayless, may she rest in peace. The news reports give no indication of the woman's medical state, whether she had completed an advance directive, or if she had stated her wishes for care in such a scenario.
I want to assume that the nurse knew Bayless, and had a sense of those wishes. And yet, the call for an ambulance would indicate that a life-saving intervention was not against Bayless' wishes.
But isn't something wrong with the assumption that performing CPR and rushing a dying elder to the ER is always the good and compassionate act?
In the Journal of the American Medical Association in March 2012, physicians Craig Blinderman of Columbia University Medical Center and Eric Krakauer of Massachusetts General Hospital, with social scientist/bioethicist Mildred Solomon of the Hastings Center, suggested that CPR should no longer be the default option for dying patients:

"Whenever there is a reasonable chance that the benefits of CPR might outweigh its harms, CPR should be the default option. However, in imminently dying patients, a default status of full resuscitation is not justifiable. Not only is CPR in this situation likely to harm patients without compensatory benefit, the default framework likely influences patients and surrogates to request that full resuscitation is attempted even when the physician believes doing so may be inappropriate."

Investigation may find that CPR would have been appropriate for Lorraine Bayless, and that the nurse was as unfeeling as her recorded voice and the corporation (not to say, the person) that employed her. And yet, with CPR on an 87-year-old, if you don't crack a rib, you're not really trying. A nurse knows this.
A colleague of mine in Community Voices in Medical Ethics recently told an EMT, as she was being loaded into an ambulance, that she did not want to be resuscitated should her heart stop. But the emergency medical technician, for personal or professional reasons, said he could not honor the request.
My friend's heart never stopped, and we had a laugh when she told me the story. Badly injured in a head-on collision, her recovery is ongoing. But she's healthy enough to find humor in having avoided unwanted resuscitation.
EMTs did not abide my mom's DNR, and attempted heroic measures. But Mom was already gone. I'd like to think she didn't feel a thing and was enjoying the afterlife she so faithfully believed in.
I know this much: the Bakersfield dispatcher demanding CPR was not there. The nurse was alone with her judgment, her employer's fear-based policy, and a dying woman.
It's worth noting that, according to a television reporter, Bayless' daughter "was satisfied with the care her mother received". And that Bayless' daughter is a nurse.

[becc971]

http://news.msn.com/us/family-woman-...o-intervention

[ShaneR]

As a nurse, I wonder about the legalities of not doing CPR. In most (maybe all) states licensed and registered nurses are required by law to do everything possible to sustain life in all situations. The only way this would be legal (not right, just legal) is if there is a definite DNR order that is known by all concerned. The right and proper thing for anyone to do is to try to save her.

I am strongly agree with you. I keep on hearing about this news, recently. Everyone has his own point of view regarding the issue. For me, if you have the knowledge to save life, try to save it. By the way, let me share what I've read just a while ago. It says that the family members who did not witness CPR, 12% expressed regret, while only 3% of those who did watch wished they hadn’t.

[wmcdonald]

The problem is that we live in a world where we even THINK about the law first when it comes to a situation like this. The reality is that people care more about animals than humans.

I blame the first jackhole who sued McDonald's when they spilled their own hot coffee on their own lap.

Often my students have the same feeling related to the lady who suffered the burn injury at McDonalds. But I have a short video of the incident who shows her burn injury. You may be surprised to know that the sole reason she sued the place was the rude behavior of the manager. In her initial lawsuit, she only sought compensation for medical care. Her legal team, however, went after the big bucks. And they won. I felt just lie you prior to watching this film. The moral of the story.........we should know all the facts prior to forming an opinion. I know mine changed after reviewing this film. I think it is on Youtube now, but really have no way of posting it here. Wes also did his usual excellent job in describing this issue in depth.

[sharpstick777]

The family reported there was a DNR.

Personally I think this was a cold and heartless decision. I would not let 'policy' prevent me from saving a life and I cannot understand why anyone else would.

[Steve Machol]

The family reported there was a DNR.

Nothing in the opriginal story and reports said anything like that, nor did the nurse even mention this to the 911 Operator. That is the only acceptable reason for not doing CPR.

[Wes]

Nothing in the opriginal story and reports said anything like that, nor did the nurse even mention this to the 911 Operator. That is the only acceptable reason for not doing CPR.

This isn't the first time the news has omitted exculpatory evidence from a story to promote and sensationalize it. This is just one of their forms of bias. Then there's the non-reporting of certain crimes, and the doctoring of information to make things seem something they're not.

[Wes]

Often my students have the same feeling related to the lady who suffered the burn injury at McDonalds. But I have a short video of the incident who shows her burn injury. You may be surprised to know that the sole reason she sued the place was the rude behavior of the manager. In her initial lawsuit, she only sought compensation for medical care. Her legal team, however, went after the big bucks. And they won. I felt just lie you prior to watching this film. The moral of the story.........we should know all the facts prior to forming an opinion. I know mine changed after reviewing this film. I think it is on Youtube now, but really have no way of posting it here. Wes also did his usual excellent job in describing this issue in depth.

While I knew generally of the incident when it happened, and of it well from having the plaintiff's position in business law, I can't take any credit for the description. It's a wiki cut-n-paste.

[MakeOptics]

Lots of facilities in my area are DNR facilities, EVERYBODY living in these facilities has a DNR and understands that even choking on food can be your downfall in one of these facilities.

[MakeOptics]

Nothing in the opriginal story and reports said anything like that, nor did the nurse even mention this to the 911 Operator. That is the only acceptable reason for not doing CPR.

5 minutes after the story first aired the family member who was a nurse confirmed that the nurse in the facility did the right thing. It was a more sensational story with that little fact left out.