On end-of-life care.

Sunday, May 20, 2018

This veers far from topics I normally choose to write about. I'm writing it because it's something I encounter so often at work and yet few people outside the hospital discuss it. I'm writing because there seems to be a wealth of misinformation. I'm writing because I think it's something we should all think about, especially those caring for aging family members. I'm closing comments on this one, but if you have questions/comments, please feel free to email me.

I see it nearly every time I go to work as a nurse.

A little old lady is admitted to the hospital. She suffers from congestive heart failure, needs diuretics, and is weak and fragile. She may weigh 100 lbs. but at least 10 of that is extra fluid. She's 89 years old, has lived a long and full life, and is now spending her final days in a skilled nursing facility. She knows her name, but can't tell me she's at the hospital or what year it is.

And there, in capital letters at the top of her chart: FULL CODE.

Often, her family has made it known that if this little lady's heart stops at any point, they want her to be revived. Whatever it takes, someone must save her.

And so as her medical team, we do. Or at least we try.

Time after time, I've been involved in code situations where a patient just like this one has stopped breathing or her heart has stopped beating. Because of her code status, she is not allowed to go peacefully. Instead, a "code blue" is called. Code team nurses from all around the hospital race to the bedside, joining nurses on the floor who are already doing CPR. There are probably cracked ribs under the pressure of chest compressions. There is often vomiting. There are sometimes holes drilled into bones to get epinephrine in as quickly as possible. There can be blood in the mouth from a tube forced down the patient's throat. It is not a pretty or peaceful way to die. In fact, it's quite the opposite. And in most cases, the patient still dies. And if they don't, would they want this traumatic intervention to return to a poor quality of life?

A few months ago, I had the privilege of caring for a younger man who was terminally ill and whose death was imminent. His code status? DNR/DNI (Do Not Resuscitate/Do Not Intubate). His breathing had become quick and shallow, his blood pressure had dropped, and the signs were there: the end was very near. He had been estranged from his family, so no one was around for his final moments. Near the end of my shift, just before midnight, I stepped into the room, sat down by his bedside, and held his hand. Softly, I sang the words to Amazing Grace. At the end of the song, he stopped breathing.

As a culture, we fear death. We do everything in our power to stave it off. We simply do not accept it. Even just writing this blog post is uncomfortable for me, but if it helps just one person understand this situation for yourself or your ill family member, it's worth it to me. Or if you're interested in learning more about end-of-life care, I've had this book recommended to me by several trustworthy physicians. Have a conversation with your loved ones: your parents, grandparents, spouse. What are their wishes? Have the conversation before you're having to make the decision on your own. Then honor them in death as you honor them in life.
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