Wednesday, March 6, 2013

Senior dies after nurse refuses to give CPR

This story is causing quite a kerfuffle in the US.
"In the seven-minute clip, a 911 dispatcher can be heard pleading with the nurse to save the life of an elderly woman by giving her CPR, but the nurse said it was against the facility's policy.
"Is there anybody there that's willing to help this lady and not let her die?" the dispatcher asked."
BAKERSFIELD, Calif. — A nurse's refusal to give CPR to a dying 87-year-old woman at a California independent living home despite desperate pleas from a 911 dispatcher has prompted outrage and spawned a criminal investigation. 

If you have ever heard about a cardiopulmonary resuscitation (CPR) event on a 80-something frail woman, you will know how awful it is. If you understand what no DNR order means, you would know what this means when a senior goes into a complex with a clear policy of DNR orders it means: RESPECT for this senior. This is the difference between a retirement home and a long-term care.

Why a Nurse Refused to Give a Dying Woman CPR

But, even if CPR had been performed on the older woman, her chances of surviving the ordeal were likely very slim. "CPR is unlikely to restore the patient to her pre-arrest condition and unlikely to be successful at all," notes Kathleen Powderly, C.N.M., Ph.D., director of the John Conley Division of Medical Ethics and Humanities at SUNY Downstate Medical Center.
Only about 5 percent of people who undergo CPR for a cardiac arrest outside of the hospital survive. Those are not very promising odds, and they get even smaller if the person is older and frail.
It is worse to die in an ER, read these true explanations: How Mr. Jones Died, or Dead Alive Dead [Updated]
My bog buddy, an ER nurse writes in: Full Code
Full code means, if a patient has a cardiac or respiratory arrest, we are ethically and legally obliged to perform life-saving measures. We go full tilt. Rib cracking compressions, intubation, defibrillation, various push medications and infusions to prolong life, in this case, for a few hours or days.
She recognized no one and spoke not at all. She had decubitus ulcers over each hip, deep and foul, eating into the underlying tissue; she could not lay on her back: the contractures from her strokes had pushed her frail legs up to her chest. ... She was incontinent of stool and urine, and when the ambulance off-loaded her onto the emergency stretcher, her adult brief was heavy and soaked.
In short: she was demented, stroked, hopelessly contracted, ulcerated (and along with any number of nontrivial comorbidities, like coronary artery disease and diabetes) — a patient with objectively no quality of life from a nursing home notorious for providing poor patient care. 

This is the reason to have Advance Care Directives. If you don't want to die in an ER, if you want dignity, Advance Care Planning in Canada (a guide) gives strict orders about your care. This doesn't mean you are not comfortable. It means you die in a bed you are familiar with, with caring professionals around you.

This woman lived in a retirement home. Their policy is NOT to give CPR. It means no extreme measures. It means comfort measures. It means treating a body with dignity. Many of my clients die in peace and quiet, in a comfortable place. All die without pain, with appropriate pain measures. I have sat with clients at end-of-life. I have sat with clients in a coma. One with a CAD to pump merciful morphine into her system. She was at rest.

A sound mind in a sound body, is a short but full description of a happy state in this world. 
          -John Locke, philosopher (1632-1704) 

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