A patient, male, 68, 95% blockage in the LAD, history of myocardial infarct, arrested as I arrived at the ward, and was resuscitated at per my instructions. 12 hours later, the patient was awake, aware, and fully conscious. However, when the cardiologist informed me that the left side of the patient’s heart was akinetic, with no salvage possible, treatment was withdrawn, with the patient’s informed consent. Morphine was given ‘to assist breathing’, and when the patient’s breathing became laboured, more was administered.
My Father had already choked to death once 12 hours earlier, no need for him to be aware of it when it happened again.
The Family, the Patient, and the Medical team must give 100% until there’s zero hope, but then it’s equally important to know when to stop. In Dad’s case, it was an easy call for both he and I to make.
I miss him though, terribly.

I know, for myself, that I’ll have everything spelled out well in advance…and if I have to carry a copy of the directives around with me to make sure my wishes are heeded…so be it!

People defininely need education about what DNR vs. full code really means. I often thought the families who insisted on having everything possible done when the circumstances were like you described were carrying a lot of guilt about their relationships with the person who was dying. As long at they kept the person alive, they didn’t have to deal with the guilt fully.

The patients I get in ICU are not romantic. There are rarely scenes where patients have nice peaceful deaths in which they see the light and die with smiles on their faces.
My patients are usually very very old, 70’s to 90’s and have multiple medical problems.
When I have a 94 year old patient who lives in a nursing home come in with tissue-paper thin skin, mulitple skin tears, and NO circulation in the entire lower half of her body,
I sort of have to wonder what her quality of life is going to be with all these heroic measures.
So we put her on a respirator, withhold pain medication per the family’s request, put tubes in her neck, her nose, her mouth, her bladder, her rectum, her arms and watch her organs fail one by one despite everything we’re doing, yet we STILL have to go on because the family won’t let her go.
Is this really someone that you think should be shocked and have chest compressions? She wasn’t romantically seeing a life that I wasn’t seeing – she was in horrendous pain from lack of circulation and from all the tubes hanging out of her body.
THESE are the kinds of patients that should be allowed to die peacefully.
Despite our best efforts, she died, and thank God.
Because we kept her body alive, her lower half rotted and stank, her bottom was raw and excoriated from the frequent cleaning and wiping we had to do, the skin tears
on her arms constantly drained extra fluid that her kidneys could not get rid of, and she had numerous sores. Her family finally consented to small amounts of pain medicine.
THIS is the type of patient that I am heartbroken to have to “do everything” for.
I could have told you at the outset that she was not going to survive; her body, at 94 years old, was just trying to die. 94 years is long enough.

I hope I’ve been able to clarify my position.

Physicians can educate, but they don’t have the time. Instead of hiring office RN’s to educate about these issues (hopefully, before the stressful illness), they hire MA’s.

I don’t see the situation improving.