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Week 23: The Fiction of the Fix
Oct. 2nd, 2014 11:02 amThe harsh tones of the emergency klaxon fill the quiet but busy ER and the Charge Nurse's screen lights up with INCOMING CALL. The ambulance gives the Charge Nurse the details of the patient they have coming in. The front half of the Nursing Station begins to move like a kicked ant hill. The technician starts to prepare the trauma room for the incoming patient. The nurses prepare the crash cart. A call is made and the overhead speakers announce "Code Blue in the Emergency Room. Code Blue in the Emergency Room". Within a few minutes the ambulance bay doors open and the Paramedics come rushing in with their gurney. One is perched on top, steadily providing CPR. The Pharmacy and Respiratory have arrived at Trauma Room 1. X-ray is waiting with their portable equipment. The patient is moved to the trauma bed. The Technician takes over CPR from the exhausted Paramedic. The Doctors begin to examine the patient as the Nurses start IV lines and Respiratory intubates the patient.
The patient is a 45 year old man who had a massive heart attack.
The patient is a 52 year old victim of a car accident.
The patient is a 4 year old girl suffering from the flu who suddenly stopped breathing.
Now let me explain why I don't want that patient to be me.
Television would provide us with a similar setting as I have described above. They would have some good looking actors bellowing directions to other good looking actors as dramatic music played in the background. There are a few marked differences between the above setting and what TV would have us believe is Prime Time Drama.
First off, they would perform CPR effortlessly. Not a hair out of place. In real life, the Technician's shirt is growing dark with sweat, as he battles to save the patient.
Secondly, the patient would survive.
Our 45 year old heart attack? Deceased.
Our 52 year old accident victim? Didn't make it.
Our 4 year old who stopped breathing? Never made it out of our ER. That was a very hard day.
I witnessed all of these deaths myself, from my position in the ER. As a Housekeeper, I cleaned up the Trauma Rooms they were in, after the Funeral home came and took them away. I started noticing that despite some really talented Nurses, and despite the dedicated Doctors....not many people who required care in Trauma 1 survived.
So I went looking.
Let me lay some numbers on ya. A 2012 study showed that only about 2% of adults who collapse on the street and receive CPR recover fully. Another from 2009 showed that anywhere from 4% to 16% of patients who received bystander CPR were eventually discharged from the hospital. A third review showed that about 18% of seniors who receive CPR at the hospital survive to be discharged.
The few who do survive after CPR are what physicians describe as the "healthy dead": i.e. "a boy who drowned moments before," "a man who collapses while running a marathon" or someone experiencing a mild heart attack.
More common are the "unhealthy dead": those with terminal illnesses, the chronically ill and patients who do not receive CPR within five to 10 minutes of cardiac arrest.
In these cases, CPR is unnecessarily burdensome, invasive and arguably cruel, with little to no chance of benefit. Many survivors suffer abdominal distention or broken rib cages; some have severe brain damage from being without oxygen for so long.
I'm not forgoing basic life saving techniques, should I fall ill suddenly, and still be in a reasonable state of health. And I realize that I have about as much chance of being in a traumatic accident as the next guy. No, I'm looking into the future. My "Golden Years". Do I want to roll the dice when I'm 80 and suffering from God only knows what ailments?
I have to admit to myself that when it comes to more invasive, less certain maneuvers.....I'm a lot more hesitant. What the studies don't always show are the number of patients, brought back by CPR, who go on to die in ICU later that day or the next. What they don't show are the recovery times of those patients who survive to be discharged. Those extreme life saving efforts are rarely a "fix".
Yes, life is precious. I'm not arguing that. But quality of life is as important to me as just "living". Do I want my final hours or days spent unconscious, with my family gathered around my hospital bed, waiting for a miracle that likely would never come? Or worse for me, do I want to wake up to find myself tied to machines that keep me alive, but provide very little "life"?
End of life decisions are difficult. My father recently suffered a heart attack and required 2 stents to be implanted. We, my Brother and I, have yet to discuss end of life decisions with him.....but I know that it's a needed thing. I asked my husband to read this over my shoulder, and as I watched his face as he read, I wondered when would be an appropriate time to have the discussion with him.
Life is a beautiful thing, but it ends. It's very end is part of what makes life so beautiful and precious. Death will eventually happen to us all, and should be viewed with a reverence and acceptance. Not a desperate push to extend the mortal body beyond it's capabilities, no matter the cost.
The patient is a 45 year old man who had a massive heart attack.
The patient is a 52 year old victim of a car accident.
The patient is a 4 year old girl suffering from the flu who suddenly stopped breathing.
Now let me explain why I don't want that patient to be me.
Television would provide us with a similar setting as I have described above. They would have some good looking actors bellowing directions to other good looking actors as dramatic music played in the background. There are a few marked differences between the above setting and what TV would have us believe is Prime Time Drama.
First off, they would perform CPR effortlessly. Not a hair out of place. In real life, the Technician's shirt is growing dark with sweat, as he battles to save the patient.
Secondly, the patient would survive.
Our 45 year old heart attack? Deceased.
Our 52 year old accident victim? Didn't make it.
Our 4 year old who stopped breathing? Never made it out of our ER. That was a very hard day.
I witnessed all of these deaths myself, from my position in the ER. As a Housekeeper, I cleaned up the Trauma Rooms they were in, after the Funeral home came and took them away. I started noticing that despite some really talented Nurses, and despite the dedicated Doctors....not many people who required care in Trauma 1 survived.
So I went looking.
Let me lay some numbers on ya. A 2012 study showed that only about 2% of adults who collapse on the street and receive CPR recover fully. Another from 2009 showed that anywhere from 4% to 16% of patients who received bystander CPR were eventually discharged from the hospital. A third review showed that about 18% of seniors who receive CPR at the hospital survive to be discharged.
The few who do survive after CPR are what physicians describe as the "healthy dead": i.e. "a boy who drowned moments before," "a man who collapses while running a marathon" or someone experiencing a mild heart attack.
More common are the "unhealthy dead": those with terminal illnesses, the chronically ill and patients who do not receive CPR within five to 10 minutes of cardiac arrest.
In these cases, CPR is unnecessarily burdensome, invasive and arguably cruel, with little to no chance of benefit. Many survivors suffer abdominal distention or broken rib cages; some have severe brain damage from being without oxygen for so long.
I'm not forgoing basic life saving techniques, should I fall ill suddenly, and still be in a reasonable state of health. And I realize that I have about as much chance of being in a traumatic accident as the next guy. No, I'm looking into the future. My "Golden Years". Do I want to roll the dice when I'm 80 and suffering from God only knows what ailments?
I have to admit to myself that when it comes to more invasive, less certain maneuvers.....I'm a lot more hesitant. What the studies don't always show are the number of patients, brought back by CPR, who go on to die in ICU later that day or the next. What they don't show are the recovery times of those patients who survive to be discharged. Those extreme life saving efforts are rarely a "fix".
Yes, life is precious. I'm not arguing that. But quality of life is as important to me as just "living". Do I want my final hours or days spent unconscious, with my family gathered around my hospital bed, waiting for a miracle that likely would never come? Or worse for me, do I want to wake up to find myself tied to machines that keep me alive, but provide very little "life"?
End of life decisions are difficult. My father recently suffered a heart attack and required 2 stents to be implanted. We, my Brother and I, have yet to discuss end of life decisions with him.....but I know that it's a needed thing. I asked my husband to read this over my shoulder, and as I watched his face as he read, I wondered when would be an appropriate time to have the discussion with him.
Life is a beautiful thing, but it ends. It's very end is part of what makes life so beautiful and precious. Death will eventually happen to us all, and should be viewed with a reverence and acceptance. Not a desperate push to extend the mortal body beyond it's capabilities, no matter the cost.