What is right?

Code 3 for cardiac arrest.

A 97-year-old woman has collapsed in the backyard. She’s in asystole. Her daughter is with her, standing quietly nearby as we start the resuscitation. She watches as the first several compressions are followed by the familiar disgusting cracking sounds coming from her sternum. She watches as we intubate her. She watches as we start an IV and push drugs.

She was a healthy and independent old woman, but at 97 it’s not difficult to imagine that she lived a full and happy life and that she was loved by her family. Do we stop? Do we transport? Should we even have started in the first place? Would she have preferred to just die, right there at her home, with her ribcage still intact?

Life is funny, as it always is. More than 10 minutes into the code, she goes into VT, still pulseless. And then after a couple of shocks, a narrow-complex not-too-fast tachycardia. Without a pulse. Or maybe there is a pulse. Shit, is it my finger’s pulse?

No, it’s getting more palpable. BP 100/62. Fixed and dilated.

We just prolonged her death.

Or, we gave her family a chance to say goodbye at the hospital.

2 thoughts on “What is right?”

  1. Been there; sad. Had a 98 yof, in a SNF, asystole that we got back….went into witnessed arrest by staff and family while in the process of signing her own DNR order.

    Rearrested in the ER about 10 min after arrival & doc was kind enough to pronounce her.

  2. I’ve worked in EMS since 1999 I started as a Junior Explorer my Junior year in High School. For as long as I can remember back before my EMS days began the protocols stood firmly that we would have to start resuscitation. Now Iowa code and our protocols state that if the patient has a DNR status ***As well as if the family or whomever happens to be there can furnish me that “Golden Ticket;”*** then all forms of life saving techniques are to stop and in your patients case (God Rest Her Soul,) she’s able to go home as you’re more then ever right she really led a very long and hopefully happy life!

    On the other hand or how I say it “Are you effin’ serious here!?!?” No documentation then I’ll have no further choice then to have to code the individual. There was a short, short time frame that i would actually take the patients spouses’ word for it and call my medical director for direction and get the blessing to run my confirmed asystole for 2 minutes and make sure i printed it and call coroner and we were done! Yet when i seen a previous medic I ran with years ago get sued for malpractice by taking someone’s word circa valid DNR.. Not worth it and getting fined as well as loosing his certifications indefinitely…. I changed my ways fast and educated my fellow colleagues.

    We all know what’s best so to speak sir. Sadly enough we’re also the ones that usually have to go against DNR wishes only because there was failure to provide required document… You did the right and legal thing on your call sir per training and laws and so on… In my opinion if we could make that determination…I would have let her go in peace as it seems you may have as well and forgive me as that’s clearly just my assumption there.

    Thank You & God Bless!!
    Stay safe out there 🙂

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