I finally took CPR training this year. I didn’t think about these issues in the hospital context, with dying patients. Thanks for sharing this article.
In my experience in ICU, addressing the DNR question was almost universally done. As the article states, perhaps not always well done.
But I observed that no matter how futile the situation, no words from any staff could sway a family member who refused to consider a DNR. In these cases, CPR and advanced cardiac life support protocols would ALWAYS be done.
I, too, remember how it feels to correctly do chest compressions and feel that sickening CRACK.
I also witnessed a “slow code” on a man who was given TPA (clot buster) in a rural hospital for what turned out to be a hemorrhagic (vs ischemic) stroke without the required CT scan prior. He subsequently suffered a massive brain herniation, resulting in total brain death.
NOTHING could convince his family of this. They insisted he would “wake up,” and demanded every possible futile, ridiculous intervention. They would scream at staff if his blood sugar wasn’t tested within one minute of ordered time (we always had 30 minutes before/after before a med is considered late), wanted the feeding tube, physical therapy, demanded music constantly to be played to give him “stimulation” regardless of how this could disrupt the other patients at 3 am, etc. etc. I understand completely grief and the horror that this situation provoked. At some point, someone has to face reality, but not one person in this huge family was willing or capable of doing so. When he finally coded, I observed the slow code. To an outsider, this probably sounds cruel or “playing God.” From what I’ve seen, it’s usually the last and final act of decency and humanity.
My daughter has occasionally related that emergency personnel will perform CPR (assuming the absence of other instructions, of course), for the benefit of the family, so that there was a chance for “everyone” to rush to the emergency room in the meantime and say their good-byes - or, so that the inevitable wasn’t “formally” taking place with the kids in the home.
This has long been an issue in hospice care. If I become terminally ill, I will have a DNR on record and tacked to my fridge incase someone panics and calls 911.
Both Ds are doctors and we have discussed CPR. I have a DNR and a DNI on file with my healthcare provider. Both my daughters know these are my wishes and support them.
The D who is an ER doctor says that CPR done outside of a ER has virtually zero chance of being successful and the success of CPR done inside a ER is highly dependent on the situation, but is usually futile and sometimes harmful. However, she recently successfully resuscitated a patient who was found cold and blue inside his car in the hospital parking lot. (Drug overdose) But she doesn’t know what kind of sequelae he suffered–i.e. whether he had any permanent brain damage.
She mostly runs codes in order to allow any family accompanying the patient to say goodbye before she calls time of death. (FWIW, D has said she would love to do a fellowship in palliative care because she is comfortable talking with families about end of life decisions and way, way too few doctors are honest with patients and their families about the nearness of death. Doctors become doctors to save lives so it make them uncomfortable/unwilling to talk about death as a positive outcome.)
My other D has performed CPR for a literal hour plus on a patient who was clinically dead upon arrival at the hospital. (No pulse, no blood pressure, massive blood loss) She too has a fairly negative opinion on the effectiveness of CPR.
My neighbor and friend had a cardiac arrest in a parking lot last year. Collapsed. Her daughter and her husband are medical professionals and administered CPR until EMS got there.
She survived and is still here kicking!
Though that kind of outcome from a cardiac arrest in the field is rare, it’s still why CPR education campaigns are done to this day, and why it’s so important to have AEDs in public places. I think one of our own CC members suffered an out of hospital full arrest and was successfully resuscitated. I love hearing about the successful outcomes!
I was recently reading a story about a person who was physically brought in to watch the team doing CPR on their mother and how traumatized they were seeing this.
As an ER/Trauma nurse for decades, I have seen the shift to where we are now encouraging family in during codes. People need to see what “do everything” for their loved one really means.
While I understand that watching a loved one die is life altering, the hope is that people begin to be more open to talking about death before they need to. We all die.
Here’s one more–years ago I got hit from behind in a line of traffic (school traffic so very slow). Police show up about 10 minutes later. At that moment someone yells from the nearby tennis court that someone’s had a heart attack. Policeman and the guy who hit me run and give CPR, revive the man and turned out okay from all reports. I always think about the timing on that day-- to have those people at that time to be there when needed. No ticket issued to the guy–guess saving a life was good enough that day.
I have a family member that had a cardiac arrest and received cpr from bystanders for over 20 minutes until the ambulance arrived. He’s completely healthy and happy, sporting an internal defibrillator now. CPR saves lives everyday.
CPR saved my dad too but he was 50 and having a heart attack. It’s not the same for a frail elderly person.
When my mother had heart failure she was rushed to the ER (with my father at her side). He told me when I got there, after she had already died, that they had worked so hard to save her. I honestly felt it was something of a comfort to him that they had done that (I assume with CPR, AED, etc.). She did not have a DNR (I was called by the ER nurse to confirm that - even though my father was present and told them - I think they wanted to double check). My father has an DNR and a DNI. I have been called every time he has been in the ER or hospital to confirm this.
I’m a respiratory therapist and spent many years being among the last faces seen by someone’s life. I got really tired of violently pumping somebody’s chest or bagging them while my coworker did it. The vast majority never recovered. I always hoped my patients could have the calm, pain free peaceful death most would prefer but unfortunately every shift I’ve ever worked in over 20 years has either been me responding to a code or now I take care of how people are “recovered” after the code in long term care or rehab…I work in peds.
My mom lived for about 5 years in a nursing home (skilled nursing facility), only going into hospice shortly before her death (she went downhill very quickly). The social worker at the nursing home was very good about bringing up the idea of a DNR at the time of her initial admission and being pretty graphic about describing what getting CPR would be like. My mom and I both readily agreed to it. Later my mom’s dementia got worse and she became somewhat paranoid and suspicious. One time the nurse came by with her meds and my mom saw her chart or laptop or something on the nurse’s medication cart. She saw language about the DNR and got worked up that they were going to do her in. We had to periodically revisit the idea with her but fortunately she never tried to revoke it.
A person I know and her H were out on a neighborhood walk a few years ago when he suddenly went down. A neighbor performed CPR and saved him.
I have another friend whose H’s life was saved a few years back when a lifeguard at a pool where he did laps performed CPR on him.
Very recently someone collapsed at one of the nearby lakes and a doctor who was there did CPR and saved him.
That’s who I can think of off hand right now. That said I will have a DNR if I become terminally ill and also after a certain age (not sure what age that will be).
This is a compassionate and compelling article. Thanks!
We have a poster here who - thanks to her son’s quick actions - is with us, doing well, and will see her younger son get married soon. 
ETA: I will definitely have a DNR after turning 75.
There are times, such as with my mom, when the very elderly and uneducated have a hard time grasping the difference between DNR and not treating. I arrived in Arizona a few years back during one of her health crises to find my 96 year old mom a full code. She thought DNR meant agreeing to withdrawal of treatment. When staff asked me why, we changed her back to the previously agreed upon DNR. My sister, who tends toward the fearful, accused me of not respecting my mom’s wishes. Eventually the hospitalist settled my sister, and all was well. But this sort of confusion can occur easily at times of stress.
I have also heard of folks who think that the organ donation designation on a driver’s license means that hospital staff will tend to not treat so as to procure your organs.
My son has always said that you’re not doing proper CPR if you don’t break some ribs. Below is a video about the LUCAS device that takes over CPR for first responders. It shows how hard and deep chest compressions need to be.
