I am a new nurse working on the Oncology floor. The stages of cancer we treat vary from newly diagnosed to metastatic. Some of my patients have good prognoses while others have only weeks or possibly days to live. Recently I experienced my first Code Blue. The patient, in his mid-eighties, had been in an altered state for 2 weeks or so: disoriented, incoherent, and inclined to curse at nurses over and over. Although he was not my patient, hearing his unmistakable behavior from the teaming station and hallway, I sensed a detachment from reality. One day, while charting, we suddenly heard a soft and anxious voice of a family member coming from the patient's room, pleading for help. The experienced nurses around me jumped to their feet and into action while I followed, my heart beginning to race. A few minutes later several professionals had crowded into the room. I tired to participate and be helpful but seeing the patient's open and lifeless eyes, feared he was unlikely to make it. Indeed, after an honest attempt the code was called and time of death noted.
Several feelings and thoughts have gone through me since witnessing and my first Code Blue, however there is one thought I am grappling with and want to share with you:
This patient had lived a long life, and being terminally ill was going to die soon. Yet he was not DNR. Because of this, the natural last breaths of his life and still moments afterward were replaced with a violent (for lack of a better word) physical act. His wife trembled as my clinical manager led her away from the scene. I thought about when my parents will die and know neither they nor I will want this if, one day, found in a similar situation. I thought about how important it can be to chose DNR. I realize however it is not for everyone and each situation is personal, individual and even complicated.
For you nurses who have witnessed many codes, how often have you seen a similar circumstance as the one I've described? More importantly, is DNR discussed and rediscussed with patients as they progress in their illnesses and into older age? Are issues such as likeliness of being revived, invasiveness of the code itself, and its effect on family members (witnessing the code or being whisked away from their loved one) discussed openly and honestly with the patient and family, so that they may make an informed decision? Anyone's feelings and opinions on this sensitive topic is welcome and appreciated. I am also curious about the thoughts of more experienced nurses.