The Slow Code - page 3

by TheCommuter 26,152 Views | 148 Comments Senior Moderator

I have been a nurse for only seven years; however, certain events and situations will remain embedded in my memory for the rest of my life. One of these events took place during my first year of nursing practice when I was... Read More


  1. 0
    Quote from BellyDancer66
    You state in your post that some physicians and hospitals have offered several explanations for slow codes but you quote statements by anthropologists. What do anthropologist know about code blues and slow codes? Nothing.
    Did you even read the linked article? I highly doubt it. If so, you would have read that it was internal medicine doctors and residents who had provided the listed justifications for performing the slow codes.
  2. 0
    Twice now, I have seen patients die who had no AD and whose families would not support a DNR. In both cases the families were relieved once their loved one died. This may or may not support the idea of a slow-code.

    The whole issue of futile care and responsibility is huge...
  3. 2
    Well I hope you are my nurse when I am old and cannot make decisions for myself. As an RN, and former hospice nurse, I am so apalled by this, I can hardly speak!! This man had the right as a patient to have every effort initiated to save his life. We are not to play God with anyone elses life. I would hate to stand before the Lord and face judgement for actions such as your co-workers. Horrible situation.
    OnlybyHisgraceRN and tnbutterfly like this.
  4. 14
    Quote from RFarleyRN
    Well I hope you are my nurse when I am old and cannot make decisions for myself. As an RN, and former hospice nurse, I am so apalled by this, I can hardly speak!! This man had the right as a patient to have every effort initiated to save his life. We are not to play God with anyone elses life. I would hate to stand before the Lord and face judgement for actions such as your co-workers. Horrible situation.

    I've never found bringing gods into discussions that helpful, as so many claim to know what the gods want, even various ppl who all worship the exact same god, can say different things are what the gods want.

    but, if we are going to claim to know what gods want, it could be argued that the gods wanted the person to die?? If one feels that gods do control life, it'd seem, the gods could have prevented the person dying in the first place.
    Or, if the gods are all powerful, the gods could make the person live even from a slow code, right? if the gods did want that person to live longer.

    It might be, the gods could think that a person who did perform a slow code, was more closely following god's will, (who apparently wanted the person to die that night)
    than those who do codes? Hard to say exactly, what the gods might think about it...
    Perhaps the gods would be also relieved, that the patient won't be suffering anymore, if it was a terminally ill person in much pain?

    but, that is just a guess on my part, as i do not claim to know what the gods want.

    Also, imo, coding ppl who are terminally ill, or extremely elderly with multiple health issues, might be seen by some as interfering with god's will, hard to say. The gods did not magically "bing" technological info into our brains, we ourselves studied it, at length, to be able to do this.
    Who knows if the gods approve or disapprove of technology, since the gods never just "bing" the knowledge into us, we humans work to acquire the info that other humans have come up with,
    regarding bringing back dead people .

    but, no argument, that our job is to squeeze our eyes shut to the end result of coding even the terminally ill ppl.
    Last edit by somenurse on Dec 6, '12
    GrnTea, hijadecalifas, Ceci81, and 11 others like this.
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    Another finding that disturbs me is the occasional hospice patient who remains a full code because their adult children cannot agree on anything and no one will step forward to sign the out-of-hospital DNR form.
    annie.rn, Cricket183, canoehead, and 2 others like this.
  6. 4
    Years ago people were allowed to die at home. Nowadays 70-80% will die in a hospital attached to some type of machine . In bygone days,death used to be, a sacred passage and was honored as such.The family gathered around when "it was time " It was a chance to honor the person,feel the sadness of letting go and raise the dying person's spirit up soulfully. Yes, there are wonderful hospices but few pt get there. A friend pointed out to me recently that often pt die alone with the tv playing cartoons or rap music to mark their passing (unless of course some astute nurse is there waiting with electric paddles to electrocute them "back to life"

    I know I digress from the topic, it is an area closest to my heart so please permit me to say. It is wonderful how advanced medicine is but I believe we are slowly losing the plot where our actions now devalue rather than value life in particular when it comes to end of life care.
    Thankfully there is a movement growing called "gentle death ". It has nothing to do with euthanasia or ending care. It promotes quality,to allow people to gently leave life with the same care and love that we welcome a new baby,by celebrating the life before us. Regular folk with no medical background are attempting to re instate that respect for life and death by simply sitting with pts., listening, comforting,simply being there.
    It feel that it really is time that we re-balance the pendulum. How terribly ironic that we "save " a pt life so they can live for a few months feeling the fullest extent of what hell on earth is.Seems to me,we are lacking both mercy and judgement (no pun intended ) Florence Nightingale was honored by Queen Victoria with a medal saying "Thou art merciful " Have the risk of law suit or a ,skewed perception of life robbed us of that mercy that Florence taught.
    Last edit by echoRNC711 on Dec 6, '12
    Cricket183, catlvr, DroogieRN, and 1 other like this.
  7. 0
    Wow, I guess this is something that I didn't even consider when I was thinking of ethical issues that I could face. I really think that first of all, you want to follow the patients wishes, but I can see where there could be an exception. I was aware that Hospice has some unwritten rules about meds and such, but this is really something to think about.

    I remember having surgery several years ago, I put down there that I wanted to be kept alive by whatever means, but I was in my thirtees and had a young child. I obviously wouldn't want to be kept alive if I couldn't be saved, but was afraid of putting that down. I guess it's silly, but a lot of people think the same way, I am sure of it.

    Thanks for the post. It gives me a lot to think about.
  8. 7
    Quote from sharonp30
    Wow, I guess this is something that I didn't even consider when I was thinking of ethical issues that I could face. I really think that first of all, you want to follow the patients wishes, but I can see where there could be an exception. I was aware that Hospice has some unwritten rules about meds and such, but this is really something to think about.

    I remember having surgery several years ago, I put down there that I wanted to be kept alive by whatever means, but I was in my thirtees and had a young child. I obviously wouldn't want to be kept alive if I couldn't be saved, but was afraid of putting that down. I guess it's silly, but a lot of people think the same way, I am sure of it.

    Thanks for the post. It gives me a lot to think about.


    You are a great candidate to have a living will drawn up. (or, as it was referred to, during the Obamacare discussions, a "death panel") A living will can state ANYTHING *you* want done, for example--- do everything, no matter what!
    Or everything unless i am verifiabley brain dead for 3 days. Or whatever algorithm fits YOUR wishes. It is NOT a "death panel" as so many seem to think it is. It is only a statement of your exact wishes, in various scenarios, to relieve your family of trying to guess what you'd want done in this or that case.

    The Terry Schiavo case proved to us, that just telling our partner our wishes, isn't always good enough in some cases.

    I've got a living will, AND i've also assigned a medical power of attorney, also. Nope, it is not my sweetie, after watching how hard he struggled to decide it IS time to put down our beloved dog who could no longer even walk. Nope, i chose my very assertive pal, who is very much on my page, who very much understands *my* wishes, and i know, without a doubt, she will go to bat for me, should i ever end up on some vent with no brain left and my family falling apart at the bedside, she will step in with that "medical power of atty" paper and REALLY "save" me.
    Last edit by somenurse on Dec 6, '12
    liebling5, PMFB-RN, GrnTea, and 4 others like this.
  9. 0
    If there's no DNR then aren't we required to use any and all measures? Just because someone's older doesn't mean they don't get the same level of care and urgency as a child. They're somebody's parent, somebody's grandparent, somebody's spouse. It almost borders on criminal neglect.
  10. 8
    Quote from T-Bird78
    If there's no DNR then aren't we required to use any and all measures? Just because someone's older doesn't mean they don't get the same level of care and urgency as a child. They're somebody's parent, somebody's grandparent, somebody's spouse. It almost borders on criminal neglect.

    yes, you are technically and legally correct, without a written DNR, you are supposed to code even the terminally ill person, known to be suffering excruciating pain, is supposed to be brought back from the dead, you are legally right.

    I wll admit, sometimes, caring for such ppl AFTER the code, sometimes feels like we have done a criminal thing to brutalize them in this way, though, with their families slowly falling off the cliff, day by day, for weeks on end, and the person dying one inch at a time....it's brutal to watch.
    but, maybe you have to be there, to see what i mean about how cruel that choice can seem, in weeks to follow, after the "save".
    liebling5, Altra, wooh, and 5 others like this.


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