The Slow Code - page 4
by TheCommuter, ASN, RN Senior Moderator | 27,296 Views | 148 Comments
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
- 1Dec 6, '12 by TheCommuter, ASN, RN Senior ModeratorI also have strong feelings about our death-defying, death-denying society. Death is a very natural end to what we call the circle of life.
Quote from echoRNC711Years 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.
- 1Dec 6, '12 by neurorn6Slow codes used to be come place in hospitals. Physicians would write or verbals tell us to do a slow code. Usually due to the patient's condition and the family's inability to come to terms with the finality of the patient. Then about 15 years ago, in the Northeast, JACHO announced that every patient had to be either a full code or DNR. No half way measures. It helped. Our social workers were availabe 24/7 and able to speak with patient and/or family members. Slow codes happen, but often if we are proactive, we can educate patients and family members get the advance directive completed before any thing happens.
- 0Dec 6, '12 by SwansonRNUnethical, but I know they happen all the time. Personally I hate having frail, cachectic full code patients in their late 90s. When they start going down hill I always think 'please don't make me have to start compressions!' But it's not my place to decide who should gets 100% during a code and who gets 25%. Full code's a full code.
- 11Dec 6, '12 by AnoetosFor the record, the "death panels" we heard about are those ethics boards and teams specially charged with determining whether the care of certain patients has become futile.
The idea of a "death panel" comes from their empowerment to, effectively, make the patient DNR without the agreement of the family in extreme cases. This is already happening and, in my opinion, needs to increase. I cannot tell you how many patients I have watched languish in effective brain death and persistent vegetative states because their families cannot let them go.
- 2Dec 6, '12 by NursieNurseLPNWhen i was 12 years old my father had his third heart attack. He was told he had less than six months to live. He went on to have three open heart surgeries and a defibrillator put in. By the time i turned 21, we were astonished and so grateful that he kept "pulling through" and that he was able to be a part of our lives. By the time i was 21, he had multiple diagnoses- chf, copd, dm, kidney disease, was on dialysis, etc. He went into cardiac arrest at home one night, we performed cpr, emt came, admitted him to the hospital. It took 3months to get him home again. But he came home, and lived for another two years. He lived for 14 years longer than anyone thought he could. While i understand that he was younger (60s), and its not the same as the 90+ year old on life support, these 14 years gave him the time to come to terms with his life, accept his death, and ENJOY every single moment we had together. When he finally passed, we were at peace because we had accepted it years earlier, and were grateful for every single extra second we had with him. So many things happened in those 14years! Ill forever be thankful to those who worked so hard to resuscitate him each and every time he coded, regardless of the fact that he was somewhat of a "lost cause". Anyone on the outside looking in might have thought that his life was over, it would be useless to put him through it all again (he was ventilated two different times). But i know its what he wanted. He was scared, and not ready. He was given time to come to peace with his death, and i am so grateful for that. If we had just decided to let him go after the doctors told us he had 6months, we would have lost so much.
I just hope before some nurses make such a big decision, they are 200% sure thats what that patient wants. And to the person that said a physician can decide/not decide when its past the point of no return, WE are NOT physicians! It truly is not out job. Even while i can see that at certain times it may be more ethical to not resuscitate, where does it stop? Who are we to decide such fate. Who's to say that the new nurse watching you will not have the same decision making process & maybe they decide to "slow code" someone who wouldnt want that. We are responsible to educate our patients/families and continue to educate them as needed. If they make the decision to full code someone who truly should be a dnr, we have either failed to educate them or we just have to accept it. I would hate for a nurse who ive known for two weeks to decide my fate over my decision or my families decison.
All this said, i do understand situations where the patient is already far gone or is just not coming back, but that doesnt mean we dont try for every patient we "think" wont want it. Im sorry if i went on too much, and i am sure that more nursing experience will enlighten me to different views, but i pray that i never forget that it is NOT my decision. Alot of you say you wouldnt want to be brought back if you were that far gone. But be careful because you never know what nurse you'll have on that day that may decide you're too far gone. It may not match up to your meaning of it. I strongly believe in advocating for ourselves, and having a living will spelling out our exact wishes. And i strongly believe all healthcare personel should follow those to a tee.
- 5Dec 6, '12 by somenurseTo NurseyNurse, i am not sure that most ppl would view someone whose had 3 heart attacks as "terminally ill", etc.
A patient in his 40s, 50s, or 60s, who is saying (whether the person is quoting their doctor correctly, or incorrectly---as sometimes happens...)
that they've been told they have 6 months to live, is not quite the same as someone actively dying or definitly, unquestionably, terminally, fatally ill and suffering. I'd think every nurse i know would have rushed to save your poppa, indeed. all out efforts, prolonging that code til our arms ached.
If it comforts you any, never ever, in 3 decades, have i EVER ever witnessed a slow code on anyone who wasn't already in the process of actively dying, or very terminally ill, or suffering extremely in fatal end-stage disease processes. Might have happened, but, i've never ever seen it.
I've participated in some awesome saves, indeed. Sometimes, we do get back the person who just arrested, oh yes we do!! sometimes, the whole person comes back!! I might have helped bring your own dad back, who knows. I am quite passionate about many many codes, and very devastated when the codes don't work on very viable people.
It just breaks my heart to code the terminally ill, the extremely elderly with a lotta suffering going on, being robbed of their chance to have a peaceful death. The aftermath there, can be horrific to watch. i hate it when my heart dislikes what my own hands are doing.
I so so share your idea that more ppl (even you young ones out there!!) should have legal living wills. Takes 10 minutes, is not expensive to do, and can be more of a comfort to those you leave behind to decide,
than you'll ever know.
Last edit by somenurse on Dec 6, '12
- 1Dec 6, '12 by 07302003I have seen doctors involve the ethics committee to make patient's a DNR when they are terminal and there is nothing more to be done but prolong suffering and the family insists on a full code. (This is rare) Then the doctor writes a DNR order. Usually these patients are already intubated, and stay intubated but if anything else happens there are no compressions, shocks, etc.
- 8Dec 6, '12 by BrandonLPNWhat about the nurse who comes across the full code pt in LTC who's clearly been dead for a couple hours? Is it "unethical" to forgo a code in that case? I mean, come on people, at some point all we're doing is desecrating a dead body.
- 1Dec 6, '12 by Twinmom06, ASN, RNmy grandmother (who is 85) saw HER mother ventilated and begging to go, and signed her own DNR/DNI - and that was 20 years ago at 65 years old...she lives with my mom now and that AD is parked in the cabinet with her medications - and we all know we DON'T attempt to bring her back - she doesn't want it...I went so far as to tell my husband where it is if he ever checks on her and finds her...
best thing she ever did for herself...at nearly 40 I'm not ready to do that (my kids are still young) but you betcha when I hit 65 or get diagnosed with something terminal that will be the first signature I make!