The most common myth I have heard is this one. In an unnamed ITU it was noted, with great concern that on a particular weekday (let us say Thursday) that patients were dying with alarming regularity.
The management looked into this of course. It was discovered that Thursday was the cleaner's day for doing a deep-clean.
Of course! The cleaners were UNPLUGGING THE RESPIRATORS to plug in their vacuum cleaners:eek:
still believe that reports of slow codes are 90 plus percent urban myth
When you see a 90 year old person, with advanced Alzhemiers who can't feed themselves, is incontinent, and probably doesn't even know they are still on the planet Earth still a Full Code because the family believes that "they might get better" you will believe in the Slow Code.
When you see a person in a chronic vegetative state - G-Feed, incontinent, hoyer lift - and has been this way for many years, but is still a Full Code because family believes that the "might get better" you will believe in the Slow Code.
When you see an 80 year, frail elderly person, who repeatedly states they just want to die and be reunited with their wife/husband. And you know that the first compression will result in fractured ribs because of their advance osteoporsis, but the family insists on a full code because "they aren't ready to lose Dad/Mom yet" you will believe in the Slow Code.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Well Willow 65 I read your story, and I really do hope that it helps you to come to terms with what happened to your patient, who despite her limitations was carving some joy out of life against all odds, it seems. It's highly disturbing to me that any doctor or any nurse would allow financial considerations to influence to what degree they will try to summon help for her. I had no idea either that medi-caid simply stopped at some point in time. I would have had none of those people with their "it's a doctor's order" BS.
I've got a few stories of my own that still disturb me to this day, they involve death also, but it was the parent's attitudes toward their babies in these cases that caused me some sleepless nights and tears wondering why. I've never shared them either. Not too many people understand.
I'm the first one to jump and say please families, call a halt to the jarring, pointless efforts to resuscitate a frail. terminal person. It is the cases such as you describe and others that sometimes make the hair on the back of our necks stand up. It sounds like you gained her trust, advocated for her, and were even willing to leave your job over the situation. You acted in accordance with your conscience. You did the right thing. Wherever that woman is now. . .I'm sure she is grateful to have had one person, you, on her side. Take care.
I've heard it called a Hollywood Code, due to everyone moving in slow motion. Never seen it myself, but I would certainly not argue against its existence.
Right out of nursing school, I worked on a medical floor. I was told several times, by various nurses, that when one of our older, chronically ill patients was slipping toward death, the bottoms of their ear lobes would fold inward. If this was noted, the patient was sure to die within 36 to 72 hours.
I would not have believed it if I hadn't seen it myself at least twice. I can't say what causes it, but I imagine there must be a legitimate physical origin. Maybe it has something to do with dehydration? As the tissue of the ear lobe dries out, its structure becomes compromised and collapses? Dunno.
Since I've left the floor and moved to ER, I haven't witnessed it. There really isn't the same sort of extended vigil here. But I still can't help but look at my patients' ears when I have concerns of their corporeal state.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Film strip! Whoa, that brought me back. Did it make a little chiming noise when you were supposed to flip the picture, just like in elementary school?
. . . yes . . They were about as lame as you can get. When I went to Parent Orientation at my daughter's college, I marvelled that they had 3 screens and video clips and all that fancy interactive stuff being run from 1 laptop computer up in front!!!
More so on the dark side. (Insert Darth Vader Breathing noise) Luke...
hahahahahahahaha. that's awesome, and what makes it even funnier is i'm taking a break from my lego star wars where i'm beating on darth vader. that is just to funny.
When you see a 90 year old person, with advanced Alzhemiers who can't feed themselves, is incontinent, and probably doesn't even know they are still on the planet Earth still a Full Code because the family believes that "they might get better" you will believe in the Slow Code.
When you see a person in a chronic vegetative state - G-Feed, incontinent, hoyer lift - and has been this way for many years, but is still a Full Code because family believes that the "might get better" you will believe in the Slow Code.
When you see an 80 year, frail elderly person, who repeatedly states they just want to die and be reunited with their wife/husband. And you know that the first compression will result in fractured ribs because of their advance osteoporsis, but the family insists on a full code because "they aren't ready to lose Dad/Mom yet" you will believe in the Slow Code.
I think things in the UK must be totally different, I have never heard and arrest called a code before. But my point is: even if that patient does not have a very good chance what gives you the right to not do everything you can? Aside form the fact the what was described in the post before that was illegal, doesn't the Dr make the final decision on a patient being DNR? That is what happens here, the family may be involved but if the Dr thinks that a resus attempt would fail and cause more distress then he/she will sign the DNR and that is that. There are limitations, for example the DNR is void if they think the arrest is due to a unforseen cause etc, like chocking but it is a medical decision.
I've heard of the notion of a "slow code". This would supposedly happen if the nurse or other staff thinks a patient should be DNR, so they make a deliberately inadequate resuscitation attempt (e.g., by walking slowly to the phone to call the code, or fumbling with the meds). That way the patient dies, but the staff look like they tried to code him.
Do you think this really happens, or is it just an urban legend?
I think things in the UK must be totally different, I have never heard and arrest called a code before. But my point is: even if that patient does not have a very good chance what gives you the right to not do everything you can? Aside form the fact the what was described in the post before that was illegal, doesn't the Dr make the final decision on a patient being DNR? That is what happens here, the family may be involved but if the Dr thinks that a resus attempt would fail and cause more distress then he/she will sign the DNR and that is that. There are limitations, for example the DNR is void if they think the arrest is due to a unforseen cause etc, like chocking but it is a medical decision.
The family or designated next of kin-in the states has the right to have their loved one be a DNR or not-the MD makes suggestions but doesn't make a patient DNR against the family's wishes.
The family or designated next of kin-in the states has the right to have their loved one be a DNR or not-the MD makes suggestions but doesn't make a patient DNR against the family's wishes.
That is odd, I harldy think the family is best placed to make a rational fact based, medical decision reguarding their loved ones status. I find it really interesting because here an attept to resus a patient who was not suitable would be termed at the very least abuse and could totally be taken further.
In response to KinshuKiba - I used to work in a nursing home and saw a lot of death. In the majority of the cases, the earlobes would "lay back" when the patient was close to dying. Most of the time, the skin would start to mottle, too - starting at the feet and gradually working its way up the body. Usually by the time it would reach their hips, they would be dead.
I also encountered the superstition about tying the corner of the sheet to the bed to keep them from dying on your shift. In fact, on my very first shift at the nursing home, we had a patient who was very close to dying. I noticed when I helped change him that the sheet was tied, but I didn't re-tie it (since I didn't know why it was tied in the first place). He died about an hour later, and one of my co-workers told me that it was my fault because I didn't re-tie the sheet!
Another myth I heard was that patients always die in 3's - at least in the nursing home. It seemed to be true for the most part, since a lot of the time we would have 3 die close together, but there isn't a set time limit that all 3 deaths have to occur in. So if we had 2 die a week apart and then a third one a month later, someone would always say something about that being the third one of the 3. Of course, in a nursing home that has critically ill, elderly people, someone is always dying.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
even if that patient does not have a very good chance what gives you the right to not do everything you can?
*** Because we are also not supposed to do harm. Having a 250# nurse breaking a little old ladies ribs while shoving a tube down her throat and filling her with toxic drugs when you are NOT saving her can be considered cruel. There are also cases where the patient wanted to be DNR and as soon as they where not able to speak for themselves their wish was ignored by unrealistic family members. That is a real problem for me.
Aside form the fact the what was described in the post before that was illegal, doesn't the Dr make the final decision on a patient being DNR?
*** Absolutely not.
That is what happens here, the family may be involved but if the Dr thinks that a resus attempt would fail and cause more distress then he/she will sign the DNR and that is that. There are limitations, for example the DNR is void if they think the arrest is due to a unforseen cause etc, like chocking but it is a medical decision
*** That would never fly here, at least not in the times we find ourselves living in. Google "death panels" to see what I am talking about.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
That is odd, I harldy think the family is best placed to make a rational fact based, medical decision reguarding their loved ones status. I find it really interesting because here an attept to resus a patient who was not suitable would be termed at the very least abuse and could totally be taken further.
In medical decisions, "fact-based" can be highly subjective. Many, many DNR situations are not the aged, frail, grandma and grandpa. Our laws favor the individual, or the family is best placed to make a decision between life and death. The theory being that this eliminate's cost factoring. Since we treat everyone equally under the law, the system will have people who are aggressively resuscitated as well as younger people with a better quality of life. No one likes to see a code as an exercise in futility, but calling it "abuse at the very least" in a legal sense is way over the top. If it was taken further, what would that be? Criminal charges for attempting to save a life? I don't think so.
The doctor in the US does have the authority to "pull the plug", and sometimes they do against the wishes of the family. A person who is clinically brain dead can't be kept on a ventilator for an indefinate period of time, for example. Cases involving the withholding of nutrition and hydration wend their way through the court system with heated opinions on both sides. It's a messy system sometimes, but the principle behind it is a good one.
I have a home care patient who is ventilator dependent but is leading a rich, full life. Would a doctor who doesn't know her be the best person to decide her code status? The most important thing to do is make sure, that we, ourselves have advance directives and try to encourage our family members to do the same.
They were about as lame as you can get. When I went to Parent Orientation at my daughter's college, I marvelled that they had 3 screens and video clips and all that fancy interactive stuff being run from 1 laptop computer up in front!!! 
Pepper The Cat, BSN, RN
1,790 Posts
When you see a 90 year old person, with advanced Alzhemiers who can't feed themselves, is incontinent, and probably doesn't even know they are still on the planet Earth still a Full Code because the family believes that "they might get better" you will believe in the Slow Code.
When you see a person in a chronic vegetative state - G-Feed, incontinent, hoyer lift - and has been this way for many years, but is still a Full Code because family believes that the "might get better" you will believe in the Slow Code.
When you see an 80 year, frail elderly person, who repeatedly states they just want to die and be reunited with their wife/husband. And you know that the first compression will result in fractured ribs because of their advance osteoporsis, but the family insists on a full code because "they aren't ready to lose Dad/Mom yet" you will believe in the Slow Code.