The Slow Code: Justified?

[echoRNC711, BSN]

PMFB ... I guess we were both typing the same time, similar sentiment . I totally agree with you. Nice job!!

[PMFB-RN, RN]

PMFB ... I guess we were both typing the same time, similar sentiment . I totally agree with you. Nice job!!

Ditto

[OnlybyHisgraceRN, ASN, RN]

I have seen something similiar in my 3 years of nursing. An elderly man coded, and initially everything was being done, but then the the doc decided to verbally end the code, but everyone involved kept documenting as if the code was still happening. Needless to say, I was shock but apparently it happens.

[PMFB-RN, RN]

I have seen something similiar in my 3 years of nursing. An elderly man coded, and initially everything was being done, but then the the doc decided to verbally end the code, but everyone involved kept documenting as if the code was still happening. Needless to say, I was shock but apparently it happens.

*** What did you think should have happend?

[imintrouble, BSN, RN]

I'v never seen or participated in a slow code.

I wouldn't slow code anybody, even if I thought their code was a waste.

Most of the time, most of the codes I participate in ARE a waste.

That's not my call to make.

[elkpark]

The reality I learned (and was shocked at ) is few pt survive a code unless it was witnessed.

Yes, this is what the general public (and even lots of healthcare people) doesn't get. When I was working for the VA years ago (which is where I witnessed the code team taking their own sweet time because they thought they knew who we were calling the code for), the VA did a huge national study of clients who got coded within VA hospitals around the country. I forget the exact figures, but the final results showed that only a tiny percentage of those coded and "brought back" in VA hospitals ever left the hospital. The vast majority of those resuscitated simply lived a little longer in the hospital and then died again. Almost none of the individuals actually resumed any kind of life anyone would want.

If it were up to me, I would make the national standard that everyone is a DNR unless there's some darned good reason to resuscitate them (y'know, young, healthy adult, some freak accident with electricity that stopped the heart ... :))

[somenurse]

I have seen many a slow code. Maybe they have are not done so much anymore, since several nurses wrote they'e never seen one. For some, especially END STAGE DISEASE PROCESSES going on, the code is robbing them of their one chance to die a peaceful death, coding them is a violent waste of time, and if you do get Mr Jones back, he's not really "Mr Jones" anymore, but, more likely, a brain dead individual who lingers and suffers, and causes extended suffering for the family, too, and forces the family to make extremely difficult decisions, when the permanently tube-fed, vegetative patient "lives" for months and months, dying at an inch at a time, slowly.

I remember as a very very young nurse, a code actually bringing back some 90 years old alzhimer nursing home patient, who had been brought to E.R., when it was found she had had died in her sleep, coded all the way. Amazingly, the code did get a heartbeat going again. Fixed pupils, couldn't quite breathe enough to get the ET removed, sent to ICU to be kept on vent (which back then, were NEVER ever ever removed, once in place) and i was elated, just elated, we had "saved" her. I recall the doc looking at me, and saying "oh yeah....good 'save'. "

and looking very sad. His reaction was such a surprise to me, it stuck with me all these many decades later. Now i do understand his sadness. but i didn't back then.

In the old days, it was always assumed a person (even a terminally ill person) usually "wanted" to be coded. Few if any ppl truly realize what it is that they are signing up for, though. They picture end-results of codes to be like on tv, where the exact same brain that existed prior to the code, wakes up and smiles at their family.

DNR options were not discussed that often, and offered and accepted the way they are today.

The general mindset of the population, and of many older ppl even now,

was DNR was "giving up". Yes, i've seen some slow codes.

There are worse things than death.

no doubt, others will slam this post, and that's fine. Technically, and legally, they are right, even terminally ill ppl, even extremely elderly ppl, should all be brutalized if we catch them slipping peacefully away

dying a natural death,

if there isn't a formal DNR order written. Yeah, sure, that IS legally right, no argument here on that. And yes, our job IS to squeeze our eyes shut to the end result of coding terminally ill ppl, and to just promote life, that any and all form of signs of life, must be preferable to the chance of having a peaceful death.

yes, yes, that is our job.

[Esme12, ASN, BSN, RN]

Years ago......back in the ice age.....it's all we had. The MD would write in the progress notes that the medical condition was such that heroic efforts were futile and that a "slow code" was indicated. There were no DNR's and the family wasn't involved in the decision nor the discussion and we told...."everything was done, we are sorry, and they didn't suffer".

Simply put it's what we did. The family was not apart of the equation. I think, in some instances...removing the families emotions...saved some patients from being tortured in ICU for endless days with tubes shoved everywhere.....and families were comforted that everything was done". We would answer all codes the same and once in the room, behind close doors...... we would

Yes we lied to them....but they were little white ones. There are times I miss those times somewhat for I think the empowerment of the patient and family has lead, somewhat, to the sense of entitlement that families now have...... there were good thinkgs about the good ole days...like visiting hours when necessary.

[TheCommuter, BSN, RN]

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.

[Anoetos, BSN, RN]

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...

[Songbird,RN]

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.

[somenurse]

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.