CPR in the Hospital

CPR

Cardio Pulmonary Resuscitation (CPR) can be life-saving especially when performed in a hospital with all the talent, knowledge and equipment that is available. It has become routine for patients to be asked on admission to the hospital some form of the following question: “Do you want emergency measures to be performed if your heart stops?” 

That question can be daunting in myriad ways. If one is being admitted for a routine procedure it can be a bit of a shock. If the patient is critical and/or of advanced age then it might be even more upsetting. Three things can help at this point, #1. Expecting such a question, #2. Being an informed patient about just what “emergency measures” entails and the risks involved, and #3. Having already considered this question and having discussed it with your loved ones. https://crookedcreek.live/2017/01/25/death-decisions/

Expectations

The first thing we all need to acknowledge is that we will one day die. Sobering as that thought might be, it is essential to know that regardless of how we answer the question above we may not be saved by CPR or any of the extraordinary measures taken if our heart stops beating. Perhaps worse yet might be to survive and be dependent upon breathing machines, feeding tubes and narcotics for pain relief. Cardiac arrest can cause organ failure leaving such organs as the liver and kidneys unable to function. Neurological deficits as the result of brain damage from lack of oxygen can occur. Unrealistic expectations can cause physical and psychological pain for both the patient and their family.

An Informed and Prepared Patient

An informed patient will have realistic expectations, will ask questions and will be prepared to make an informed consent. When a patient decides that they do not want heroic measures they can have a DNR (do not resuscitate) order to alert staff that the patient does not want CPR performed. Some hospitals now use the less promising acronym DNAR (do not attempt resuscitation). Before making this decision it is imperative that a patient know what resuscitation is and is not. It does present a chance at survival but it is nowhere close to a guarantee. The average chance of successfully resuscitating a healthy young person, i.e., to be neurologically intact, is only 30 percent overall. 

Once you have researched these issues and are armed with scientific information the next step is to discuss your wishes with your loved ones. Finally, prepare the legal documents that leave no doubt if the time comes when you need to inform your healthcare provider of your decision.  https://crookedcreek.live/2017/01/19/death-intro-ii/

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In the end, what matters most, quantity or quality of time here on this planet? 

 

Graphics by Pixabay

Death-Hospice

Follow Up

To follow up on important topics from the last post in this series, please read the comments left by “Lula.” Remember that little black bubble at the end of each post?  fullsizeoutput_9edJust click the bubble on Death Decisions (Jan. 25, 2017) to read the important information she has shared with us. 

Lula shared interesting information about a service which sounds like a good idea for anyone, but especially those who travel often. I am not familiar with Living Will Registry, but you can read about Lula’s own experience as a frequent traveler (in her comments) as well as reviewing the service Online.*

One issue that Lula mentioned is Emergency Medical Services (EMS), when called to a home, will likely begin CardioPulmonary Resuscitation (CPR), even if one has a Do Not Resuscitate (DNR) order on a Living Will. I have always heard the same thing, but an official form** in this state (KY) is meant to address this problem. You should check with your own state, city and/or county for the law where you live. Regardless of one’s current health status it would be helpful to fully understand the guidelines before a need arises. It is understandable this is a potential for problems. The very fact EMS is called indicates an emergency and they come prepared to do what is necessary to save lives. If one has a terminal condition CPR is not likely an appropriate response, but it is unfair to expect emergency personnel to make that distinction or take that responsibility. 

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Hospice

Having Hospice involved in end-of-life care can often prevent such situations from occurring. Hospice is a national organization with local offices across the US, providing palliative care to patients facing advanced illnesses and to their families. Palliative care involves relieving pain and enhancing quality of life (as opposed to addressing a cause and/or cure) and may be provided in the home, special centers, extended care facilities or special units within an acute care hospital.

When Hospice care began gradually in the US, during the second half of the Twentieth Century,  there were specific parameters regarding how long a patient was expected to live in order to be admitted into palliative care. Although this is no longer the case, it is a lingering belief and can make it hard for families to approach the subject. I personally feel Hospice is extremely valuable in providing clinical, pastoral and grief support as well as practical assistance with medical supplies, equipment and even volunteer and respite care. Extensive information is available from National Hospice & Palliative Care Organization*** (NHPCO).

Possibly many of you used Hospice services for your family or maybe a close friend and I invite you to share your experience with us if you are comfortable doing so. I will share that in my experience with loved ones the service was not instituted soon enough. In one case, incredulously, it was not possible to get the physician to admit the patient was dying and by the time a referral was made the patient only lived a few hours. The other personal case was just the opposite. The physician recommended, even urged, Hospice service, but the patient wanted to wait a little longer, not realizing the time would approach as quickly as it, in fact, did. In each case the patient did not receive care that would have perhaps eased their passing. I painfully share this hoping it might prevent others from waiting too long. 


Websites referenced:

*Living Will Registry http://www.alwr.com

**KY DNR Form http://manuals.sp.chfs.ky.gov/Resources/sopFormsLibrary/Do%20Not%20Resuscitate%20Form.pdf

***NHPCO http://www.nhpco.org


Coming Up

We will look at Funeral and Burial Planning in the next post. I realize this may be a bit too pushy, but if you are so inclined how about working on writing your own Obituary before then? Then we will work together. Your participation is great and makes our experience together so much richer. Thank you!


“I find it delightful that the optimal way I can live my life from moment-to-moment is also the optimal way I can prepare for my death, and equally delightful that acknowledging our future death is a prerequisite for living a truly joyful life now.”  Ram Dass, Still Here

Death – Decisions

Decisions

It is understood that family units are all different and may be made up of biological or chosen family, spouses or partners, relatives or close friends. We will use the term “family” for those closest to you. These differences may dictate what, exactly, you need to do to from a practical standpoint to prepare for your death, but regardless, the first step should be honest family discussion. We’ll call it “The Talk.”

The Talk

It doesn’t have to be a formal meeting. If you and your family are open to the discussion of death “The Talk” can be in increments and flow from normal conversations. When discussing the death of an acquaintance it is a natural time to say, “When I die, I prefer . .” Since such discussions may not include everyone who needs to hear, having your wishes in writing, leaves no doubt or confusion. So, what do you need to talk about and how will you document it?

Living Will

Legal agreements can be our guides. Let’s start with those things usually addressed in a Living Will. If you are diagnosed as terminal and are no longer able to make your own decisions, because you are permanently unconscious or otherwise unable to express your wishes:

  1. Do you want treatment withdrawn except for pain control?
  2. Does that include withdrawal of food, water?
  3. What about a DNR (do not resuscitate) order?
  4. Do you wish to participate in anatomical donation?

Decisions for #1-#3 can be very difficult for a family member. You may have no doubt that these life prolonging actions are inappropriate or undesirable for you, but to your loved one it is not that clear. To them it may feel as they are hastening your death, while you are more likely to feel that such measures would prolong suffering. If this has been discussed and documented ahead of time, there is less anxiety when the decisions must be put into practice. Physicians, emergency personnel and hospitals must provide every means available to save a life if they have not been given the legal right to withhold those interventions. Resuscitation (CPR) will be initiated, regardless of the patient’s prognosis, unless there is an order in place for DNR.

Number four (#4) involves whether you would like to donate organs for transplantation or all of your body to science. If donating the entire body is your desire, besides documenting, it is best to make logistical arrangements in advance. Most such donations are made through a university or medical school.

Organ donation decisions are often made long before formal end of life planning. In most states one can designate the wish to be an organ donor while obtaining or renewing a driver’s license. Organ donation more specifically is addressed in the Living Will. If you have explicit wishes, maybe you are willing to donate corneas, but not hands for example, this needs to be legally documented. On this subject people often think first of heart or kidney, organs which dramatically save lives. In fact, donations may be made of tissues such as skin which is used as dressings for severely burned patients or bone for spinal surgery. There may be personal or practical reasons for specifying exactly which organs/tissues you are willing to donate and these can be itemized in your Living Will.

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Consider Donation of Organs or Tissue

Transplantation is a subject that I feel strongly about, having worked in that field for many years. I find it unfortunate that after over sixty years of successful transplantation, only 52% in the US choose to donate. If you have not already made your decision, please give some consideration to it now. There is no lack of information available to answer any questions you may have. I recommend calling your local/state donor affiliate or researching Online.

The United Network of Organ Sharing (UNOS) is the national organization which governs transplant facilities and Organ Procurement Organizations (OPO) in the United States. Their website probably contains more information than you would ever need: https://www.unos.org

Cornea transplantation differs in some ways from other donation and a good site for more information is https://www.donatelife.net/types-of-donation/cornea-donation/

Bone marrow and stem cell transplantation is still in the experimental phase for cadaveric donation, but is showing promise. If you are interested you may find information at the National Marrow Donor Program: https://bethematch.org

Your Surrogate

A Living Will allows one to record legally, exactly what one wants and does not want. Or, with this document you can authorize a HEALTH CARE SURROGATE, sometime referred to as a proxy or Medical Power of Attorney (POA), to make these determinations for you at the time of need.

Choosing a Health Care Surrogate is a very critical decision. First, of course, is that it be a person you trust. Your designated surrogate should be geographically close if at all possible and should know your wishes before accepting this responsibility. A few of the subjects included in a legal Surrogate Designation are:

  1. Access to your medical record
  2. Right to choose your health care providers and long term facilities
  3. Withdrawal of life-prolonging treatment

This legal document names your surrogate and an alternate surrogate in the event the first person designated is unable or unwilling to serve at the time she/he is needed.

Update and Storage of Documents

Sometimes we change our minds about the directions we’ve given and the Living Will and/or Surrogate Designation may require legal revision. These documents need to be reviewed on a regular basis. If our wishes remain the same, it is probably advisable to initial and date each page to show that they remain current. Having your Living Will on file at your hospital can make it difficult to keep current. I would trust a photocopy carried by my surrogate (and in my car’s glove box) more than the hospital’s computer system. It goes without saying that original documents need to be stored in a locked fireproof box and that your surrogate and/or POA has access.


“It seems to me most strange that men should fear; Seeing that death, a necessary end,  Will come when it will come”  Shakespeare in Julius Caesar

Death – Intro II

Introduction II

As we move forward discussing the topic of death and end of life decisions, in particular, I refer you back to this blog’s first page, HOME. At the bottom is a disclaimer and it is important that you review it at now, particularly this:

The content of this blog is not intended as advice . . . . Information contained herein is not presented as medical, legal or clinical recommendation . . . .”

And, I would add:

  1. It is extremely advisable to seek legal counsel from an attorney for estate/end of life planning.
  2. Forms are available Online for your review (or printing), but I caution you to use either the US Government (https://www.usa.gov/federal-agencies/a) or (https://www.irs.gov/forms-pubs), your State Government (state laws differ) or the American Bar Association (http://www.americanbar.org/groups/real_  property_trust_estate/resources/estate_planning/living_wills_health_care_proxiesadvance_health_care_directives.html) Websites. Using these sites one can avoid ads and scams.

The kind of end of life decisions we will focus on are sometimes included during estate planning which deals with financial issues. Money management is not part of our discussion.


Future Posts

In the next few posts we will discuss the following topics, some more in depth than others:

  • Power of Attorney (POA)
  • Living Wills
  • Health Care Surrogate/Proxy
  • Organ Donation
  • DNR (do not resuscitate) orders

Other topics in the future will include: Funerals, Obituaries, Grief and Suicide.

In the last post I asked you to say the words: “When I die” and to acknowledge we are born terminal. Some of you responded with your thoughts and experiences and I appreciate your honesty and willingness to share. It is not surprising there are those who are not ready to talk about such personal feelings. Discussing death is difficult in varying degrees based upon our past experiences and other factors, e.g., religion, age, health status. It was reassuring some of you have already taken formal steps to inform others of your wishes at the time of your death.

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Reader Feedback

Marybeth, while sharing that her parents were very organized in having preparations in place for death, also stated, “Perhaps it is the way a person dies (long illness, accident, suicide, etc. ) that shakes our world more than the actual act of death itself? ” This is a valid observation, because while losing a person one loves will always be painful, there are many variables which affect how we react and how we grieve.

Rita discussed the awe of her own conception which is the beginning of the brief interlude we have on this planet. We often hear “cradle to grave,” which sums it up.

Finally, Lula shared the preparation she has made for her own death having had that responsibility for deceased loved ones. Such experiences in dealing with the estates and last wishes of others certainly point out the value of thinking ahead and making the decisions we are about to discuss.

Thank you to each of you who shared.

With the next post we will begin discussing the person (proxy) who makes medical decisions for you when you are unable to express your wishes. That person may be designated in a Medical POA, a Living Will and/or Designation of Health Care Surrogate.

“Life cannot exist without death; neither can death exist with life.” Osho Rajnish


Past Problems with the COMMENT Section

Some have expressed frustration with trying to comment on posts. I understand and I admit it isn’t easy to figure out and I’ve made some changes AND mistakes along the way. To comment on any post click the little bubble below and right on this page. If yours is the first comment that little black bubble will have a + sign on it. If others have already commented there will be a number in the bubble. Either way, all you have to do is click the bubble and a space will be provided on which to write.

Here is a screen shot from my phone that shows the illusive “bubble.”

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Thanks again!