BEST UPDATE OF ALL: Here’s an article in Forbes with all the facts. FINALLY!! Most important one? The elderly woman who died didn’t have a Do Not Resuscitate Order but she was very clear (and had made it clear to her family) that she did NOT want life sustaining measures taken to keep her alive. In the end her wishes were observed. No tragedy. No horror. No fault.
UPDATE: Some side effects and statistics: If CPR is done properly (i.e. hard enough to move the blood) the three biggest immediate risks to the recipient are broken ribs and possibly the sternum, vomiting with aspiration of the vomit into the lung and subsequent pneumonia, and brain injury due to prolonged absence of oxygen to the brain. Then there the subsequent dangers faced in a long stay in intensive care including infections (with a rapidly growing list of drug resistant viruses and bacteria), all the side effects (and possible errors) of complex drug regimens, inadequate pain management and/or opiate side effects such as increased difficulty breathing and eliminating, rapid muscle loss leading to loss of ability to perform activities of daily living, and…well, more. All of these can easily lead to even further complications in the case of an elder.
One study in Michigan put the chances of a person in their 80′s being discharged from the hospital alive after CPR at under 4%. Another one in Washington State put the odds slightly higher with about 9.4% of those in their 80′s being discharged and 4.4% of those in their 90′s. Neither one really defined what quality of life they were living when they were discharged though, other than “alive.” The hidden numbers would be fascinating.
As I write this there are twenty-three headlines trending on the Google news feed about the breaking case of a nurse who refused to administer CPR to an eighty-seven year old woman who collapsed in a nursing home. The elderly woman subsequently died. All of the headlines are worded something like this:
Elderly woman dies after nurse refuses CPR.
Punchy, no? These headlines are factual but, far more important, they’re attention grabbing. They’re designed to outrage you because, as every editor worth their salt knows, outraged readers are far more likely to read the following article than un-outraged ones are.
But they’re also totally lacking in nuance. They reduce the entire situation to a couple of sensational facts and then conveniently ignore everything else, which make the reports ultimately misleading…and I say that with 100% conviction even though I don’t know the particular details of the case.
This is what I do know:
1) How incredibly violent and destructive CPR is on a frail, weakened, and aging body, how much intense pain and suffering it inflicts on the elder involved, and how often CPR leads to further complications that then help kill said elder anyway, just in a different, longer, and more painful way.
2) How often Do Not Resuscitate orders (a legal document specifically citing the wish of the elder NOT to have CPR administered) are ignored by facility staff and emergency medical personnel for legal reasons.
3) How often unsuspecting families wind up being called to the ER after the fact and presented with an elderly loved one who just wanted to be allowed to die peacefully in their own bed, but who is now stuck in intensive care, cocooned in tubing, medicated into unconsciousness, and off limits to all but a handful of core loved ones now faced with the unimaginable (and mostly incomprehensible) battery of choices concerning what to do next.
4) How often these same families are then also presented with an unimaginable (and mostly incomprehensible) bill.
5) How often the medical personnel involved hate to do any of this to a frail elderly person and their loved ones.
6) How the numbers of these kinds of tragic, confusing situations are escalating as our exploding elder population lives longer, more debilitated, multi-disease prone lives while, at the same time, our medical technology grows ever more adept at keeping them alive and dangling whether they want it or not.
Let me be clear here: I don’t know what happened in this specific case. I don’t know whether this particular elderly lady had specific wishes about CPR or, if she did, whether she’d ever expressed them to anyone. I have no way of knowing how sick and/or frail she was, how she felt about the quality of her life, or how her family felt about losing her. I don’t know the legal reasons why the nursing home she was in had a No CPR policy in place, or whether the nurse involved was following facility protocol willingly or totally against her conscience.
But I do know this: everyone involved in this incident was, in one way or another, influenced by the extraordinary stresses listed above…we all are, even if we’re not elderly yet or know anyone who is…and it doesn’t do any good to try and reduce it to sensational black and white headlines that outrage and/or scare the shit out of everybody.
In fact, it’s doing a great deal of harm by impeding calm, rational discussion.
I’m hopeful though that as time goes on, this incident will help promote a better conversation about CPR and the elderly, a wider conversation that’s badly needed.
UPDATE: Here’s a link to another article that starts to address more of the nuances involved. Evidently, the woman’s daughter “said she has no problem with the care her mother received at Glenwood Gardens.” The conversation begins?
UPDATE 2: According to a local news station the elderly woman did not have a Do Not Resuscitate order. The woman’s daughter is a nurse and still says she’s satisfied with the care her mother received which suggests there may be specific medical details pertinent to the situation which have not been released.
copyright Dia Osborn 2013
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And this (the sensationalism of a story that should have stayed with the family for a multitude of reasons) is why I dropped my journalism major. Well, that and I couldn’t get into my pre-reqs.
While I had never thought about the damage CPR could cause, it does make sense. Families of those (of any age) with brittle bones should certainly discuss whether CPR should be administered.
Along with the more obvious compressive stress on organs and bone, what other damage can result?
Almost journalism, eh? Me, too. Yet another parallel universe in which we nearly met. 🙂
Okay. So some other side effects apart from cracked ribs and possibly a broken sternum? Hmm. Well, the two biggest immediate risks are probably vomiting with aspiration of the vomit into the lung and subsequent pneumonia, as well as brain injury due to prolonged absence of oxygen to the brain. Following hard on the heels of these are all the subsequent dangers faced in a long stay in intensive care including infection from a growing list of drug resistant viruses and bacteria, the possibility of errors with complex drug regimens, inadequate pain management and/or opiate side effects such as increased difficulty breathing and eliminating, hospital errors, rapid muscle loss, and…well, more.
One study in Michigan put the chances of a person in their 80’s being discharged from the hospital alive after CPR at under 4%. Another one in Washington State put the odds slightly higher with about 9.4% of those in their 80’s being discharged and 4.4% of those in their 90’s. Neither one really defined what quality of life they were living when they were discharged though, other than “alive.” It’s always the hidden numbers that fascinate me. 🙂
Under 4%? Yikes. And yes, the hidden numbers would tell the full story.
I hadn’t thought about aspiration or brain injury. All of the subsequent (mostly iatrogenic) problems make sense, as well. None of these mesh with what I’ve come to think of as a good death.
So funny about all these coincidences! One of these days I’ll have to make it to your end of the state again.
Thanks for posting this, Dia. It can’t be stated often enough. We need to shout it to the heavens so it will echo back to remind us to make sure our DNR orders are in place, that our families and caregivers know our wishes, and that we do not make snap judgements based on insufficient knowledge about the actions of others.
Actually, I’m such a hypocrite. Our advance directives are still sitting there on the table, all filled out and signed but not delivered to anyone else who needs to know what’s in them. The emotional block with these things clearly runs deep! Aiyiyiyi…
This is the most sensible reaction I’ve read to this story, and I’ve read over 100 of them so far. My disagreement was with the media pitching this as “Nurse refuses CPR, CAUSING woman to die!” The poor lady was 87, and had a heart attack. That’s what caused her to die, not anyone’s lack of proper response! The 911 dispatcher also allowed her emotions to override her assessment skills, since the caller said the woman was still breathing. You don’t perform CPR on a person if they are breathing. Oxygen (for comfort) and possibly an AED to restart/regulate her heart would have been useful, but this equipment isn’t ordinarily available in an Independent Living community.