Too Quick?

(What I'm going to post about might come across as being heartless, or myself being lazy – I don't think I'm either of them, but if you disagree with this post, as always feel free to leave a comment)
Tonight we got called to a residential home for an 87 year old female with 'difficulty in breathing', once again it was way out of our area of coverage, but we made good time to get there. I've been to this home before, and it is one of the better homes I've visited – the residents are always clean, and appear well looked after. The care staff know their 'charges', and are always friendly, helpful and courteous towards ambulance crews.

I knew there was something wrong from the face of the member of staff who met us, she had a look of total concern, and I don't like to see that look on someones face – it never bodes well. We went through the clean corridors and busy lounge of the home into one of the residents rooms. There were three nurses there, one of which was crying (something I don't think I've ever seen before) – laying in the bed was a little old lady who was extremely close to death. Her pulse was weak, and thready, something I could have guessed by the patients colour. I very quickly told the staff that, yes, she was extremely ill and that she would have to go to hospital unless she had a 'Do Not Resuscitate' order. The staff said that it would be best to take her to hospital. We scooped her up, and her heart and breathing stopped in the lift to the ground floor.

I don't believe in a 'slow blue' (where CPR is performed by 'going through the motions' knowing that the patient will not survive and that the CPR is for the benefit of the relatives), so I started active, aggressive treatment while my crewmate drove us the five minutes to hospital. The patient remained in Asystole (no heart activity at all) and on reaching hospital the doctors there declared her dead.

I may have previously mentioned the study that showed that “out of'185 patients presenting with out of hospital Asystole arrests, none survived to be discharged“. Both my crewmate and myself, and the hospital staff knew that this patient had no chance of survival – and that the reason we started CPR was because of our policy to commence resuscitation except in certain tightly defined circumstances.

If we had got there a minute later, the patient would already have died – in her bed surrounded by people that cared for her (although not her family) as opposed to being hoisted out onto a chair and then suffering the indignities of CPR in the back of an ambulance. While trying to resuscitate her during the transit to hospital I found myself looking into her dead blue eyes, apologising to her and hoping that she couldn't feel anything that I was doing to her.

I don't know if it is because I've had one and a half hours sleep in the past thirty eight, but it made me feel bad to put her through the indignity of pointless CPR. I know the policies are there to protect us (and members of the public), but sometimes I wish we could use some discretion.

Now I'll see if I can get some sleep.

10 thoughts on “Too Quick?”

  1. I've always really respected paramedics, it seems like a hard job at times and as an ex-soldier I know what you mean about having to follow policy when it may not actually apply. It's some thing that can easily get you down if you let it.Damn nice post, made me feel kind of guilty about some of the trivial crap I post some most of the time.

    Miles, http://milesprower.blogspot.com

  2. I agree it can be tough to preform CPR knowing that there is no chance of success but sometimes that's the way it happens. I have consoled myself that the relatives,carers or whatever then can be happy that “everything was done” and so are able to accpet the death a little easier.Sometimes there just aren't easy answers or any way to set up guidelines or protocols which cover any situations.

  3. Last Friday you wrote:”I know I can't write; and my life isn't that interesting surely?”

    Then you go and write a piece like today's…

    … keep up the good work, mate.

    – Tony –

  4. You are doing the job inside the limits set for you, carry on.But if it was me on the bed I'd prefer to stay there.

    But I guess it's really hard to consider your own mortality and sign the 'Do Not Resuscitate' order.

  5. I work as a paramedic too and have encountered this question many times and can both empathise and sympathise. What works for me in this situation is that I don't play God.. I don't have the right to decide on a person's quality of life and so do everything I have been trained to do and let 'god' decide, whether she lives or not. The problem with us humans is that we have a conscience and a sense of morality, this makes us ask the big questions ever since we bit into that apple from 'The tree of knowledge' in the Garden of Eden. If you look at animals they don't have this and that's why they are still in 'paradise'… Que Sera, sera, for them . IT JUST IS and Ignorance is Bliss (very Taoist) and they don't have to consider the morals of situations. You never see a lion crying over the carcass of the antelope that he's just eaten.. he was hungry and that's that! Neither does the antelope (or his mates) think bloody lion, what a b*s*a*rd… Life is so unfair!That's why I suppose when Jack Nicholson finally had the frontal lobotomy in 'One flew over the cuckoo's nest'… he didn't mind, once it had been done?

    P

  6. Hello, I'm a new reader to this blog…I'm finding everything so far very engrossing and interesting. Regarding the the elderly woman and CPR, I don't think that you come accross as heartless. On the contrary, I appreciate your concern for the lady's dignity in her last moments. At the end of the day, perhaps those who work closely with death have the most respect for life…..Neil

  7. Agreed with a previous reader that you come across as compassionate in this article.As a note, I'm a person who would sign a 'Do Not Resuscitate'-type order if I knew the procedure for doing so and it occurred to me (I'm 26 and reasonably healthy). Were I in a position that I was aware of what was happening to my former flesh as an EMT was trying to revive me while knowing it wasn't going to work, I'd understand. I can't imagine that anyone who has sufficient peace to accept their death wouldn't accept the apology you were thinking to her (and if they aren't accepting it then they'd most likely appreciate the effort). There's also the very real possibility of no awareness of what's happening to your body at that point, afterlife or no.

    Adios,

    Bill

  8. I'm a junior doctor working in the NHS, and we regularly have conversations like this with other doctors, nurses, EMTs and associated staff. Often the reason there is no resuscitation order on a patient is that no one had the courage to broach the subject with the patient or family. The previous person has said: “Don't play God unless you have to, just follow the protocol” and I couldn't agree more. When I am on the cardiac arrest team (1x/week) in my hospital, if an arrest call goes off on a person without a clear “no attempted CPR order” even when I know it is likely to be pointless, I will give it 2 cycles of the Advanced Life Support protocol before having to play God (People who pull through, pull through quickly. Once I was at an arrest for 1 hour before the person leading decided that it was pointless).I think it is vital that there is a public demystification of death.

  9. I know this is a late reply, but just for the record I want to say that your post came across as niether heartless or lazy. You do a fantastic job, for all the right reasons, and show the utmost respect and concern for your patients. If I ever need an ambulance I hope I get someone like you come out to me.

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