Let?Äôs say that you have been admitted to a hospital. Typically, you will be given a hospital gown to wear and vital signs will be taken by a nurse, such as me. I will do a physical assessment and the physician will be notified of your arrival. The next step is generally a litany of questions about medications, past medical history, the reason you are there, and so on. Eventually, you will be asked a question about your ?Äúcode status?Äù. The usual way it is asked is something like this: If your heart were to stop, would you want us to do everything we can to get it restarted?
If you are a relatively young and healthy person, you might be a bit startled by the question (Is there something they aren?Äôt telling me?), but you would respond with an emphatic ?ÄúYES?Äù. However, if you are elderly and not very healthy, this question becomes maybe the most important one to consider. So important, in fact, that it really should have been discussed previously. While many patients will naturally evolve in their outlook on their own mortality, others do not. However, the one thing in life that remains certain is that we will all die. While we don?Äôt choose how or when, we can participate in decision making that may make the circumstances around our eventual demise more acceptable to us.
When a patient opts to ?Äúhave everything done,?Äù it generally means that the health-care team will do all it can to restore a heart rate and blood pressure necessary for life to continue. When a patient arrests in the hospital setting, the first staff member to reach the scene after a patient loses consciousness and quits breathing calls for the ?Äúcode team?Äù and initiates cardiopulmonary resuscitation (CPR). This involves compressing the chest externally to artificially pump the blood. This leads to the administration of some powerful medications, putting a tube down the throat, and placing the patient on a ventilator (?Äúbreathing machine?Äù). All of this causes some real discomfort for the patient, but it saves their life ?Ķ right? The short answer to this is ?ÄúYes, but maybe no.?Äù
In fact, there is some pretty reliable data now that shows only about 17.5 percent of all patients who arrest while in the hospital actually survive to be discharged (Thigpen et al, 2010). Even after the implementation of recent changes in the American Heart Association CPR guidelines, this number only improves to perhaps 28 percent. As a young and healthy person, chances for survival are probably better than that, certainly good enough for you to want that chance to continue your life. However, many people admitted to the hospital are not healthy and many are elderly. At some point, you might want to reconsider the odds and talk with someone about what YOU truly want.
While this might start out with a discussion involving immediate family, these discussions should also include your primary healthcare provider. This is the logical person to talk to about what specific options are available for end-of-life care. Any decisions made should come within the context of two things: patient condition and goals of care. Getting back to the numbers, a 2014 study looked at outcomes for 358,682 patients age 67 and older who had CPR during hospitalization. Patients without chronic disease had a 7.2 percent survival rate to six months after hospitalization without readmission, but less than 2 percent of patients with chronic disease reached that point. With chronic disease and advancing age, I suggest that everyone should re-look at just how they want to die.
Mr. Lind is a practicing cardiac nurse in the Twin Cities and a graduate student.