The Inhumane Code

Working the ER this month. Yesterday I got a heartbreaker.

87 yo F dementia, CAD, CHF, CRF, etc. 1 week AMS per her nursing home. Before I even walked into the room, one of my favorite hospice nurses pulled me aside and told me that the woman had been considering hospice last week, the day before she became altered. Had almost signed on. Has no family. Here's her guardian's number - talk to him.

Turns out lady is SICK - CXR white out, STEMI, LFTs of ungodly number, etc. Medical opinion is: it is not appropriate to code her but we need the okay from guardian. Guardian says he thinks that sounds appropriate but need to talk to his supervision (you are the $$*(*#@$ guardian on the legal document, make a #*$* decision). TAlk to supervisior. By her notes, two years ago, 87 year old wanted to be full code, so we want full code. $*(#@$* If she wanted a piece of paper to make her decision for her, she could have signed it, but no, she asked a human being with a concious who is capable to judgement to make that decision. That's you. Step up to the plate.

Codes are ugly. They are not the heroics on all those television shows. They are ugly, ugly, ugly. Ribs are broken, flail chests, crunch, crunch. Sheets, gowns, covers are all over the bed - breasts, pannuses, legs are all spread open. There is no dignity. Why can't people just die because they are supposed to die? Legally, when I'm on the code team or that doctor I have no choice - I have to hurt these people in their last hours when I know I'm doing nothing, NOTHING for them. YEs, I'm happy to try when they are 32 or otherwise healthy but so many times we beat dead bodies.

And it makes us inhuman. I feel bad not only for the body we are hurting but for every health care person in that room. You always have to store part of yourself on a shelf when walking into death but when its beyond futile, it kills the Human in you a little bit.

I stayed 2 hours past my shift with the lady. Of course she didn't make it. Cried the whole dang drive home and then put on a smile for Fairy Princess. Some people wonder how I can make it through residency with a child, I can't imagine not being able to heal without hugs from a Fairy Princess.