Way to go!

“Curmudge, our title sounds like the congratulation that a ball player receives upon returning to the dugout after hitting a home run.”

“No way, Jaded Julie. Our topic is an end-of-life issue, and the title might be more appropriate if we changed it to A Way to Go. We’ve all heard the chilling announcement, ‘Code Blue,’ in the hospital. It has been described quite graphically in Nurse Gina’s codeblog.com, ‘How do you suppose being coded feels?’ For the patient whose heart has stopped, the process involves starting IVs, intubation, defibrillation, and chest compressions. None of this is comfortable for the patient, but for about 20% of 40-year old heart attack victims it might be the key to a longer life.”

“It’s been a long time since there were 40 candles on your cake, Curmudge. I’ll bet that your interest is what happens when a ‘code’ is called for an elderly patient with multiple diseases and infirmities.”

“Right as usual, Julie. The odds of success go down and the discomforts go up. Resuscitation (CPR) is apt to fracture the elderly patient’s ribs, and to what avail? To my knowledge I don’t have multiple diseases and infirmities, but I don’t want to have my chest crushed under any circumstance. I guess I’m a good candidate for ‘No Code’ or DNR (‘Do Not Resuscitate’).”

“But, Old Guy, what if you are unable to say that? Pulseless, non-breathers are also non-speakers.”

“That’s why one must have an advance directive. Your health care power of attorney authorizes someone who knows your wishes to speak for you if you can’t. You should discuss this with your providers and have a copy of your document put in your file.”

“Are there special situations where one might want something between a ‘Full Code’ (which seems to be the default) and a DNR?”

“There can be a ‘Partial Code’ that specifies actions to be or not to be taken, but Gina’s blog doesn’t speak very highly of them. But let me tell you about a case where a partial code was ‘just what the doctor ordered’ (literally, because your physician must order your code status to be put on your chart). You are going to be our model patient, Julie, and you have just been brought to the ED with a severe respiratory problem.”

“But I feel fine, Curmudge.”

“C’mon, Julie, play your role. You are a senior citizen and you are critically ill.”

“Okay, I know what happens now. They see that I am gasping for breath despite breathing oxygen from the tank on my lap and take me right back. Someone sticks an IV catheter in my arm, and someone else takes the list of medications that I brought and starts doing the med rec (medication reconciliation). An emergency medicine physician comes in, performs a brief, focused examination, and asks a lot of questions. After viewing my chest x-ray, he and my pulmonologist (who happens to be on call) decide to admit me to a med/surg floor in the hospital. Of course, more time than I would wish passes before I am taken upstairs.”

“Wow, Julie, you really know the drill. When you are settled in your room the hospital provides lots more oxygen than you could get at home; it’s either via a mask or a cannula in your nostrils. Because pneumonia seems to have catalyzed your chronic lung disease, you are given antibiotics via IV.”

“Now I feel better. Maybe I’m on the road to recovery.”

“That may be wishful thinking, Julie. When your pulmonologist comes by, you ask, ‘Do you think we should call our son home from overseas?’ His answer is, ‘yes.’”

“That’s a real bummer. I must have had a premonition that things were not going to go well. Because our son’s trip will take several days, perhaps we should revisit the DNR order on my chart.”

“Actually, that’s the whole point of this posting. You definitely don’t want a code blue if your heart quits, but you will accept more help with respiration until your whole family is here. And in the interim you want to be kept comfortable without pain or gasping for breath. We are all in accord, and your pulmonologist specifies the partial code on your chart.”

“And to end this chapter of our two-part posting, night is falling and I am left in the care of the excellent nurses on the floor.”

“Hang in there, Julie, so we can bring this to a conclusion next week.”

Affinity’s Kaizen Curmudgeon