Mr. Dunnfore Rides Again

"Good evening, my name is Arlene, welcome to Homeland. I have to ask you an uncomfortable question. In the unfortunate event, God forbid, that I come in and find that your heart has stopped beating, do you wish me to attempt to revive you with chest compressions? Often during this process, it is not comfortable. People's ribs are broken, and often the paramedics will be called; there will be lights and sirens and they will shove a tube down your throat so you can breathe . . . "

Obtaining a "code status" as soon as possible after a new resident is admitted has become a priority at Homeland, after this was neglected, in one case, for twenty-four or more hours. The difficult consequences which ensued resulted from the fact that the "default" situation is that, with no stated preference, all residents have a "full code" status and all attempts must be made to resuscitate them, no matter their level of viability to begin with. In my view, this is a sad state of affairs. Some time in the last century, with the availability of CPR, people have lost sight of the possibility of a natural death and no longer view it as a desirable thing. Death, more than ever before, has become the enemy.

I spent an excruciating hour on the phone yesterday at work listening to a family member of a newly admitted resident ask me at least a dozen questions related to every detail of Mr. Dunnfore's prospective care at Homeland, and comparing his idea of this prospective stay with what he did or didn't enjoy at Madigan Army Medical Center. Both the resident and his family seem extremely angry about his pain and his multiple myeloma.

One of his principle objections was to my approach when I asked the resident to clarify his advance directives, his code status. He said that someone had come in and sat on the bed with a clipboard and asked about CPR. I said, "That was me." He thought my approach, according to the resident who had phoned him, was "rude." Not only death, but now the nurse, had become the enemy.

I apologized that the resident found my questions offensive, but said that I needed to be clear about what it means to have people pounding on your chest, and that I try to paint a picture of what that experience might entail. I pointed out that many people have a rosy picture of what this process is like, and believe that it is usually successful, which it is not, even in the best of hands. The family member's reply was that, given a choice between this scenario and death, most people would probably pick the CPR. I stated that, in my experience, no, most people would not.

So I awoke reflecting on how I might change my approach to this challenging subject. Stay tuned.