Tuesday, June 30, 2009

A Last Goodbye

Codes are messy affairs.  The patient often lies naked on the stretcher, surrounded by strangers as nurses twist arms searching for IV access and a resident suctions secretions while trying to force a tube down the patient's throat.  The brown stains of betadine may dye the patient's skin as a central line is inserted through the groin, and blobs of ultrasound gel are smeared over the chest while a prodding probe checks for cardiac motion.  Monitor alarms ring, ribs crack under the weight of compressions, and a layer of empty plastic wrappings, used flushes, and medication caps builds on the floor.

In short, it's not something I would like to watch a loved one go through.  Like many healthcare providers, I have reservations about bringing family members into a code situation.  In a 2006 paper published in Circulation, less than half of urban emergency department personnel surveyed felt that family presence during resuscitation attempts was appropriate.  Yet other studies have found that family members who were allowed to watch report a stronger sense of closure, an improved grieving process, and greater confidence that everything possible was done. 

My doubts over this practice were called into question recently, when the attending allowed the son of a patient in cardiac arrest to stay while we coded his mother.  For thirty minutes he cried silently with a chaplain, watching.  His mother received CPR, medication, and defibrillation, and was eventually brought back long enough to squeeze her son's hand as he whispered in her ear.  Sadly, her heart soon stopped again, and further attempts at resuscitation were unsuccessful.  

Am I glad this mother had one last chance to communicate with her son?  Absolutely.  Would I want the same opportunity myself?  I honestly don't know.  It's a decision I hope I'll never have to make.

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