Friday, April 1, 2011

A Fate Worse Than Death

I had a patient recently who wanted to be sure I knew she had a DNR. Told me first thing, when I walked in the door.
I think that's a good idea. If she has one, it would be best if we knew about it.

But what puzzled me this time is that my patient was relatively young, and in fairly good health.  There was nothing wrong with her that suggested she might be in a position anytime soon where someone would need to decide whether or not to resuscitate.

Now maybe she's just a very organized, prepared sort of person, and knows that when the time eventually comes, she doesn't want to be resuscitated, and on the offchance that it happens sooner rather than later, she wanted to be sure her wishes were known.


I think it's something else.

I mentioned a bunch of posts ago- maybe it was a blog ago- something about a retirement facility near here where the residents' council refuses to have an AED on the premises. Most of them don't want to be resuscitated, so they don't see a need for an AED.  Never mind about any possible visitors, or anyone who doesn't agree with the majority opinion.

It seems odd to me.
And unfair.
Having an AED on the premises doesn't mean that anyone who doesn't want to be resuscitated would be, against their will.
But it might save the lives of those who don't have a DNR.

Then again, it might not.

And I think that's the issue, really.

There are some people with DNRs who have lived a long and full life, who have a whole host of medical conditions, and who have decided, rationally, that if it's time for them to go, it's time for them to go.  There are some whose conditions cause them a fair amount of discomfort, and they are ready to have that end.

But there are, it seems, a number of people- like my relatively young, healthy patient- who have decided for other reasons, that they don't want to be resuscitated.

I think it isn't that they are ready to die.
I think it's that they are afraid of what will happen if they don't.

There are horror stories about people who are resuscitated, and never regain consciousness.  People who live on, unable to care for themselves, who become "a burden to their family."

THAT is what people don't want.
It isn't that they don't want to be resuscitated, it's that they don't want an attempt made that does not result in a return to a neurologically intact quality of life.  They don't want to end up as "vegetables."

And who can blame them?

What is the success rate of CPR and AED use?
How often is a patient resuscitated, who survives to discharge, neurologically intact?

And how often do they NOT?

I don't have the numbers handy, but I can tell you that the survival-to-discharge number isn't very high.


In some places, it's getting higher.
There are some remarkable numbers to be found in places where there is a focus on improving the entire cardiac chain of survival.
And in places where they are using therapeutic hypothermia.

And Medtronic's Heart Rescue Project  

Some encouraging stuff.

I wonder when it will translate into the average person, in an average place, having a much better chance of survival, to the point where we don't see healthy people already sure that they don't want to "be resuscitated" because they see that as a fate worse than death?

Soon would be good.

1 comment:

  1. I can't comment on the statistics because I haven't done my homework, BUT I can share this anecdotal fact: As a rural fire/rescue agency, in the last 5 years of SCA'a either we win, or we lose. Either we get a grab that yields a patient with full neurological return and discharge, or we lose them completely before arrival at the hospital. We haven't had a 'vegetable' yet. If your young, healthy and want to enjoy a long life, throw the DNR in the trash and take your chances. They ain't good, but they are always better than quitting before the game starts.
    Just my 2 cents,