Yolanda has been a cardiac nurse for a long time. She works on a cardiac telemetry unit in a mid-sized hospital serving a primarily rural population.
She told me about a situation that haunts her: Doing chest compressions on Margaret, a thin, frail, 74-year-old woman with end-stage COPD and advanced heart failure. She’d been admitted, and readmitted- a frequent flyer on their unit.
Yolanda knew it was coming. She saw the patient’s condition deteriorating all day.
She looked through the electronic medical record to find out what conversations they’d had about revising the code status, but she couldn’t find anything.
There was no advance directive.
No progress notes about goals of care or advance care planning.
There was no family around to clarify Margaret’s wishes.
Yolanda talked with the hospitalist about revising the code status, but he didn’t want any part of it.
She talked with her charge nurse who also talked with the hospitalist, getting the same response.
Towards the end of her shift, Margaret went into Ventricular Tachycardia and became unresponsive.
Yolanda called a code and started chest compressions while others ran for the crash cart and initiated ACLS protocols.
On the first compression, she felt the sternum break under her hands. Yolanda kept going, relieved when they told her to Clear for the first shock, so she could hand off the compressions to someone else.
They continued ACLS for 30 minutes, but nothing worked, and eventually they called the code.
She wished she could have done something to prevent that code, which she knew would be futile. This woman had been admitted and readmitted, and it was clear she was nearing the end of her life.
She regretted having to do CPR on her, and that her attempts to advocate had been dismissed.
She continues to live with that regret, and often wonders how long she can keep doing this job.