By: Debbie Moore-Black, RN
He was in his ICU bed without movement or brain stem involvement. His weight was down to 90 pounds.
His six-foot frame and skeletal body made me gasp.
After countless sessions with the patient’s daughter to make her 92-year-old dad “comfort care,” the intensivist sadly hung his head down low.
The daughter insisted on doing everything for her daddy.
It was my night shift, and I knew what was to be expected. Another endless code. A futile event to please a family member.
I’ll never understand this.
He coded twice on this day. The ICU doctors called in the ethics committee. But that was a process, and we had run out of time.
He coded on me this night — his third code blue in 24 hours. We pushed the code blue button. The nurses, an intensivist, a virtual ICU MD, respiratory therapists, and CNAs to assist in CPR showed up promptly. We all had our roles.
He was already on the ventilator.
Unresponsive.
Central line.
Levophed, vasopressin, and bicarbonate drips infusing.
His heart stood still.
Asystole.
The daughter and her husband insisted on watching the code. They wanted to make sure that everything that could be done was done.
They said they would have their lawyer “after us” if we did not do everything.
They watched us do CPR. They listened to his frail body as we cracked his ribs. They watched me push epinephrine, and we announced each medication we gave IV push — epinephrine every three to five minutes.
The doctors begged the daughter to let us stop.
He said that this treatment, this code was futile. It was brutal.
Yet, she refused.
After 15 minutes of CPR and never regained a pulse, asystole was his only rhythm. He essentially had “died” 15 minutes earlier.
And the ICU doctor said: “Stop CPR.”
The doctor addressed the daughter.
“After 15 minutes of vigorous CPR, epinephrine IV push, your father has not responded. He is without a pulse. He died. There’s nothing more we can do.”
I watched the daughter as she shook her head. “Daddy, you almost made it to 100 years. We tried daddy. We tried.”
I was in disbelief. I could not comprehend the brutality in this, how this was so inhumane.
How sad that we can end our own pets’ lives when they are suffering and dying, but we can’t accept humans to die peacefully.
This scene tormented me for months.
That song, “How could you be so heartless,” rang in my head over and over again.
…….
Do Not Resuscitate 
As an ICU nurse , I have been there . As a Palliative Care Nurse Practitioner, I’m often still there. A few thoughts….
This death is not about the patient, but the family. They will always remember that ‘ they tried’, and if we continue to offer ‘choices’ to families about care- we should expect this, and some of those choices to be repellent to us.
It’s interesting when a highly educated and experienced MEDICAL team, delivering exquisite, advanced resuscitative medical treatments can turn to a family and ask that family what they “should do next”.
I’d like the family to say, “ why the hell are you asking us? we’re civilians you are the experts .”
Sometimes they do, but usually they say ‘ keep goin’.
I have found that setting limits; a day, a week can sometimes help. But my impression is that we often lead families so far down the garden path (with different clinicians offering varying tests and treatments that extend a death) that eventually the family is lost in grief, anger and disappointment and there is no choice but to keep walking.
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There needs to be statutory relief so that the treating physician/intenivist and one uninvolved physician or nurse can override the family’s insistence to continue futile treatment based upon emotions
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