Anytime I admit you to the hospital, I have to ask you about code status. In other words, if your heart stops beating, do you want us to try to start it again? (The process of attempting to do so is called cardiopulmonary resuscitation, or CPR.) If you are unable to successfully breathe on your own, do you want us to put a tube down your throat so a machine can breathe for you? (This is mechanical ventilation.) If you want both, that means you are “Full Code.” If you would not want CPR but would want to be on a ventilator, then you are DNR (Do Not Resuscitate). If you don’t want either, you are DNR/DNI (Do No Resuscitate, Do Not Intubate). If you want CPR but not intubation, too bad, you can’t do that. When your heart stops beating you also stop breathing, so you have to be ok with getting both.
On the regular, I will ask someone this question and they will answer, “I’d like you to try to revive me, but if it looks like I’m going to be a vegetable then stop.”
My answer: We can’t know if you are going to be a vegetable.
(It goes without saying: you will never be a vegetable. We are mammals. Nothing medical science can do will ever turn you into an edible plant.)
There is the question, what do they mean by vegetable. I think they usually mean, permanently unconscious: brain dead. Well, guess what. As doctors, even with the best tests we can’t generally say that 100%. There is a surprising amount of controversy in this area. I don’t think most people realize it is so gray.
But more importantly, we aren’t God. If you heart stops, we have no idea what is going to happen when we start chest compressions, electric shocks and IV medication pushes. We can guess what we think is going to happen, but I’m pretty bad at that. Maybe you are just going to die. Maybe you will wake up in a minute and talk to us. Maybe we are going to pound on your chest for forty minutes and then you will be unconscious and on a ventilator in the ICU and maybe you will wake up in a few days or maybe not, and maybe if you wake up you won’t be able to move the right half of your body. Saying you want to be “Full Code” means you have to be ok with all of those options, you can’t just choose the good one.
You know what I want your answer to be? If you are a healthy person over the age of 85, I want you to be DNR/DNI. If you are an unhealthy person over the age of 65, I want you to be DNR/DNI. If you are a really unhealthy person over the age of 40, I want you to be DNR/DNI. (Exception being if you are in surgery. Most people, even if they are DNR/DNI, will transition to Full Code during surgery, because it is so successful in this situation.)
Why? Do I hate people? Do I want to take care of fewer patients?
Admittedly, it’s probably bias. I haven’t seen that much CPR, actually. But the CPR I’ve seen has not been pretty. It has been brutal. And it has been mostly unsuccessful. Do you want the last minutes of your life to involve someone pounding on your chest, breaking your ribs, shoving a tube down your trachea, shocking your chest?
Doctors, advanced practitioners, nurses and other healthcare providers go into medicine because we want to help people. Oftentimes CPR feels like we’re doing the opposite.
I, as a healthy person in my mid-thirties, want CPR. I would want my husband, my siblings and my mom to have CPR. I’m not against it. It’s just not for everyone.
SDG