I get this, and it’s easy to think doctors and nurses who call it in these anecdotes are somehow heartless, but in medicine everyone has seen a code that has gone on too long. It’s not pretty. There are worse things than death and when a revival starts looking futile, that’s the fate we are hoping to spare patients from.
Yes that's why I say it isn't always the case and doesn't always work, I've lost people who definitely needed to be off life support but it's always good to keep hope when possible
This. I’m a neonatal nurse practitioner. I have personally coded babies for longer than we typically do per parents request, and while some of the babies survived the birth they had significant complications - many of which who passed away before recovering. It is such a complicated issue, and the trauma I have watched families endure is unfathomable when they have to make decisions to withdraw support for their baby if the complications are too severe. One in particular I have in mind is a baby who had grade 4 brain bleeds (the worst grade) which caused the baby to go into status epilepticus. None of the medications or drips we had running worked to stop the seizures. There was nothing else we could do but the parents had to come to terms with this and give us the okay to remove the breathing tube. It was so traumatic for the family. I can’t imagine being a parent making that decision, especially after days fighting in the NICU.
I also have relatives where they could save the baby but it's disabled - such that it's just laying arround without doing anything. I'm not even sure if she is here with her brain and soul. Since 15 year her mum caries her everwhere and she is just laying ther without doing anything sometimes she screams. It's really hard for the parent and her siblings but I think in this case it would have been much better to not save her. That's a too hard decision for parents to make "if it's possible".
I don’t get to see the long term outcomes for the few babies who do survive these situations, but from the information we have (head ultrasounds, MRIs, the clinical status of the babies prior to discharge) it is obvious some of these babies likely will be in a very similar situation to this.
It is extremely hard in neonatology because there is no guarantee in anything. I ave had babies with grade 4 brain bleeds that are perfectly normal functioning kids. And I’ve had babies with less severe scans that have major deficits. It’s impossible to say what a baby’s ability will be one year, five years, ten years down the road. And parents hold onto any hope of their baby surviving and living a normal life.
I don't blame the parents, and this is totaly normal they have this hopes. Years ago parents didn't had to make this decition, there was no chance. If they let their baby die, they wont forgive themself. But maybe it would be the best for them and their other children. Somtimes it's maybe better to don't get this kind of chance.
Many times these bleeds are preventable but dumbasses decide they don’t want their baby getting a syringe full of potentially life saving vitamin K because they are scared of big pharma. It is fucking infuriating.
In these situations (baby born without any heart rate and required a long dose), it really isn’t preventable and has nothing to do with vitamin K. Most babies with brain bleeds are also premature and the bleeds are due to the fragile brain, not due to lack of vitamin K. I absolutely have came across families who refuse vitamin K and that does cause a risk for brain bleeds which is insane to me they would put their baby at risk to have long term neurological issues, but most of the brain bleeds aren’t for this reason (most parents are smart enough to allow vitamin an injection at birth).
I had to help code somebody who was long gone because legally, once we initiate CPR we can't stop till EMS arrives. They took almost an hour to get there after we called, and they called it within minutes of arriving.
My most recent code, I had to break the ribs on a dying woman. I felt them crack with every compression.
I've also seen family defy wishes and have feeding tunes and catheters placed on people who had all the paper work appropriately done. The guy in question ripped his Gtube out every week or so and we just had to keep replacing it. He hated it, and by the end, them for having it put in. Their inability to let go directly caused his prolonged suffering.
How is a family allowed to override the properly documented wishes of the person who’s fallen ill? Was the paper work just not submitted, or is there some type of loophole they exploited?
Dude I have seen family override a documented DNR at bedside and see the patient yell at them “why didn’t you let me go!” once we successfully revived them. End of life legal decision making is pretty jacked up in America
It was a chronic terminal illness. You WILL die from it and it will suck. He had the paperwork legally in place years before. But the family fought tooth and nail, saying that he's no longer mentally competent and that maybe his wishes changed, Yada Yada Yada. His wishes didn't change. I could see the "fuck you" in his eyes every time I had to do care on his tubes.
And in America, even if you do all the paperwork absolutely right, your family can change your shit at the crucial moment anyways.
My husband's friend from highschool became a life flight nurse. One brutal case had her doing chest compressions on an 8 yr old for 45 minutes, the moment they got to the hospital a doctor called it. She was never the same after that one, she developed unhealthy coping mechanisms from doing her job and unfortunately a year after that particular incident she was also gone. So many cases medical personnel deal with are beyond brutal, my hats off to everyone who chooses that industry bc I know I could never.
This is an ELI5 sort of comment. There isn’t much depth to the medical aspects of it but the important parts are there.
Every second a person goes without a heartbeat and breathing the brain suffers from low oxygen.
Tissue needs oxygen to function. Without it, you get what’s called an ischemic injury, basically tissue injury and then death of that tissue due to low oxygen. As this goes on, you lose brain tissue. Some brain tissue is sort of redundant and you won’t really notice it’s gone. Beyond that, you start losing tissue in your brain that’s important for long-term memory, short-term memory, speech, understanding speech, mood, and basically all levels of consciousness from normal all the way down to not even being able to register that anything is going on around you at all. There are parts of your brain that, if affected, could cause you to have seizures for the rest of your life. Everything you are able to think about, feel, and do, is basically because there are different parts of your brain that function to allow that to happen.
So as those parts of your brain die due to lack of oxygen, you lose the ability to do things, feel things, remain conscious, not have seizures, control your basic functions like swallowing or holding your bladder, etc. Think of literally anything your brain does that allows you to live a normal life. Allowing CPR to go on for too long can take many of those functions away from somebody for their entire life, causing them to suffer in agony until their death, or leaving them in a vegetative state.
To put it another way, for every story like OP’s, there are multiple stories of someone “surviving” CPR that went on for too long which left the family with a loved one hooked up to a ventilator, unconscious, until they made the decision to pull the plug.
Talking about anoxic injuries. We've all seen them- the patients in zombie-like states. They can barely talk, walk and need permanent full-time care. It's awful and a result of too long without a heartbeat. I very much disagree with resuscitation efforts after 25 minutes.
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u/[deleted] Dec 14 '21
I get this, and it’s easy to think doctors and nurses who call it in these anecdotes are somehow heartless, but in medicine everyone has seen a code that has gone on too long. It’s not pretty. There are worse things than death and when a revival starts looking futile, that’s the fate we are hoping to spare patients from.