Sunday, 22 January 2012 16:57
Below, I have compiled a list of 10 reasons why it's wrong for me to do chest compressions on your 90 year-old grandmother. Please share this list with everyone you know...
1- CPR is ineffective in the very old and very frail.
2 - I will break all of her ribs.
If all of her ribs are broken but her heart is actually restarted, she will most likely be on full life support. And:
3- She will likely die within a few days anyway... or, if she lives longer:
4- She will probably never get off of life support -- her family will have to decide whether or not to remove the machine(s), or
5- If in the very, very rare event that she regains consciousness, enough to feel that all of her ribs are broken, she would wish that she were dead, or
6- She would die of the complications of the multiple rib fractures anyway.
Other reasons why it is wrong to perform CPR on your 90 year-old granny:
7- If the family witnesses effective chest compressions being performed on their granny, they will be horrified at how violent it appears and this may be the last mental image they have of the end of her life.
8- It causes PTSD (Post Traumatic Stress Disorder) for the healthcare providers who are dutifully crushing her chest wall in attempts to perform CPR on her, and she may in fact look like their own grandma.
9- Grandma probably didn’t want all of this anyway!
10- Yet, the last and possibly most compelling reason is this true story, a real-life summary of all the above points, submitted by my doctor-friend, Daniel MD:
“I was an intern doing an EMS rotation, and one of the first patients we got called on was to the bedside of a 90-something year-old man who had terminal cancer-- as his family had found him unresponsive. We arrived about 7 minutes later and found an extremely thin, wasted, pale gentleman lying on his bed, not breathing and without a heartbeat. He was still warm, and the family was crying and asking us to do "everything to save him". Thus, we initiated CPR, with me starting on chest compressions while the paramedics obtained an IV and gave medications.”
“I will never forget that first compression, as every rib in his chest shattered and I felt the sickening crunch of many newly-fragmented bones under my hands. I proceeded for the next 10 minutes or so as we transported him to the emergency department to crunch up and down on his now severely-deformed chest, despite the fact that, as he had been dead at least 7 minutes without CPR (and was elderly and terminally ill), the chances of a meaningful recovery were essentially zero, and I can only imagine what all the sharp bone ends were doing in there as they ground up and down.”
“As would be expected, he stayed as dead as we found him, but now with a great cavity in his chest where his chest had collapsed, and the memory of that feeling of doing that to his body and the absurdity of what we were doing haunts me to this day.”
“If someone went into a funeral home and did that to someone lying in a casket, they would almost certainly be arrested and get psychiatric evaluation, and yet, somehow that was what the family thought they wanted. We have a long way to go in educating people on what is possible, what is realistic, and most importantly, what is dignified and natural about a good death.”
Amen, Daniel, Amen…
Monica Williams-Murphy, MD