Speaking in Code

I am going to tell you something shocking now.  Shocking and terrible but true.  Read this sitting down. 

Ready?  Do you have a glass of warm milk?  Tissues handy?  Your mommy’s phone number on speed dial? 

Okay, then, here it is:

You are going to die. 

Take some deep breaths.
 

It is shocking, I know.  You will die, I will die, everyone around us will die.  Everyone who has ever lived has died.  All the heroes and villains and mediocre folks in between are dead.  Genghis Khan, Edgar Allen Poe, Plutarch and Alexander Fleming, the guys who built the pyramids, Solzhenitsyn’s tutors and Cleopatra's wet nurse.  Dwight D. Eisenhower’s mother is dead.   And his father.  And his dog.

You get the picture.

                               "I feel poorly"

           

We are a species that denies death.  We need to in order to  carry on with our lives.  Our amazing brain allows us to predict the future (I’ll retire at 68 with full benefits and move to Tahiti), but it also makes us aware of our own demise. 

It is stressful. 

When we think about it, it overwhelms us.  It makes it difficult to engage in day-to-day activities.  So, we push it aside our whole lives.  Death is going to be something that will happen to us “later”.

But, "later" always becomes, "now" eventually. 

We all "know" that we are going to die, but we don't realize it. 

I see patients every day who need to have their code status addressed.  Translation:  they need to be made a NO CODE.

What is a code?  A code is when a bunch of people run in and start pumping on your chest, breaking your ribs, shoving a tube down your throat and pouring thousands of dollars of drugs into you.  If needed, they shock you with electricity.   It is brutal, horrific to watch and stressful to be a part of.

When polled in 2010, Americans said that they thought that the success rate of a code was 64%.  Actually, it is closer to 11%. 

The outcome of a code is directly correlated with the patient's age and previous medical conditions.  A twenty year old who falls into a swimming pool should be aggressively coded.  An eighty year old with metastatic cancer, should not.  It is pointless, costly and sadistic.

Death is the end of life.  That's it.  The reason that the patient has coded is because they are trying to die.  Even if the patient survives the code, they still have all of the diseases that caused the code in the first place. 

Nurse's Note:  a code does not cure cancer, heart disease, hepatitis, COPD or kidney failure

I often hear anxious family members--who have been brought up on a steady diet of television hospital drama--asking their doctor, "So, is there NO chance?"

Your doctor is a scientist.  His degree is not in haiku, pointillism or underwater basketweaving.  His degree is in science.  No scientist worth the salt on his french fries is going to say, "No, there is NO chance." 

There's a chance that my trash can might learn to skydive.  There's a chance that Neptune's climate is compatible with growing pink grapefruit.  There is a chance that people with triple-pierced ears won't get prostate cancer.

The chance might be 0.0000000000000000000000000000000000000000000000000001, but it is a chance.

Don't put yourself or your family member through a code.  Have the courage to realize that when the medical team brings this issue up, you are going to die, regardless of anything and everything we do.  You can choose to spend your last days imprisioned in the ICU going through procedures that you will think were invented by the Marquis de Sade, or you can be made comfortable surrounded by your family.

How do you want to spend the last days, hours, minutes of your life?