Code Blue: Should Your Loved One Watch?

CPR

Because I have been present too many times with my patients during the unnerving drama of a hospital CPR I question how good it would be for a family member to watch.  It’s probably the most dramatically graphic and emotionally charged event I’ve witnessed as a nurse.

The all-consuming helplessness that one can feel while it’s happening is probably the main reason I’d tell families not to stick around. Especially knowing that in all likelihood the outcome will be poor.

Time stands still from the moment the first responding medical team member pushes the big red emergency button next to the dying patient and yells “Code!” Staff members are drilled on how to act when it happens and everyone has an assigned role. Within seconds the “code team” arrives and the room is filled to capacity with a frantic sea of  nurses, doctors, respiratory therapists, lab technicians, and voyeuristic students who stand against the wall straining to see what’s happening. It would look like chaos to a lay person.

I will venture to guess that family members who would opt to watch imagine that it will be just like on TV — quick and clean with a happy ending. They need to be told it’s not like their favorite TV drama. It’s a long drawn out battle: blood, cracking bones, shouting, endless alarms, lots of needles, and extreme roller-coaster-style energy — anger, joy, tears, smiles, terror, relief, frustration, exhaustion.

The team does their absolute best to have a positive outcome and this might be the sole reason for a family member to watch. They’ll see the dedication and effort that went into the attempt to save a life.

During my hospital bedside nursing career I did a stint on a surgical step-down unit and it seemed that almost every shift I worked someone’s patient “crashed” and a code was called. If it was my patient I would stay throughout the process. Even though I didn’t have a required role to play I’d often step in and do a round of chest compressions. I felt that I owed it to my patient — a show of solidarity or support at the end. From a psychological standpoint, assisting with chest compressions helped me to feel less helpless. A family member in the room wouldn’t be able to do anything but stand against the wall and watch. And they would feel extraordinarily helpless.

The WNYC Radiolab podcast “The Bitter End” (January 15, 2013) reveals some interesting facts about how doctors honestly feel about performing CPR when the outcome is often poor. During the podcast they discuss how many doctors, nurses, and other medical personnel do not want CPR done on themselves. As a fail-safe, many have chosen to wear medical alert tags around their necks stating “No CPR” and some have gone so far as to have it tattooed on their chests.

If one of your patient’s family members asked if you thought they should watch, how would you respond?

2 comments

  1. My best advice to a family member of a patient would be that CPR can be a scary, confusing and brutal process to those that are not trained or have never seen it and that it is more emotionally charged when it is a loved one so they should not watch. In theory that works well, in practice the family member is not going to readily leave their family member.

    One issue that I run into is that television shows a romanticized version of CPR so people take that as what it is really like. My own 80-something grandmother is a full-code and the rest of my family insists on it. She has cardiac and respiratory health complications that lands her in the hospital every few months and I have tried to explain to my family what being a full-code means, but they (and my grandmother) want everything done. My sneaking suspicion is that if they saw the reality of a Code, they would have a different opinion. I also suspect this to be true of the general public.

    For young/middle aged adults, or adolescents and children, by all means, CPR is a very smart option and it does save lives (and I do not want to discourage family members of older adults to do CPR as that is a deeply person matter), but even if the outcome is great (and plenty of times it is), the process is brutal and not something families may want to see.

    1. Thanks for your thoughtful comment and for stopping by my blog. I wish the best for your grandmother; that’s a tough spot for you to be in, certainly. All we can do is try to provide education, which it sounds like you’ve been doing. Not an easy situation.

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