I was put on ER coverage during my office hours without me knowing and just before I could question why me, I got a call that the ambulance is bringing someone and they needed me in the ER. Of course, as always, its right at my lunch time so there goes lunch. I get to the ER and the ambulance had not arrived yet. I really wanted this done ASAP so that I could go out to eat something.
"What is the story?" I asked the nurses who were preparing the Acute care unit in the ER. No one knew, they said the charge nurse took the call. I walked back to the nursing station and found her. "Who is coming?"
"Oh, this one is an easy one, an 89 year old female coming out of a restaurant coded (ie. died), the ambulance arrived 5 minutes after and intubated her and put her onto the automated CPR machine. They should be here any minute now."
Jeez, an 89 year old who coded! At that age, coding usually meat they died with no hope of recovery, I might get to my lunch after all.
I walked back to the ER and the ER and ambulance crew were there. A frail old lady was attached to a CPR machine which was continuously giving her chest compressions. I could not feel a pulse. Another ambulance crew member was giving her breaths via a pump attached to the tube.
The nurse came in and told me that the daughter has just informed her that this patient has a DNR/DNI order (Do Not Resuccitate/Do Not Intubate) and she is just outside the ER right now. Great! I will have lunch after all. I left the patient and found her daughter and confirmed the DNR/DNI order. Absolutely no heroics. The patient had seen her husband suffer in a nursing home post resuscitation and had been very explicit with family and friends that she "wanted to die with her boots on". I rushed back in and turned off the monitor and then extubated the patient and removed the CPR machine. Good for her I thought, as not many people survive CPR resuscitation specially when there is a period of unresponsiveness, which was the case with this patient. The patient was gasping breathing in an agonal breathing pattern which I have seen in many patients on their death bed.
I walked back to the daughter and by now, other family friends were there too. I brought them all in around the patient and explained to them that she is dying as we speak but that I could not put a time frame to it and they should be moved to the hospital wing so that family can be with her comfortably. They all agreed and again insisted that nothing be done as she wanted to die when the time came.
I left the room with instructions for the nurses and went out for lunch. The day finished uneventfully. I did end up ordering CT of head and Cardiac enzymes as she was still alive, with the same breathing pattern and the family kept asking about the cause of her impending death to have a diagnosis. Results came back suggesting a massive heart attack (her EKG in the ER was normal). I relayed that message to the family.
The next morning. I did not get the call that she had died yet. I walked by her room and her daughters were sitting on the couches outside and were very emotional. I said hi and discussed possible hospice/comfort care as we didn't know how long this was going to take. I left the family outside the room and wanted to check on the patient. She was breathing comfortably now. I put my hand on her arm and gently shook her and called her name. She opened her eyes, turned her head and looked at me and I almost fell down. I rushed outside and asked the daughters if they had spoken with their mom yet and they said now. I brought them back inside and the patient, looked at each one and tried to mouth some words which we could not understand. She did shake her head appropriately when asked a yes or no question. WOW. I had never seen something like this before.
As days past, her speech returned fully back to normal, so did her strength. She was discharged to an assisted living home and she has been my miracle patient since then. They say when its your time to go, its your time go. It wasn't her time to go yet.
