89 year-old, death not immediately imminent, but certainly on that road, septic, obtunded, dehydrated, atrial fibrillation, blood pressure in her boots, Levophed drip. Previous history of Altzheimer’s dementia, congestive heart failure, myocardial infraction, osteoarthritis, CVA, etc., etc.
She’s a full code, by which we mean that if her heart stops, we do the full monty.
Numerous family members do shiftwork at the bedside, all extraordinary dedicated. They watch the cardiac monitor, then scrutinize my reaction if it beeps or whirrs.
Will she get better? they ask. She was well up to a day ago, they tell me.
I find this hard to believe, given her long difficult medical history. I tell them as gently as possible that she may not survive, she is too sick, that her kidneys have shut down and her heart is tired.
Dr. Sivampillai, the internist, comes in. He reads the chart, and looks thoughtfully at he family members clustered about the patient. He’s a lovely, conscientious man. He shakes his head and sighs.
“She’s a full code, no?,” he asks. “And on Levophed too.”
“We’ve all talked to them.”
“They need to get used to it,” he says. Sure. Conventional wisdom.
But then he says: “Give them time — they very soon will get tired of all this, this toing-and-froing, and jumping at every beep from the monitor and then we will see them make her a DNR.”