Sunday, August 22, 2010

Full Code

What is Full Code?
It's a term for a medical directive.

Full code means, if a patient has a cardiac or respiratory arrest, medical personnel are ethically and legally obliged to perform life-saving measures. They go full tilt. Rib cracking compressions, intubation, defibrillation, various push medications and infusions to prolong life.

If you asked patients whether they would want to be subjected to pain and suffering before succumbing to their death, you'd find that most would kindly decline your offer. If you asked them if they would rather die a natural and peaceful death, most would rally behind that thought.
Physicians frequently deal with life-and-death decisions, and increasingly with discussions about the quality of death as well. What is a "quality death"? Who defines it?  Does the patient want everything possible done to prolong his life—"full code" in hospital parlance—or does he want to let death happen without interference—a "do not resuscitate" order? 
Full code is permission for a doctor to insert a tube into failing lungs, shock a fibrillating heart, and unleash a plethora of punctures, dissections, and exsanguinations on the human body. These interventions save lives and restore functioning for a small number of people. For many others, they take their final hours of pain, suffering, and death and stretch them into weeks, even months of agony as organs fail one by one while the brain can still experience anger, depression, and pain. Yet to give the lucky few patients a chance to recover, all patients are granted full-code status until their wishes can be verified though documents or conversation. In the emergency department, if a patient says they want "everything done," and the admitting resident documents a presumptive full code.

So just because we have whiz bang medical techno equipment and capabilities, does not make it ethically correct.  More people live longer lives--- but is it quality of life?

One of the first things my Mom said, when she was told she has to move into a care center, was that she would "rather go to the cemetery." OK that sounded dramatic and reactionary, but she felt that being in a care facility was equal to death, without the peace & closure. 
Of course if she know how much it cost per month (in memory care), she might have died! 
$7000 a month, plus laundry services & meds. 

For an active, vibrant person being laid up in a care facility, it feels like a prison. No matter how kind the staff is, there is still this feeling of being locked in to their routines & schedules. 
My Mom can no longer decide to go anywhere on her own. 
Another relative is unstable and needs a belt & an assistant if he wants to walk. He has fallen, and one fall caused a hip break. Once in a care facility, you are exposed to Noro Virus (hellish flu), MRSA the super bug infection, and C- diff an intestinal superbug. 
It is a slippery slope. 

On one hand they have nursing staff available, and deliver all needs- meals & medical attention are covered. Meds & care are on tap 24/7. But it is institutional care, and I don't know if you have spent any time in a Senior care facility lately-- it is depressing. Not as bad as in the old days, but still people with health problems, in various degrees of decline, it is a very hard place to visit, let alone live in. 
When we tried to ease my Mom into it, and said we need to just have you try it & see how it goes- she argued-- oh no--people go into these facilities & never get out. 
She was right, in her case. As hard as that transition was, she needed to be in a facility. 
She could no longer keep up the house, and it was not practical to do in home care because it still involves the home maintenance, as well as all the other everyday stuff. Meds, food, 24/7 care. 

But as Dorothy put it, there's no place like home. 

So we learned that Grandpa's medical directive is listed as Full Code- take every measure to sustain life. We know he requested DNR @ one of his last ER hospital stints, so we figured he probably did not know that is what his current directive is set up as. 

It was important that the discussion was had while his immediate next of kin family was in town for the memorial of his wife's recent passing.  Of course it is a delicate topic, but Grandpa immediately said OH NO! I do NOT want that. He just did not know that was how the directive was set up. 
He did not even need to have what it is explained. There was no hesitation, and no uncertainty. No way! Change it - now!

So that will get changed today- with the Care Facility, and his Doctor's and the hospital. 
He has endured Chemo, radiation, multiple surgeries, has been in a care facility for 10 months & no end in sight. He's also been in the hospital about a dozen times this year alone, in several near death situations. 
Also currently facing a 3rd hip surgery within 1 year's time. 
The Full Code directive may have made sense last year when he first broke his hip, but it does not make sense now. 

At some point this endless heroic saving simply prolongs agony. The patient "lives", but the quality of life is absent. 

I even have that in place for myself. Should something major happen, I do not want to "live" sustained on feeding tubes & breathing machines. Make medical efforts if there is reasonable hope for recovery, but do not sustain life without quality of life. 
DNR with pain management for me, should there be a catastrophic situation. 
That's do not resuscitate.  At some point one can choose to be in harmony with Nature & the spiritual aspects of the circle of life. 


nonnie9999 said...

this is exactly the conversation seniors should be having with their doctors, and the rethugs tried to tarnish it by saying it was killing grandma.

Fran said...

Yea Nonnie~ For sure. People need to be fully informed as to what their options are.

It was interesting how emphatic Grandpa was about his wishes.
He changed his directive the very first chance he had. First thing this morning.

He did not know his directive was different than what he actually wanted.

I have the same thing in place for myself-- if there is no hope of reasonable recovery, or genuine quality of life, then let me go in peace.

this is one of the most important & personal choices people make for themselves.
DNR w comfort or pain medication.

Spadoman said...

I filed documents at the VA a couple of years ago that say DNR. I don't care what others do, but I hope they pay attention to my wishes. Then again, maybe it'll happen quickly when it's time.


Fran said...

Hey Spado ~ My husband & I had a chat about this tonight. Your medical directive is your most personal decision. Much as your spouse loves you, it would not be OK for my spouse to change my health directive. Apparently spouses have that kind of power.
I vowed to my husband I will honor whatever his wishes are & he to me, that there would not be an override of changing that directive. We are both of the mind, if there is reasonable hope of recovery & quality of life, fine. But I do not want some kind of prolonged medical misery just to stick around w no quality of life.

Good life, Good death.
Death w dignity is a blessing.