"And who are you? Tracking the voice, I realise the nurse is talking to me. I'm the physician looking after the patient. I have drawn back the curtains to find my new patient slumped in bed. My hand reaches for her pulse in her neck, wrist or groin but I feel nothing. A nurse says the patient was just speaking, which doubles my consternation. No pulse, we need compressions, she prompts."
"In her late-80s, the patient has end-stage kidney disease and other serious conditions. Having consistently refused dialysis, she has identified her priority as spending her remaining days at home with her husband. Wanting only to be kept comfortable in case of an emergency, here she is unconscious and by all appearances, comfortable. Suddenly, the room is teeming with people and a crash cart. Wait, she doesn't want to be resuscitated, I exclaim. It's not in her notes, says the nurse, hands primed over sternum."
A physician finds an elderly patient unresponsive with no palpable pulse despite recent speech, prompting an immediate resuscitation response. The patient had end-stage kidney disease, had consistently refused dialysis, and prioritized spending remaining days at home with comfort-focused care. Absence of documented do-not-resuscitate orders and a junior doctor's uncertainty initiated chest compression preparations. The team contacted the patient's usual specialist, confirmed the patient's longstanding refusal of resuscitation, and halted the code after bedside assessment showed minimal cardiac activity. Rapid decisions, crowding, and incomplete documentation produced moral and procedural uncertainty among staff and trainees.
Read at www.theguardian.com
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