King County: (206) 528-5315 | 
by Nora Gibson, Executive Director
The Way Out
An 87-year-old woman recently passed away of an apparent heart attack (later recorded as a massive stroke) in a retirement community in California, stirring up tremendous controversy. Someone from the facility called 911, and when the dispatcher asked a nurse to initiate CPR, she refused, saying the policy of the building was to not initiate CPR and to wait for the first responders.
On the 911 recording, the dispatcher begs the nurse to find someone, anyone, who would be willing to initiate CPR. The elderly resident was transported to the hospital were she was declared dead.
Not surprisingly, her loved ones supported the facility and stated they were aware of the policy and it was in accordance with their mother’s wishes and expectations.
Seattle is famous for the number of people who are trained and capable of administering CPR. I personally know of two people who dropped over when their hearts stopped. Both were in their 50s and playing basketball at the time. Both were revived through the use of CPR and portable defibrillators.
But CPR outcomes for the frail elderly are often poor. Decades ago, a 90-year-old woman participating in one of our day programs had a heart attack in the dining room. A young nurse sprang into action and began administering CPR. The elderly woman was taken to Harborview Medical Center and survived. Our nurse went to visit her at the hospital, and he discovered she was furious with him. “That was my way out,” she said. “I am ready for death. I’ve lived a long life.” Her family supported her wishes and expressed their displeasure. Now she was in the hospital with broken ribs waiting for her next chance for a “way out.”
That was a different era, and Full Life now has a policy to document and honor the life-sustaining treatment preferences for everyone in our day health programs and residences. Some of our clients are very clear that they do not want to be resuscitated.
My mother is one of those people. She and my dad shared their living wills with family members prior to moving to Seattle. She lives at Gaffney House, and while she is still able to enjoy things, she has moderate dementia. I was travelling and family members were visiting her when she became ill. My family made the decision to take her to the ER. Fortunately, they were aware of her wishes but they felt like she could benefit from an evaluation of her condition. She ended up in the hospital and was treated for urinary tract and upper respiratory infections.
Two important lessons: Hospitals are not good places for frail older people with dementia and yet, on this general medical floor, that’s who comprised the patient population. Second lesson: Never leave a frail older person in the hospital without an advocate. Mistakes are made and you need to be vigilant. Despite all of our efforts to communicate my mom’s end-of-life wishes, she was listed as a “full code.”
Mom was discharged and is now back at Gaffney House on hospice. Now she seems to be rallying a little, but while she was in the hospital and after her discharge she saw people in her room that had passed away. My Aunt Ann and the mother of one of her son-in-laws, both deceased, were people she described as being in the room with us.
I personally believe that she came very close to dying but then came back. (I know, call me “woo-woo.”)
I feel a little guilty when I wonder if Mom missed her “way out.” But then I’m overwhelmed with the pleasure I feel at still having her with me.
Comments? Contact Nora at norag@fulllifecare.org.