The Show and Tell Prelude: Futility in the nursing home

Jaimee Leigh Joroff
Washington DC, United States (Summer 2015)

“Freedom is the open window through which pours the sunlight of the human spirit and human dignity.”—Herbert Hoover1

 

ambulance lights

Several years ago, as I was working as a firefighter/paramedic in the Washington, DC, our medic unit was dispatched to one of the many local area nursing homes for “one more unresponsive than usual.”

There was no room number on the dispatch printout. My shift-partner Alasdair and I arrived on the ambulance walking down the long hallways of the nursing home looking into room after room of unmoving, locked away people—any of whom we could have taken as our patient. At last, a nurse directed us to a bed where a frail, elderly woman lay, body contracted, head permanently to the right, eyes unseeing except perhaps something in her own mind.

“Does she have any advanced directives or a D.N.R. [do not resuscitate order]?” Alasdair asked the nursing home.

“No.”

There were no cards or flowers in her room; no sign of visitors.

We took her to the hospital where the staff followed rules and regulations, running tests, inserting IVs, administrating medications to preserve whatever her life was defined to be. Before we left, the overloaded nurses had Alasdair and me help pry the contracted woman’s legs open while they changed out the filthy urinary catheter from the nursing home. Such a routine task, the busy nurses forgot to close the open curtain of the room. Alasdair stepped away to do it and block out the view of the rest of the emergency room.

Since that day my colleagues and I have been to those nursing homes thousands of times for the same types of patients, many suffering, or suffering more from the life-sustaining treatments the law requires EMS and the healthcare system perform.

Last A-shift, I was detailed to Station 94 to fill a 24 hour vacancy on the medic unit. I was working with Shannon again for the shift. Around noon, we responded for a woman having trouble breathing. We arrived on scene of a two-story brick ranch house to find a skeletal frame woman being carried down the front steps by her two distraught sisters.

“Don’t let her die! You keep her alive! Keep her alive!” the sisters cried to us as we took the woman from them. She was so light, I could easily carry her myself, leaving Shannon free to quickly retrieve our cot from the back of the medic unit.

A basic life support ambulance arrived to help. One of their crew members drove our medic unit to the hospital while Shannon and I worked on the patient in the back. Her headscarf slipped off her bald head, a testament to the cancer treatments that her sisters had told us she had finished a few months ago. She had stage four lung cancer, and whether anyone else was ready to acknowledge it or not, she knew this was the end. We tried everything to help her trouble breathing—positioning, oxygen, bag valve mask ventilation, CPAP, medications, and then we got the tubes out to nasally intubate her. Summoning her last bit of strength, through the weakness and hypoxic struggle, the woman suddenly heaved herself straight upright, grabbed Shannon and me by the arms and clearly told us in a last wish and statement that came out as three separate sentences. “Let. Me. Die.”

But she had no paperwork, none of those legal documents that would excuse Shannon and me from negligence, of failing to assist her. But what does that really mean? Shannon and I locked eyes, frozen in our actions for moment other than holding the hands of the woman and comforting her as she fell exhausted back onto the cot.

“She wants to die.” Shannon and I whispered to each other.

I don’t know how much time ticked by, or what we did for a few moments as we debated between ourselves. But we are not God, Judge, or Executioner. We are simply paramedics whose licenses require us to follow state protocols, laws, and operate under a physician’s ultimate authority. We got on the medical radio and called the receiving hospital, consulting with a physician on the other end and relaying the patient’s condition and her expression of wanting to die.

“Does she have the paperwork?” the physician asked.

“No. . .” Shannon reluctantly replied.

“Go ahead and intubate,” the physician ordered.

Shannon and I looked out the back door windows at familiar landmarks flying by in reverse. We were still a ways from the hospital. Plenty of time to intubate, plenty of time to make excuses why we couldn’t, plenty of time to open the door to lose our jobs, our paramedic licenses. . . . Shannon and I were both moved to our own distress as I got behind the helpless and weak woman, took her in a controlled head lock, sprayed the inside of her nose with lidocaine, said, “I’m so sorry,” and inserted an endotracheal tube down her right nostril into her trachea. It was not a pretty process.

“Tube’s good,” Shannon affirmed, listening with her stethoscope to the patient’s chest. The tube was in correctly, but we both knew it wasn’t good. The woman coded a minute later. As we started CPR, Shannon’s and my voice each promised the woman we would do whatever we could once we got to the hospital to stop this and make her wish be heard.

We could have done something differently. But we had to follow the rules. And neither of us thought it was the right choice for the patient.

Sometime later, on TV, the news was announcing that Dr. Jack Kevorkian, the physician advocate for the right to die, had died that day, his nurses playing recordings of the music of Bach by his hospital bedside.2 As the news continued we reflected that dying is not a crime”3 and that leaving this world in peaceful dignity is still not allowed to so many hopelessly terminal patients in nursing homes and the world beyond their walls.

 

References

  1. Hoover, H. (1965) Congressional Record: Proceedings and Debates of the Congress, Volume 111, Part 15 (U.S. Government Printing Office.) Retrieved from http://izquotes.com/quote/87437
  2. http://www.npr.org/2011/06/03/136917033/jack-kevorkian-assisted-suicide-advocate-dies-at-83
  3. Bio. True Story. Jack Kevorkian, Biography. Retrieved from http://www.biography.com/people/jack-kevorkian-9364141?page=1

 


 

JAIMEE LEIGH JOROFF worked for over a decade as a firefighter/paramedic and EMS Supervisor in the Washington, DC, area, observing life and layers of the healthcare system unfold in the shadow of the nation’s Capital. She is currently a therapeutic harpist with the International Harp Therapy Program.