The horror of keeping a loved one alive at all costs
He was in his ICU bed without movement or brain stem involvement. His weight was down to 90 pounds.
His six-foot frame and skeletal body made me gasp.
ADVERTISEMENT After countless sessions with the patient’s daughter to make her 92-year-old dad “comfort care,” the intensivist sadly hung his head down low.
The daughter insisted on doing everything for her daddy.
It was my night shift, and I knew what was to be expected. Another endless code. A futile event to please a family member.
I’ll never understand this.
He coded twice on this day. The ICU doctors called in the ethics committee. But that was a process, and we had run out of time.
He coded on me this night — his third code blue in 24 hours. We pushed the code blue button. The nurses, an intensivist, a virtual ICU MD, respiratory therapists, and CNAs to assist in CPR showed up promptly. We all had our roles.
He was already on the ventilator.
Levophed, vasopressin, and bicarbonate drips infusing.
His heart stood still.
The daughter and her husband insisted on watching the code. They wanted to make sure that everything that could be done was done.
They said they would have their lawyer “after us” if we did not do everything.
They watched us do CPR. They listened to his frail body as we cracked his ribs. They watched me push epinephrine, and we announced each medication we gave IV push — epinephrine every three to five minutes.
The doctors begged the daughter to let us stop.
He said that this treatment, this code was futile. It was brutal.
Yet, she refused.
After 15 minutes of CPR and never regained a pulse, asystole was his only rhythm. He essentially had “died” 15 minutes earlier.
And the ICU doctor said: “Stop CPR.”
The doctor addressed the daughter.
“After 15 minutes of vigorous CPR, epinephrine IV push, your father has not responded. He is without a pulse. He died. There’s nothing more we can do.”
I watched the daughter as she shook her head. “Daddy, you almost made it to 100 years. We tried daddy. We tried.”
I was in disbelief. I could not comprehend the brutality in this, how this was so inhumane.
How sad that we can end our own pets’ lives when they are suffering and dying, but we can’t accept humans to die peacefully.
This scene tormented me for months.
That song, “How could you be so heartless,” rang in my head over and over again.
Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate.
I'm currently searching for EMPA jobs in the Seattle area. Looking to move in late spring/early summer of 2021 for my boyfriend's job. I've completed a postgrad residency in emergency medicine in an inner city hospital in the midwest. Will have 2 years of experience by time of move, was also an EMT-B for 3 years prior to school. I was wondering if anyone had information on good hospitals/groups to look at or knows of any places hiring!
I am currently working on finishing out my second to last didactic semester and starting to plan for clinical rotations. I worked as a ED tech prior to PA school and loved it. I also worked a telemetry/cardiac floor tech and between that and lots of shadowing was most interested in EM. I would consider primary care and hospital medicine as well.
Is an emergency medicine residency a must in order to work ED? Can anyone give pros and cons? I am interested in a residency, but also would consider primary care or hospitalist medicine and maybe transitioning to ER eventually if I could not get an ER job right away without residency. Is that unreasonable to think of transitioning?
As far as rotations are there any rotations to try to get to either prepare for a EM residency or to apply for ED jobs without residency? We have 3 electives, plan to do extra EM electives. Is that the best way to use all 3 extra electives? Or add Trauma surgery, urgent care, critical care/ICU?
By UCSF Fresno
The University of California San Francisco (UCSF) - Fresno Emergency Medicine PA Residency is accepting applications for the 2021 application cycle. This 18-month postgraduate program, affiliated with the UCSF School of Medicine, is designed to prepare PAs to practice in a variety of emergency medicine environments.
We will be accepting 2 residents in 2021. Virtual interviews will be offered in 2021 due to the COVID-19 pandemic. The class will start late June 2021 but we will be offering rolling admissions into the Fall for accepted applicants who have a later PA school graduation date.
Deadline to apply is January 15, 2021.
Trauma Critical Care Pediatric Emergency Medicine Burn Orthopedics Dermatology Ophthalmology Oral Maxillofacial Surgery Toxicology Emergency Ultrasound Anesthesia EMS Resuscitation courses include: ACLS, ATLS, BLS, PALS
18-month stipend: $87,000
Benefits include medical, dental, vision, life insurance, disability insurance, 401k, employee assistance program, 4 weeks of vacation, membership in the Society of Emergency Medicine Physician Assistants (SEMPA), UCSF email access, textbook, malpractice coverage, and more.
Paid travel to SEMPA 360, SEMPA's annual conference.
Our state-of-the-art ED at Community Regional Medical Center serves as the only Level 1 Trauma Center/Burn Center for Central California, and handles an annual ED volume of over 110,000.
The Department of Emergency Medicine hosts fellowships in Emergency Ultrasound, Medical Education, and Wilderness Medicine. Our faculty are involved with EM:RAP, EMS, wilderness medicine, ultrasound, medical education, toxicology, international emergency medicine, and more. They are also leaders within the emergency medicine and EMPA community.
PA Resident safety is our highest priority during the COVID-19 pandemic. PPE is in supply and rotations are constantly evaluated to ensure a safe work environment.
What's it like to train here?
I am a graduating PA and am currently looking for outpatient jobs, particularly in primary care. From what I have heard and seen, many primary care clinics are going through hiring freezes, and the few positions I have seen have required 2-5 years of experience. I have applied to them anyway in case they take a look at my CV and consider me, but they have either not contacted me or told me that I do not have enough experience.
I had a good first and second interview for an endocrine PA position. I do like endocrine, however I believe at least 90% of my time will involve working only on diabetes management. If I am offered this position--or if I am offered a position in another specialty that I do not see myself in long-term--should I take it to get experience (and a paycheck)? Should I wait it out hoping for a primary care position? If I take a specialty position will I be less desirable as a future applicant for primary care positions? The job market is difficult, generally, for any new grads, but the pandemic seems to have made things a bit harder as well.