March 3, 2007, 8:08 pm

“I Code Dead People”


Okay, let’s see here…

Bayer works on a headache no matter if you’re a housewife, a football player in the rain, a mailman with a cartoon dog at your feet or a prostitute washing your hair!

Yep, that pretty well covers it.

Except for the part that says, “Men who know medicine recommend Aspirin!”

What do women who know medicine recommend?



Bayer Aspirin: it flakes in your mouth, not in your hand!

And who is responsible for this anatomical representation of an esophagus?

It looks like one of those toys you put a marble in and watch it roll around to the bottom.


The title of this post was supposed to be a take on the line from The Sixth Sense, “I see dead people”.

Then it dawned on me that the only people we do code are “dead” people. I mean, nobody calls a “Code Blue” on a person who is still alive.


Technically, if a person stops breathing or their heart stops beating they are four minutes away from a conversation with their Deity of choice.

That’s where we come in.

We’re professionals.


And we’ll resuscitate them.

Oh boy, will we resuscitate them.

We may separate every rib from their sternum, but those compressions will continue fast and effectively.

We’ll put a tube in every orifice and where they don’t have a hole, we’ll make some holes to put in more tubes.

We send electrical shocks through their heart muscle until is looks like a well-done steak, if that’s what it takes to get them back.

Even if they don’t want it.


Why, you ask?

Because instead of letting your loved one die in peace in whichever nursing home or board-and-care they might be residing, 99.9% of the time the staff will find it necessary to place a frantic call to the paramedics.

Because 99.9% of the time, the nursing home or the board-and-care your elderly relatives are residing in will be unable to produce the required documentation that states their wish to not be resuscitated.

Even if they actually have it.

And if they can’t produce the documentation needed to prove beyond a shadow of a doubt the wish to be a DNR (Do Not Resuscitate), our paramedics will be required, by law, to resuscitate your loved one to the best of their ability using their protocols.

Even if your family member doesn’t want it.

And when they bring the just barely resuscitated into the emergency department, we are required to do the same thing.

Even if they don’t want it.


This is nothing new. It has been going on since the dawn of time, back when I graduated from nursing school. If I had a nickel for every elderly patient with a DNR that has been “resuscitated” only to die a day or two later, I’d be independently wealthy.

If I had a dime for every upset family member who had to see their loved one suffering when they thought all parties involved in the care of their family member knew the wishes of the patient, I’d own Starbucks.

If I had a quarter for every time the “unable to be located” DNR was in the packet of papers found in the fifty pages of xeroxed materials sent with the intubated patient I could personally pay for the health care of the entire nation.

And I’d pay anything to take back my part of the pain and indignities inflicted on these patients who just wanted to die in peace and thought they had made their wishes known.


So what’s the point of this post?

Talk to your older/elderly family members about their wishes. Find out the requirements in your county/in your state for having a legal Do Not Resuscitate order. Make sure all members of the family are on the same page. Educate yourself on what a full resuscitation actually entails. It isn’t pretty and is sure as hell can’t be comfortable.

Get that Durable Power of Attorney for Health Care now, before you are unable to speak for yourself. If they can’t find your legal document, you need a person with the authority to say “STOP!”.

If you have a family member in a nursing home or a board-and-care, make sure the code status of your family member is obvious to all the staff and that the legal papers are in a place in the chart where they can be found immediately. Keep a copy in your own records, readily accessible.

Because you know what?

If you want to be resuscitated, I’ll do everything in my power to assist in doing that very thing.

But if you don’t want to be resuscitated, I don’t want any part of the torture you will endure.

After almost thirty years, I’m tired of coding people who would prefer that I did not.

As for me, after the age of 80, if I live that long, I will tatoo “Do Not Resuscitate” along with the date and my signature across my chest.

At least they won’t be able to say they couldn’t find it.




  • Sherri

    March 3, 2007 at 9:11 pm

    I knew my Grandfather would be passing soon after my cousin called to tell me what was going on. So I contacted my parents, and found out my father’s LONG-awaited heart cath was in a few days, so I asked him not to go because I didn’t want him stressing in a one-hospital town (turns out he had 99% blockage!)

    So I have him sign me over medical power of attorney, then we made copies of his medical POA to attach to his hand-written one.

    I walked into my Grandfather’s room the next day; he was in very good spirits with all his visitors, and after all the hugs, my cousin told me about my Grandfather telling his primary that he didn’t want any resuscitation at all.

    So I told cousin I had medical POA, and asked him if the dr had written the DNR order (cousin is not a medical professional, but he knows all that stuff, and often runs the show, so he’d probably know or could find out). He grabbed my POA, and went to the desk. He came back kind of urked, because there was no DNR order, or no DNR stickers on the chart. But he had the nurses make copies of my stuff to add to the chart.

    Next day my Grandfather started Cheyne Stoking and I panicked and pushed the call button before I realized it. One nurse came in and saw his breathing, my cousin thought my Grandmother would be better off out of the room (Alzheimers) and asked me to take her to our other cousin in the waiting room a few doors down. We were panicky and did it exactly backwards, but I did as he asked without thinking. A minute later he rushed in and told me to get back in there, because I was the only legal relative there to stop the 10 or so nurses on code stand-by.

    So he stayed with Grandma as I rushed back in there in time to see his last few breathes. I told the nurses he didn’t want any kind of code, and I had POA and was next of kin anyway, so there’d be no code!

    They looked relieved!

    My cousin thinks that dr takes in older patients so he can make extra ICU money off them when they’re coded, then on life-support. I’ve never worked ICU, and in my six years at a hospital, never had a code on a unit I was working (close call in nursery, but that turned out surprisingly happy). So I don’t know whether having life-support patients makes drs extra money or not. Either way he wasn’t that great a dr, even for a one-hospital town.

    But at least the nurses had the decency to know when resuscition is futile.

    Sorry about the book, you hit a nerve.

    PS: one of my patients had large DNR signs in 2-4 places throughout their apartment (nurse relative helped her).

  • A Bohemian Road Nurse...

    March 4, 2007 at 12:37 am

    Great post, and I totally agree!

  • George

    March 4, 2007 at 1:38 am

    This is a very correct post. The desire or intention to be resuscitated during death should be a topic of discussion in all families including the desire for organ donation. Family members of the going-to-die patient may not be willing to take the responsibility for no active resus. I have had many a times, where despite explaining that mortality is enormously high, the guilt written on their faces to say,”yes we agree and understand but….” will make them end up saying,” please doctor, please go all the way!” Then we make holes where no holes are preent and insert catheters through each of them.

    thanks for the post

  • JustCallMeJo

    March 4, 2007 at 2:14 am


    We had a woman come into the ICU last week, who, bless her heart, was born in the Cretaceous Period. Her family didn’t know what to do when she fell down, so they called 911.

    Seventeen tubes, an extravagant ER and ICU bill and maybe four hours later….we withdrew care and she died.

    I wish the in-between stuff had never been necessary. For her sake and the family’s sake.

  • NurseWilliam

    March 4, 2007 at 4:12 am

    There’s no feeling quite as horrific as the sickening crunch of a 95-year-old sternum under my hands as I, weighing 205 easy, continue the CPR on the poor 84lb cachectic old woman that the medics initiated it on because the dumbass at the adult family home couldn’t find the DNR sheet.

    There’s no feeling quite as frightening as the furious desire to stomp the everloving crap out of the same dumbass after she hauled her incompetent butt to the ED an hour too late, waving the DNR papers in her sweaty hands.

    And explaining why we just shattered grandma’s ribs to her horrified children? Well, that’s just something best left to the imagination.

  • NPs Save Lives

    March 4, 2007 at 6:54 am

    Reading this just makes me cringe. Great post! I will be linking to it on my blog as well. I get the best ideas from you Kim. I just have to write about it as well on my blog too.

  • Carrie

    March 4, 2007 at 8:45 pm

    Wow Kim,

    I practically had tears in my eyes reading this… Right now, my great-aunt (who is 88) is in a hospital in Florida, being given pain medication until she dies. A little over a week ago, she had gotten pneumonia and was intubated in the ICU. She has an advanced directive, but because the pneumonia was deemed “treatable” – they decided to intubate for a select period of time. I also think my great-aunt’s daughter was asking them to do everything at the time. And then when they extubated her, she was more lucid than ever. They did a swallowing test, which she passed, and decided she didn’t need a feeding tube. And she was gradually transferred into a nursing home a few days ago.

    Then maybe 2 days ago now, the nursing home called 911, and I know the ambulance was sitting in the parking lot for a long time, and I was told later that they couldn’t find her DNR paperwork – so I suspect that what occurred is exactly what you are writing about – I don’t know if they had to temporarily intubate her (she wasn’t back on a vent at the hospital) or if they were doing some sort of code, but I do know that whatever they did wouldn’t have been done if the nursing home had provided the DNR paperwork.

    Today, they removed her 2L NC. She’s no longer eating. She is receiving pain medication, but here’s the latest. I talked to my grandma around dinnertime today, and she tells me that my aunt was turned this morning and given pain medication in the morning, but then despite my aunt and grandma asking for assistance, nobody touched my great aunt again until dinner time. I was so upset… Apparently they are now giving her less morphine, even though she is flailing her arms up into the air from pain at times. When they finally turned her, they did rub her back a bit, and they determined she didn’t have any breakdown. I told my grandma they should be turning her at least every 2 hours – my grandma said, “That’s certainly not happening!” I also told my grandma they should find out how often my great aunt Connie (I know you actually read a post I wrote about my great aunt back in September – remember the one who always wore high heels and then had the achilles shorten??) can get morphine, and when that time comes – ask if she can have more pain medication. I told my grandma that the nurses and docs need to be medicating her pain better and not leaving my great aunt to die in all this suffering.

    It makes me cry just to write this. I wish I were there. I hate that they are just letting her lie there, not even caring. When she was in the step-down unit after coming off the vent, the nurses told my grandma that it wasn’t their job to help feed my great aunt, so basically if she couldn’t feed herself (which she couldn’t), then nobody was going to feed her unless my family was there to do it. I was so angry. I’m almost considering writing a letter, but the thing is that all the info I have is based on second hand info I get from my grandma.

    It has ALWAYS broken my heart to see older people just discarded or not cared for simply because they are too much work or annoying or considered a burden. I feel my heart breaking now as I hear what has happened to my great aunt. At this point, I’m praying for her to die so that she can be in peace – and no longer tortured by all the things they are doing/not doing to care for her. I know my family is doing everything they can for her – but they only know so much. They’re using the little swabs to wipe her mouth, and apparently my great aunt gave some kind of sign that this was a comfort to her. Just listening to my grandma talk about what is going on was just making me feel so sad….

    I love my family – and it pains me to hear that those working in a caring profession don’t even see that she is a person. They just see a body there, and they don’t seem to really care how she is treated. It isn’t the case of my family just wanting her to be kept alive. They are doing everything they can to make sure my great aunt is comfortable while she dies. They had established the DNR and the advanced directives – they had done everything as best they knew how. Yet still it can end so badly. I hate it…

    Sorry to ramble/rant on. Obviously something really close to my heart right now….

    Take care,

  • CardioNP

    March 4, 2007 at 10:13 pm

    Perhaps Joint Commission should work on reconcilliation of advance directives/DNR orders rather than medications.

    An NP friend went to visit her frail 90 yr old mother last week (they live in different states). I asked if her mother had a DNR – she did. I then asked if her care home/primary MD had instructions re: DO NOT HOSPITALIZE. She did not know.

    When an elderly patient with multiple comorbidities becomes ill it usually results in a prolonged terminal hospitalization with huge resource utilization.

    A lot of unneccessary care and suffering could be avoided if more family members specified that transfers to a hospital were to be avoided and comfort care given at the nursing home.

  • Markie

    March 4, 2007 at 10:23 pm


    As always, you’ve chosen a topic with deep resonance and importance to not only the nursing profession, but the people themselves.

    I would recommend people making a small investment and doing something like 5 wishes ( if it’s usable in your area.

    Get a copy for everyone in your family out of their teens. There’s no telling when you’ll be in a position where your choices and wishes can’t be communicated effectively.

  • Mother Jones RN

    March 5, 2007 at 5:17 am

    A worked in a nursing home once and met a lady there who didn’t want to be brought back, so she framed her DNR papers and hung the frame over her bed. She told everyone she wanted to “go to heaven” and if tried to stop her, that she would come back and haunt them. I thinks it’s shameful what we do to people who are old and sick, and who just want to be left in peace.


  • emmy

    March 5, 2007 at 10:31 am

    These stories are heartbreaking. But for me they are also down right frightening. I have a DNR and a POA. I have filed a copy with the local EMS in the county that I live and have given copies to the 5 hospitals that I most likely would be transported to. I’ve given copies to my PCP, Surgical and Medical Oncologists, Infectious Medicine Specialist and the Hospitalists whose services I’m usually placed with. Still I’m told that I stand about a 99% chance that it will be ignored. Short of having the thing tattooed on your chest, what can you do?

  • Andrew

    March 5, 2007 at 10:53 am

    More full codes at work uh?

  • Alyson

    March 5, 2007 at 1:37 pm

    Luckily when my mom was dying she was in hospice care so we didn’t have to worry about a DNR but my husband and I ran out and got DPOA for health care on each other and explict instructions on DNR, up to and including whether we felt that feeding tube fell into that category (a la Terri Schaivo).

    I’m still trying to convince my dad and stepmother as well as my in laws how important a will/trust/POA for health care are as a set of documents. Sometimes the older one gets the harder it is to face what will become reality soon rather than later.


  • The Angry Nurse

    March 5, 2007 at 5:01 pm

    I was a great ICU nurse until one day I did one too many codes! Not that things are any better now that I’m in emergency! At least I don’t have to stare at the results for weeks on end or listen to the family try to justify what they have demanded we do because they can’t face the reality of the situation or because it hasn’t happened at the right time for them! As if there is a right time for this stuff!

    Personally I’m planning on having DNR tattooed on my chest and forehead! It may not actually work to stop them, but at least they may get a laugh out of it, to bad it will be at my expense!

    I also took the added step of having my personal directive amended to remove any blood relative from having medical power over me and assigned binding power of attorney over to a list of people I trust to make the right decisions! The ability to do so will vary from jurisdiction to jurisdiction, but it never hurts to make sure who the say in the end.

  • TC

    March 7, 2007 at 6:59 am

    Forget DNR’s! Do you know how many nursing home pt’s I’ve taken care of that had “Don’t hospitalize” orders? It’s shameful. I think the NH’s send them in because they don’t want to deal with them. I know there are good places out there, and good staff in them, but I’ve taken care of too many elderly people with dried poop on them.

    And when you’re having that conversation with your family, don’t forget to bring up organ donation….I just had to throw that in.

  • Marci

    April 5, 2008 at 7:00 pm

    The tatoo thing sounds great to me. I sometimes think we should have some sort of monitor or tatoo with our medical information. How hard would it be to tatoo your blood type on the bottom of your foot? Seems nutty but if it saves even one life…….

    Take care


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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