A Definition of "Heroic Measures"

Heroic measures. What do these words mean? In a hospital, when this phrase is heard, it means that if a patient's body tries to quit, a group of people will do everything in their power to keep the person alive. The group of people is the "code team". There are doctors, nurses, nurse's aides, x-ray techs, and respiratory therapists on the code team. Their goal is to keep you alive, according to your wishes. It will be assumed that these are your wishes unless there is a POLST or DNR in your chart, signed by yourself and your physician. Basically, A POLST/DNR says, "Let me die naturally, according to the function of my body". It means "no heroic measures".

So we are back to heroic measures. Rather than explain, let me paint a picture for you to envision. Imagine that you have been ill enough to need to be in the hospital. There you are, sitting in bed when suddenly, you collapse. Now imagine you float to the ceiling and can observe the chaos. The first person to recognize your apparent collapse calls out, "call a code" and it goes out over the intercom, in hospital speak, calling all the code team to your bedside. While the call goes out, that person approaches you in the bed. They put their fingers to a spot on your throat, checking for a pulse. Finding none, they will lie the bed flat while and call for "a board". If you have no pulse, you aren't breathing either. You are clinically dead. Lucky for you, somebody noticed as soon as you collapsed, so you are getting immediate help.

The next person to enter the room is carrying the stiff backboard that's been asked for. Together, they roll you on your side and slide the board underneath you, letting you roll back onto your back. By then third, fourth, fifth and sixth persons have arrived. The first two persons begin CPR, "pumping" on your breastbone in an effort to force your heart to pump by squeezing it between your back and your breastbone. Compressions are not done gently. Ribs almost always break. The person giving the compressions feels them go and keeps right on pumping. Broken ribs can be a problem, but a broken rib can heal, along with the complications that come with them. You will stay dead if they stop. The other of the first two people is usually a respiratory therapist. That person has placed a silicone mask over your nose and mouth. The mask is connected to a ventilating bag connected to oxygen. They are breathing for you, in rhythm with the person who is giving compressions.

The third person is a Doctor, who begins giving instructions, doing what is called "running the code". Despite the doctor's presence, the entire code team has been so well drilled in classes every two years, that everyone in the room knows the steps, especially their own. To the untrained observer, it looks like chaos, and in a very real way, it is. However, it's a rehearsed and controlled chaos and everybody knows their part.

Person numbers 4 and five are nurses, like the first person, and each takes an arm and begins to try to get a large-bore IV into it. This is not easy when there is no pulse, no blood pressure. I know nurses who specialize in this very skill, and those are the ones whose smiling faces I look for in codes). Person number 6 will often act as the scribe. This is the person who writes down everything that happens during the code, (including meds with their times given, as well as shocks and their strengths and times) may be the scribe is usually a nurse.

By now all extra help has arrived. Others enter and help where they can: maybe they run to get more supplies as they get used up, for example). Every respiratory therapist working in the hospital respond to all codes, (with the exception of the ICU therapist.) One respiratory therapist has shoved a laryngoscope down your throat and is trying to put in an artificial airway to make certain that you can get enough oxygen (so that you don't have brain damage from a lack of oxygen), and remember, you are still clinically dead, we need to breathe for you as all around you, efforts continue. You are still limp and unresponsive. No pulse.

A large (usually red) cart was wheeled into the room by the fourth person. The cart has lots of drawers with "code meds" in handy, ready to use units and other code supplies in the drawers. On top sits something that looks like a tiny old fashioned TV on top. It's a defibrillator. It "shocks the heart". Someone slaps some conductive patches onto your chest, the doctor says how hard to shock your heart, everyone steps back, not touching you or the bed, and you get the shock. It makes your body jump. But immediately after, everyone goes right back to what they were doing. CPR continues. One of those gifted nurses got a good IV going, so now the doctor is ordering drugs for your IV. These are drugs that will help your heart to stay started if a shock gets it "jump-started".

Let's say that the team "got you back" after 2 shocks. You are still not responsive. The doctor orders drugs to keep you sleeping. While you are getting stabilized, once your heart is beating and your breathing is ensured, the nurses and respiratory therapists get you all cleaned up and get you settled into your room in the ICU. The ICU respiratory therapist is waiting for you with a machine called a ventilator. Lots of new faces, but you won't see any of them for awhile. A nurse lubes a little tube up and slides it into your urethra, (pee hole), and up to your bladder, to drain your urine, because you can't do this yourself right now. A special pad is placed under you from your waistline to your knees. This will simplify clean up if you have a bowel movement.

While the nurses are getting you all wired up to be monitored, and setting up the IV meds the doctor ordered, the respiratory therapist is getting the settings on your ventilator set just right for you. They tell the machine how often to give you a breath and how big the breath will be, stuff like that. Then the respiratory therapist puts a smaller tube down your breathing tube and your body responds to this invasion by jerking a bit and you gag/choke while the therapist uses that little tube to suck the phlegm, out of your lungs. This is done to ensure that phlegm doesn't clog up your breathing tube. If you already have diseased lungs, or you are a long-term smoker, you probably will have more "gunk" than normal people and you will have this procedure, this "suctioning", more often than a young person with healthy lungs. It a cruel-to-be-kind type of thing. Nurses and other healthcare professionals are cruel-to-be-kind. If you are to recover, they must be. These people were my tribe for many, many years.

While you sleep, if we didn't know why you tried to die, the doctor has sent blood tests to the lab to help him figure out what happened, (again, if we don't already know. Most of the time, we know). Maybe we took you to the CT lab and took images of your insides. You won't know any of this. It takes a team to take you to the CT scanner while you are connected to a ventilator and monitors and IVs, they move you from your bed onto the CT scanner table. It's challenging, but they know how to coordinate with each other. You get your scan and then it all goes in reverse to get you back onto your bed and down the hall, we go back to ICU.

If something needs to be treated, you get treated. Then the doctors let you wake up by stopping the sleeping drugs, and we see what we can see. If you act appropriately, (follow commands, make eye contact, nod your head), and we can get you to cooperate, we will try to get your breathing tube out, as long as your lungs are healthy enough. If you don't act normal when you are awakened, they put you back to sleep and run more tests. This is often understood by non-medical people as a "drug-induced coma".

If you have pneumonia or COPD, that could be why you "coded". You will wake up with that tube in your throat and both nurses and RT's will suction your phlegm and you will hate it. Sometimes, not often, but now and then, a patient actually throws up from being suctioned. But it can't be helped. If you have an artificial airway, we must keep it clear, for your survival. It's one of those "cruel to be kind" things that have to happen to help you recover. If your heart is why you "coded", there will be trips to the "Cath Lab" so heart doctors can explore your heart's blood flow, and, if it's threatened, they can often fix it, right there in the Cath Lab, by placing a stent in the narrowed area.

As I mentioned earlier, broken ribs have complications. A broken rib can puncture a lung, causing it to deflate. This will become an emergency and threaten your life again if it is left untreated. So while you are asleep, the doctor cut you between your ribs and stuck a large bore plastic tube into that and pushed it in until the lung began to re-inflate. Then he stitched it into place. So when you wake up, you might have a big old garden hose sticking out of your body for a few days. It hurts. It makes you not want to take deep breaths. You MUST or you will get pneumonia. Mean respiratory therapists and nurses come into your room and make you WORK at it and at coughing, and that hurts too!

If your lungs are diseased, or if your heart is very weak, you may have to stay on the ventilator, with the artificial airway and the suctioning, and maybe a chest tube (that's what the garden hose is called), for a few days, sometimes longer. Don't forget the tube in your bladder that can be uncomfortable. Don't even make me tell you what happens if you have unrelenting diarrhea. Yes, there is a device for THAT. They might be "starving" you for testing purposes even after you can breathe on your own.

So, what I would like you to do now, the purpose of me writing this article, is to make you think about your life and your health.

Are you healthy as a horse, active, fully functioning, maybe you have some kids? Awesome. I completely understand when a person with this level of health would want the full treatment, the "heroic measures", which, by the way, come with huge price tags. But raising a child without a parent has a higher price tag. When you are still raising kids, staying alive can be worth a lot of suffering.

If you are sick, think about the quality of your life as it is, today. Ask yourself, what you have to look forward to. If all you can imagine is pain and suffering, maybe having to be "on a ventilator" for the rest of your life, or maybe having to have, say, open heart surgery. Ask yourself, "Do I want to live like that?" "Will I suffer more OR less by delaying my death?". If u have cancer everywhere, for example, and your doctors say it's time to "get your life in order", ask yourself, "Do I want to hang on through the pain until "...when? Discuss this with your family and with your doctor. Make your wishes clear and threaten to come back and murder whoever tries to muck with your plan.

If your loved one is sick, ask yourself, "Who am I saving them for?" "Is it humane or even fair to keep their body alive so a loved one can fly in to say their "Goodbye"? Because truth is, we live in such a litigious society, that the hospital will go against your loved one's SPECIFIC instructions, just so you don't waste their time and money with a frivolous lawsuit. HOW SAD. How angry/sad do you think your loved one would be to wake up on a ventilator, getting suctioned? Be honest. You're saving them for yourself. In which case, have MERCY.

I "have been on both sides of the bed" where this is concerned. I loved and married a man with a terminal illness. But before we became romantically involved, we were friends because he was my patient, (another story altogether), and when we began to socialize outside of the hospital, he asked me about codes. He really needed the information that I impart here because he knew he was dying, slowly.

I told him the truth. I owed him that much. He became a DNR. Then he became THE love of my life. I knew only too well what was happening to him. I loved him enough to respect his wishes. It was awful and it was wonderful. It was an honor and it was a horror. To me, it was the greatest demonstration of my love and respect, to deny my need for him, and let him go because he was suffering. He was in pain. I was merciful, I feel, almost heroic. Still, I miss him every single day. Still, love to talk about and remember him.

I tell you about my beloved because I want you to understand that these are my feelings and my perspective. But I have accurately described what happens in a code. I wish to provoke thought, and, if necessary, action. It depends on you and your family. What do you think and feel about death? Your sick loved one? Let them talk to you about these things. They are important decisions, and we all die. Death is a transition. But we have choices about how and when we transition (whether it takes place in a hospital, for example). I strongly believe in the importance of informed consent. Now you are informed.

If you/your loved one want(s) the full treatment, code, etc., do nothing! It's alright, you/they WILL receive the full treatment.

But if the full treatment is not desired, you must act. Make an appointment with your/their doctor about you/them "being a DNR", (Do Not Resuscitate). They will put it in your/their medical chart. That is the only way to prevent "being coded". I have been at many codes in my career as a registered respiratory therapist. I choose not to be "coded". I made it official.

One more thing: If you go into the hospital for surgery, and your body tries to quit during surgery, they will CODE you! Nobody dies on the table.