The first time I saw how cardiopulmonary resuscitation is done was on TV. I was a teenager – it was probably the American medical drama ER. Perhaps it was an accident.
There was always a crazy scene where a medic was pumping out the blood of a patient who had a cardiac arrest.
Someone broke in with defibrillator electrodes. Someone else would have yelled, “CLEAN!”
For a moment all hope seemed lost, and then the body came back to life. Relief all around. The patient was already up and talking or perhaps even heading home before the credits rolled. It was exciting, dramatic and glamorous.
Years later, as an aspiring doctor working on an ambulance crew in hospital wards, I saw it and did it for real – and it couldn’t be more different.
CPR, or cardiopulmonary resuscitation as it is officially called, is cruel and undignified.
It is given when the heart stops, that is, in fact, the patient dies, in the hope that this will bring him back to life. But it almost never works because it is usually done on the sickest and most debilitated patients in the hospital.
Their clothes are pulled off so the emergency crew can put the oars on their chests, and there are medical personnel everywhere.
Some feel for a pulse, others remove blood and vomit. It’s noisy. Someone shouts out the number of chest compressions, doctors grunt, pressing. Rib fractures are incredibly common due to the force required to start the heart – you can hear the bones breaking.
If the patient’s heart begins to beat, they may be left with bruises or bleeding lungs. And damage to the brain and kidneys is not uncommon, due to the time spent without the heart pumping blood throughout the body.
In 80% of cases of successful CPR, the patient never leaves the hospital.
DRAMATIC: Cleaned-up TV version of CPR shown on ER with George Clooney (right).
Two-thirds of them die within a few days. About two percent remain in a long-term vegetative state – neither dead nor truly alive.
Once I brought someone back when I was working in the emergency room, the person was in intensive care for two weeks. Then we realized that he would never recover, and we had to turn off the ventilator. It was terrible for his family.
Later, as a breast cancer surgeon, I had to discuss all this with patients. Whether we want to be resuscitated if our heart has stopped is a common question doctors ask when they hospitalize someone.
This can be worrisome. But it’s important, if someone is particularly ill and not going to get better – for example, with advanced cancer – that they understand that if their heart stops, CPR will really, at best, just delay the inevitable.
Most recently, I had to face my own potential death after being diagnosed with breast cancer twice – first in 2015 when I was 40, and then again three years later.
Fortunately, my treatment was successful. But this experience pushed me to make some decisions about how I would like to end my life. That was not easy.
No woman wants to talk to her husband about how she might die before him. But it is very important that we communicate our wishes.
In particular, I made it clear that if I make it to the end of my life—if my cancer comes back and my heart stops beating—then I don’t want CPR.
Of course, if I had a sudden heart attack on the street tomorrow while I was fit and healthy and a defibrillator was around, I would really like someone to try it on me.
But this is because I really have a chance to recover.
There are chances that if I feel really bad – I’m cared for at home or in the hospital – even if CPR restarts my heart, my condition will get worse. And I don’t want to die like that.
I would like to lie in bed surrounded by my family, and not a team of doctors trying to bring me back to life. This does not mean that I will not be treated. By no means. But I just want the medical care to make me as comfortable as possible in the end.
LIZ O’RIORDAN: I’d like to be in bed surrounded by my family, not a team of doctors trying to bring me back to life. (archive photo)
Of course, there will be people with chronic diseases who think otherwise. They can say: I want to be given a chance, no matter what.
But it must be a decision made after consideration of the facts. And I’m all for it. Nobody can tell you what to choose.
For a healthy person whose heart stops suddenly, CPR, given for a few minutes, has a 10 to 20 percent chance of survival.
There is still a significant risk of long-term damage, but the benefits far outweigh that.
If a person has serious long-term health problems and their heart suddenly stops, CPR is less likely to succeed – the heart may restart, but the body is unlikely to recover.
And if a person has an incurable disease, if they die, and if there is significant damage to the lungs, liver and kidneys, CPR, in my opinion, is useless.
Restarting the heart cannot undo the damage already done by the disease.
Of course, like everyone else, I was horrified when I read, without prior discussion, that “no resuscitation” orders are written on the medical records of older people in nursing homes during a pandemic.
And I have heard of cases where doctors explained things poorly and caused suffering. Not all doctors have excellent bedside manners.
In the hospital, if you are too weak to tell someone what you want, the senior doctor may decide not to perform CPR if it will do more harm than good – and it can be difficult for loved ones to do this without first having a thorough conversation.
If you have a relative who has been hospitalized and is very ill, it is worth bringing this topic up. If the desire is to do CPR no matter what, doctors will do it.
And if, after thinking about it, you think that in some circumstances you may not need resuscitation, then there are steps you can take to let people know about it.
If you are already under the supervision of the medical team, discuss your wishes with them.
There is a form that your doctor will fill out and keep in your medical records called DNACPR – Do Not Attryt CPR.
This does not mean that you will not receive treatment, but if your heart stops, you will not try to restart it. This form is not legally binding.
If you want your relatives to know about your wishes, you can make a will to refuse treatment.
It can be changed. It is only used if you are unable to communicate. This is another way to make sure that the people close to you know about your wishes.
You can complete it online by visiting mydecisions.com. You then print it out and send or email copies to people who need to know.
Or you can call Compassion In Dying on 0800 999 2434 and they can post a hard copy.
You don’t need a lawyer – in England, Wales and Northern Ireland, medical teams are required by law to follow what is written on the form.
In Scotland, living wills are not legally binding, but physicians generally abide by them. And if you change your mind or want to change your shape, just create another one.
I bequeathed to life. It was unpleasant. But I’m happy that I won’t get CPR and get the death I want.