Wednesday, September 16, 2015

CODE: quilt

 (warning for long post, a heavy topic and some graphic descriptions)
One of my patients coded the other day.  For those of you fortunate enough to not know what that means, "code" is short for Code 44, which is what they announce over the intercom in the hospital when someone stops breathing/heart stops beating.  It's the signal for people to come help try to resuscitate.

After over 2 years as a nurse this was the first time one of my personal patients has coded.  I'm usually able to see them getting sicker and move them to a higher level of care, but the population we work with is so chronically ill at their baseline that they can turn pretty quick. 

We were able to bring them back, but they never regained consciousness and passed away the next day.  I don't like to be in on codes.  Normally when one happens on my unit I go gather the spouse or family and take them to our break room, give them a box of tissues and pass them off to the chaplain. Then I stay at the station to direct traffic and answer the phones. Being in there is too jarring for me.  The whole thing just left me feeling off for the rest of the weekend. 

Since the patient passed on a Saturday the chaplains' offices were locked and I didn't have any Covered in Love quilts.  Fortunately, the amazing Nancy (of the rail fence quilts) just donated me two finished quilts and I was able to mail one off the next week.

Nancy just got a long arm and we are the lucky, lucky recipients of some of her "practice" quilts
As we all know, when I feel off, when I'm stressed, I quilt. But more than that, I quilt as a direct response to situations like that one.  I know that as a nurse, Codes are part of what we do. We're supposed to keep people alive. And if they attempt to die, then we try to resuscitate them and keep keeping them alive.  

(Soapbox rant, if you want to skip it go down to the picture with the quilts)

But personally, I won't ever feel good about what we do in situations like that one.  The vast majority of Codes run in a hospital are on patients who are so old, and so sick. The dying process is the elephant in the room and no one, not the family and definitely not the doctors, wants to address it.  Dying is a natural part of life, it happens to everyone eventually.  And no, we don't want to hasten it. We're never ready to lose the ones we love.  But if you ask most people what they fear for death, they'll say pain, suffering, and being alone.  We're terrified not so much of dying as of the part right before.  Yet despite that, most people die in hospitals, surrounded by caring strangers rather than family, being poked for blood draws and IVs, restrained, with hard plastic tubes down their throats during the last few weeks of their lives, with aching chests and punctured lungs from CPR that only buys them a few more days of hazy consciousness and pain in the ICU and finally, when their body has absolutely had it, they die in a code (pardon me, graphic) naked in a room packed full of strangers with a nurse pumping on their chest, breaking their sternum and ribs, beating the literal crap out of them.

CPR works reasonably well for relatively young, relatively healthy people who have sudden cardiac events. That is what it was invented for. It was never supposed to be applied across the board. The success rates for CPR in any other demographics is abysmal.

No one who has ever seen a code wants to die that way, yet so so many people do.  Why? I guess because we don't want to talk about dying, and everyone assumes it won't happen to them.  Every patient that codes never thought it would be them either.  We tend to assume that when the time comes our family members will just know what we would want, but trust me, they don't.  Please, please have the conversation with your family members about what care you would or wouldn't want at the end of life. There are tons of resources online to help you get started.  

The Conversation Project can help you talk to your family. And while you're at it, read this article.  And remember, it's always too early, until it's too late.

Ok, end of rant. Thanks for anyone who hung with me though that.  I'm not trying to traumatize you, but here's the thing if what happens in hospitals at the end of life is too graphic to talk about, how can we let people send themselves and their relatives to it blindly, having no idea what they're going into? That's like saying 18 year olds are too young to watch a graphic shoot 'em up war movie, but then handing them a gun and sending them off to actual war.

We are working in my hospital to create a palliative care program that would help head off situations like these and improve end-of-life care, but it will be years before the program is up and running and the resources are barely a drop in the bucket next to the need.  We are working to create a better future, but what about the patients dying today? This is why I created Covered in Love, to do something, even a small something, for the patients and families that are suffering now. 

I had a basting party last Sunday so today I am working on quilting and binding the stack above, look for more of these quilts in future Friday Finish posts.  Thank you, as always, to anyone who has contributed blocks, tops, or quilts to Covered in Love.  If you would like to get involved please check out the main page.

Linking to WIP Wednesday at Freshly Pieced.


  1. Aloha! I am visiting from Freshly Pieced's link up. What am amazing project Covered in Love is. You have such a big heart. I love that the activity you do to relieve stress is to help people. Beautiful.

  2. You are so wise. Wise beyond your years.
    Having worked in the Trauma ICU as a nurse and before that as a respiratory therapist, I've been in on many, many codes. Often as an RT, I was the first one in the room until the code team arrived. Then later, in the ICU everyone rushes in to take part. Staffs that work in ICU's live for that adrenaline rush - I know that sounds awful but it's true for the most part.

    I've seen 97 year old's whose families refused to let them die in peace, insist that their loved one be coded and coded and coded. It's so sad, it breaks your heart. I understand they don't want to loose their mom, dad, grandma or whoever but to do that to a body that is obviously ready to go is just wrong.

    I agree with your rant. Working in the Trauma ICU, most of our patients were young - usually in the 14-45 age group and usually male. So, those code situations are different. But everyone needs to talk to their loved ones and let them know what they want. Or write a letter, anything so that they know. Especially if you have any kind of chronic illness.

    We never know what tomorrow may bring so it's best to be prepared. I know your program will be successful and I think that all of your patients are so lucky to have such a caring wonderful nurse.

  3. Your post is a great, must-read for all of us. As I enter my 6th decade of life, I realize how limited my remaining time is, and how important it is to let my family know my wishes for the process of dying. Thank you for a stirring post. And thanks for the wonderful work you do with Covered in Love.

  4. This is so true. I have never worked in the medical field, I'm not sure that I could have the strength that you do, but even being on the other end I completely understand. When my grandfather was dying, it was so hard for my grandma to accept and she just wanted him to live so badly. But even if he could have he wouldn't have wanted to. He would have had no quality of life. Everyone needs to discuss this and make discussions for their future. I love and respect the charity work that you do, trying to bring comfort to those that have lost loved ones.

  5. i am with you on the sent them off to war, maybe we should send some of our congressmen off to war and they woulds think twist about having one.. I don't think i could handle death nearly every day , lost to many of my loved ones

  6. My grandmother was resuscitated after a stroke, but she was never the same afterwards and did not have the same quality of life. She passed several years later in hospice care, but she no longer recognized anyone and was not able to do anything for herself. She was a very intelligent, independent and strong woman, and I wish that the end of her life had reflected that. My mother was closest to her, but her older brother, emotionally I think, made the decision to keep her on breathing support until she could breathe for herself again after the stroke. My mom said at the time she agreed with her brother, but now she does not. I think it depends on your experiences, and certainly a nurse in a hospital, or even an assisted living facility, has seen enough to understand the implications of trying to extend a life that will then go on without much actual living. Thank you for the resources and the conversation. Thank you for creating and continuing Covered in Love. So glad to know you through your blog and glad to help out every now and then with a few blocks for Covered in Love!

  7. Kat, your post and the information you shared are so, so important! Loved ones do not know and even if they do, if your wishes are not in writing, there is no guarantee they will be carried out. As you said, the sad fact is that those in the position to make the decision when there is no written directive, typically are in no way emotionally able to say enough.

    Hugs to you. I hope this post has helped you work through some of the feelings this experience has brought. If your post is the catalyst to just one person having this conversation with their family, you have accomplished so much!

  8. Thank you for what you do with your program and for this post. We just went through this with my Grandma and she had DNR.

  9. Respectfully, honestly, & sincerely expressed and written.
    As RN's, our focus is always on quality of life. This is often in direct conflict with the physicians determination to extend that life. As family members, we want our loved ones to remain with us... but as they were... often choosing to avoid acceptance of their current conditions.
    As all take on different roles, our patients wishes are often no longer considered unless they were in writing & notarized! Frankly, there is no time...
    Your charity allows a way for family to have some love to hold on to. Your words both a reality check and a warning.

  10. So true Kat. As a midwife thankfully we do not have many Codes but I feel with you. Such an important topic to have a discussion about. Tour Covered in Love Project is a brilliant cause. Hugs.

  11. So sorry for the loss of your patient! Fortunately, the nursing home we had some family in, made sure that their last wishes were met.