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CPR is brutal, undignified… and few survive it. That’s why I’ve had Do Not Resuscitate written on my medical notes, writes former cancer surgeon Liz O’Riordan
The first time I saw CPR being performed was on TV. I was in my teens – it was probably the American medical drama ER. Maybe it was Casualty.
There would always be a frantic scene of a medic pumping away at a patient whose heart had stopped.
Someone would rush in with defibrillator paddles. Someone else would yell ‘CLEAR!’
For a moment, all hope seemed lost and then the body would jolt back to life. Relief all round. The patient was up and talking, or perhaps even heading home, before the credits rolled. It was gripping, 7060 allis chalmers head gasket dramatic and glamorous.
Years later, as a fledgling doctor working on a crash team on hospital wards, I got to see it and do it for real – and it couldn’t have been more different.
CPR, or cardiopulmonary resuscitation as it’s formally known, is brutal and undignified.
It’s given when the heart stops – so in effect the patient has died – in the hope that it will bring them back to life. But it almost never works, because it is generally carried out on patients who are the sickest and the most frail in the hospital.
Their clothes are pulled off so the crash team can get paddles on their chest, and there are medical staff everywhere.
Some are feeling for a pulse, others are cleaning up blood and vomit. It is noisy. Someone is shouting out the number of chest compressions, doctors grunt as they press down. Rib fractures are incredibly common because of the force needed to start the heart – you can hear the bones break.
If a patient’s heart does start beating, they may be left with bruised or bleeding lungs. And damage to the brain and kidneys is not uncommon – because of the time spent without the heart pumping blood around the body.
In 80 per cent of cases where CPR is successful, the patient never leaves hospital.
DRAMATIC: The sanitised TV version of CPR, as seen on ER, with George Clooney, right
Two-thirds of them die within a few days. About two per cent are left in a long-term vegetative state – neither dead, nor truly alive.
The one time I did bring someone back, when I was working in A&E, the man was in intensive care for two weeks. Then we realised he would never recover and had to turn off the ventilator. It was horrible for his family.
Later, as a surgeon specialising in breast cancer, I had to discuss all this with patients. Whether we want to be resuscitated if our heart stops is a routine question doctors ask when they admit someone.
It can feel alarming. But it’s important, if someone is particularly ill and not going to get better – with late-stage cancer, for instance – that they understand if their heart stops, CPR really will just delay the inevitable, at best.
More recently, I’ve had to face up to my own potential death, after being diagnosed with breast cancer twice – for the first time in 2015, when I was 40, and then again three years later.
Thankfully, my treatment was a success. But the experience spurred me into making some decisions about how I’d like my life to end. It wasn’t easy.
No woman wants to talk to her husband about how she might die before him. But it’s vital we make our wishes known.
In particular, I have made it clear that if I reach 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 out in the street tomorrow – while I’m fit and healthy – and a defibrillator was close by, then I would absolutely want someone to try it on me.
But that’s because I’d actually have a chance of recovering.
The chances are, if I’m very unwell – whether I’m being cared for at home or in hospital – that even if CPR did restart my heart, I’d be in a worse state. And that’s not how I want to die.
I’d like to be in bed surrounded by my family, not a team of doctors trying to bring me back to life. It doesn’t mean I won’t receive treatment. Far from it. But I just want medical care to make me as comfortable as possible at 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. (file photo)
Of course there will be those with long-term health conditions who think the opposite. They might say: I want to be given a chance no matter what.
But that needs to be a decision that’s made after considering the facts. And I’m all for that. No one can tell you what to choose.
For a person in full health, whose heart stops unexpectedly, CPR, if given within minutes, offers a ten to 20 per cent chance of survival.
There is still a significant risk of long-term damage, but the benefits far outweigh this.
If a person has serious long-term health problems, and their heart stops unexpectedly, CPR has a smaller chance of success – the heart may restart, but the body is unlikely to recover.
And if a person has a terminal illness, if they are dying, and if there’s significant damage to the lungs, liver and kidneys, CPR is futile, in my opinion.
Restarting the heart cannot repair the damage already done by the illness.
Of course, like anyone, I was horrified to read of ‘Do not resuscitate’ orders being written on medical files of elderly people in care homes during the pandemic, without prior discussion.
And I have heard of cases where doctors have explained things badly and have caused distress. Not all doctors have an excellent bedside manner.
In hospital, if you are too poorly to tell someone what you want, a senior doctor may decide not to administer CPR if it would do more harm than good – and loved ones can find this difficult without careful conversations beforehand.
If you have a relative who’s been admitted, and is very unwell, it’s worth raising the subject. If the wish is to have CPR, no matter what, doctors will honour that.
And if, having thought about this, you think that you might not want to be resuscitated in some circumstances, then there are steps you can take to make sure people know.
If you are already under the care of a medical team, discuss your wishes with them.
There is a form your doctor will fill in to keep in your medical notes called a DNACPR – Do Not Attempt CPR.
This doesn’t mean you won’t get treatment – but if your heart stops, there will no attempt to restart it. This form is not legally binding.
If you want to make sure your relatives know your wishes, you can create a living will that lets you refuse medical treatment.
It can be altered. It’s only used if you’re unable to communicate. It’s another way to ensure people close to you know your wishes.
You can fill it out online, by visiting mydecisions.com. You then print it off, and post or email copies to people who need to know.
Or you can call Compassion In Dying on 0800 999 2434, who can post a paper version.
You don’t need a solicitor – in England, Wales and Northern Ireland, medical teams are legally bound to follow what’s written on the form.
In Scotland, living wills are not legally binding but doctors generally honour them. And if you change your mind or want to amend your form, simply create another.
I made a living will. It wasn’t pleasant. But I’m content to know I will be spared CPR – and have the death I want.
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