Confusions Over that CPR Incident

POLST(This is from the form used in my state.)

Some of my friends have been asking me to react in print about the case of Lorraine Bayless, who died Feb. 26th.  Now that more of the facts are known, I can admit that I was misled by news reports, as most everyone else was.

How the Media Spun the Story:

An 87 year-old woman collapsed in the dining room of the nursing home where she lived.  A nurse on staff at the facility immediately called 911.  The 911 dispatcher assessed that the woman needed CPR, but the nurse refused to perform it, nor would she seek others to assist in her place.  The nurse cited a policy that the staff was not allowed to perform CPR at the facility.

All over the country people have been reacting with shock and anger, demanding investigations and penalties.  Legislators, pundits and advocacy groups have been piling on.  The case raises a number of important issues.  Unfortunately, the issues being focused on don’t fit what really happened.  The story was prematurely, incorrectly reported, possibly intentionally, to make it more sensational.  This is an instance of a little knowledge being a dangerous thing.

The Story’s Inaccuracies:

1.)  It didn’t happen in a nursing home.  It happened at an Independent Living community.  Independent Living means apartments for seniors, with concierge amenities, no medical staff, no medical care provided.

2.)  The 911 caller was not a medical staffer.  The fact that she is a nurse is coincidental.  Her job was as a director of Resident Services.

3.)  The woman did not need CPR, and it would not have helped.  The 911 dispatcher concentrated her assessment solely on whether or not the woman was breathing, and did not proceed to check other symptoms.  She got sidetracked and engaged in an argument with the caller, trying to force her to get someone else to do CPR.  If the woman’s other signs had been checked, it may have eliminated the incorrect assumption that this was a heart attack.

Facts That Have Emerged:

1.)  Lorraine Bayless died from a thrombolytic (ischemic) stroke.  She was attended by her doctor less than 20 days previously.  The same doctor gave the post-mortem diagnosis.  The patient was aware she had occluded carotid arteries in her neck.  Advancing atherosclerosis caused the formation of clots, and they traveled to the brain, triggering the cerebrovascular accident.  If she had survived the stroke, her chances of full recovery would depend upon reaching a hospital-based stroke unit within three hours.  Nothing anyone could have done in the room where she collapsed would have helped.

2.)  The patient did not want her life prolonged by heroic measures.  Her family has confirmed that she was aware that if she had a health emergency, no medical staff or equipment would be available.  If and when something happened, she wanted to be allowed to die naturally.  The family has expressed regret that the media invaded the privacy of their grief, and they hold the facility and the nurse who called 911 blameless.

There’s been some grumbling about punishing the 911 caller for refusing to act or get someone else to do what the dispatcher wanted.  Was she aware of the woman’s wishes to be allowed to die?  Was she able to observe other stroke symptoms such as hemiplegia?  The incident is under internal and external review, but since the family believes the nurse acted correctly, there’s little likelihood of a negligence lawsuit.

Even though I only worked with terminal seniors for a year, I learned some important things I didn’t know before.  Many older people want to avoid entering hospitals, no matter how sick they are.  They have deep fears about ending up helpless, sustained by life-prolonging equipment.  The mere mention of all those tubes and wires upsets them.  It makes them feel like they will be an imprisoned living experiment, kept around for mad scientists to torture.  That’s one reason some seniors prefer to live where there’s no medical assistance.  The other big reason is that it’s much cheaper.  Assisted Living facilities cost several thousand dollars a month to live in, if you want a room by yourself.

The best way to make your wishes known is to provide a legal document detailing what you want done under what circumstances.  In my state it’s called a POLST form (Physician Orders for Life Sustaining Treatment).  Other places call it a DNR, for “Do Not Resuscitate”.  Some Independent Living facilities require them.  Some don’t.  Lorraine Bayless hadn’t filed one.  It might have prevented some of this controversy over her death, though it appears in this case that those on the scene where she died did exactly as she would have wished. 

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28 Comments

Filed under Emotions, Ethics and Morality

28 responses to “Confusions Over that CPR Incident

  1. I hope the media will correct any of their inaccuracies and make the relevant facts known.

  2. The media correcting something…if you’re lucky a small little article on Page 5 of a paper.

  3. Thank you for this. It is exactly what I thought when I first heard the story. The fact that the family was not at all upset by the situation really gave it away for me.
    The “media” loves stories like this. It ups the level of terror and a high level of terror is necessary if the population is to be controlled and predictable.

    “This happened to her, so, it can happen to me.” Nothing makes people suspicious and less tolerant of “others” than being reminded of the fact that they are mortal. Terror Management Theory is abundantly clear on that.

    Thanks again
    Mrs. N.

    • I haven’t heard of Terror Management Theory, but that’s an intriguing point to add, so I’m glad you did. Getting fooled by a news story sometimes triggers a kind of compulsive behavior in me you might call “research frenzy”. Reading that the family were happy with what happened made me wonder “Why is everyone else upset about it?” I listened to the 911 call a dozen times before picking up on the dispatcher missing the likely diagnosis by stopping at one symptom. I thought it was all about a heart attack too! The news certainly implied it was. Then boom, her doctor releases the post-mortem. Well, thanks for weighing in, Mrs. N.

  4. Well, it had been sensational. I read about it after I saw a bunch of reporters setting up in front of the gates of the facility. Good to know this part of the story.

  5. Does anyone believe the media any more? This was interesting!

    • Glad you enjoyed reading it. I’m quite gullible. I fall for media stuff all the time, so I do a lot of fact-checking. Fortunately, I’m also cheap. People can fool me, but I probably won’t give them any money.

  6. Until I worked in a library that had resources on emergency medicine for paramedics (the library served firefighters /paramedics as part of our client base), I was not aware of DNR concept.

    I wish people weren’t so afraid of hospitals. I realize the cost of health care in the U.S. might be a serious deterrent for people seeking medical care at a hospital.

    What does help is to have a family member or close friend (long standing) who advocates on behalf for you/person should they suddenly need to go into the hospital.

    My opinion is very different: I have several siblngs who worked in major hospitals over the past few decades: a doctor-sister who is an emergency services doctor, a pharmacist-sister who works as a hospital pharmacist and also gets involved in clinical drug trials for research projects, another sister who is a receptionist at a pediatric cancer dept. and finally a brother who works in IT with a mental health health care facility. They are all in public facilities, funded largely by the Canadian govn’t.

    Anyone who is against Obamacare is crazy. It just compounds many life threatening situations where it may be fear of hospitals, but also fear of health care out of pocket costs for the patient.

    • I think it’s “all of the above” that you refer to, Jean. Many seniors have an irrational fear of dying. They believe if they never enter a hospital it can be put off. In the US, the cost of dying is greater than the cost of living, so that’s part of it too. I don’t think people who oppose the Affordable Care Act are crazy as much as misinformed, and possibly resistant to change, no matter what kind (NIMBY Syndrome). Some do dogmatically oppose anything Obama is in favor of, but I try not to focus on that. I like the philosophy of Hospice care, and that can often be performed in your own home. Thanks for coming by and contributing!

  7. I hadn’t heard about this, but you portray the truthful side of the story very eloquently. It’s such a pity that this poor woman’s death has given birth to such controversy, I’m sure this isn’t what she would have wanted to happen.

    • The story died within a few days, once the facts came out. I thought it was a particularly clear example of how to distort a story to appeal to the emotions, so it was worth a post. This sort of nonsense goes on in news all the time. And I agree with you that she wouldn’t have wanted it, as does her family.

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  9. A helpful post on many levels! Don’t believe everything you read/hear on the news. Don’t jump to conclusions. Don’t be quick to blame. And make your wishes known.

  10. Very glad you wrote this. I love when peple clear up the misreports. Good for you.

  11. Very interesting to hear your impression of seniors fears regarding the hospital. I’m with those seniors who would prefer not to enter a hospital unless absolutely necessary. Thanks for clarifying this incident!

    • I think most of us want to posess the illusion that we are in control of our lives. And sometimes we are! But unanticipated things happen to everyone and we have to adapt, and we aren’t usually happy to have to do that. A nice cultural shift is the emergence of hospice care, so you can be aided in the process of dying at home. Dying can be difficult to do all by yourself, but it usually need not be as complicated as hospitals have made it (again, because of our desire to keep control of everything).

  12. Unhappily, the media is not known for correcting stories so thanks for the info. Also, I appreciate your stopping by my blog, Washington Freak Show, and for the like.

  13. Hello Invisiblemikey,
    I know what you mean, So I have no idea what to do i went to a trade school and i came out with a 16000 dollar loan back to the school but i found out my cpr is useless(not so worried about this) but my MA certificate is useless i cant use it anywhere, Ive read all over the internet the school i went to is a scam.. Should i contact a lawyer for fraud?
    I look forward to your next post

    • (This SPAM of the DAY winner was a disguised DSL sales offer)

      There must be thousands of MA trade schools that are not properly accredited. If their program doesn’t guarantee qualifying you to take the standard national certification test from AAMA, a CMA certificate, it’s a scam. I can’t personally advise you about what good (if any) getting a lawyer would do. I haven’t had to myself.

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