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.