- Okay, those of us who work in healthcare
have seen some horrible, scarring things in our careers,
and it's weird because we're actually still afraid
to talk about these things with our patients
to prevent them from happening in the future.
So I am gonna walk you through one of these scenarios
that terrifies doctors and nurses
and people who take care of you and should terrify you
into actually doing something to prevent it.
Imagine this.
You have not talked about
what your wishes are at the end of life.
You've never had the conversation
because you think you're gonna live forever,
and something happens.
You're found unconscious,
the paramedics rush you to the hospital, and this happens.
You lose your pulse.
You stop breathing.
You're in the emergency department.
What happens next?
The nurse who notices this calls what we call a code
or a rapid response, and all hell breaks loose.
Every single person you can imagine in the hospital
shows up at that bedside:
medical students, nursing students, nurses, doctors,
anesthesiologists, pharmacists, everybody,
and this is how it goes down.
Someone checks for a pulse,
and they realize you don't have one.
They put pads on you to try to see what your rhythm is,
and they see you don't have a rhythm.
The next thing they do is they grab a student
and they put them at your sternum
and say, "Begin compressions."
And it looks like this.
They are on your sternum pushing hard on your chest.
Presumably you're unconscious, but if they push hard enough
you just might get enough circulation
to be peripherally aware
of the rest of the torture that's about to happen.
At this point one of the attending physicians
sees that this guy's pushing on your chest
and says, "You're not doing it right.
"You need to push harder and faster."
Two to three inches and you start to hear the ribs crack.
At this point someone's at your head
pushing your head back into a jaw-thrust position
and taking something called a laryngoscope
because you're not breathing.
They need to do something ASAP.
They don't have time to worry about
whether this metal crowbar
that they're using to pry open your airway
is gonna crack your teeth
or cause any damage to your soft tissues.
They are gonna pry it open
to take a look at your vocal cords,
and then they are gonna pass in a tube about this big
into your airway and start bagging you.
They might miss first.
They might go into your esophagus,
in which case your stomach will hyperinflate
and get distended until they figure it out,
pull out, and put it back in.
At this point there's yelling and there's shouting,
and they start to figure out we need to get IV access
so we can give you drugs to get your heart started
and get your blood pressure back up.
Well, where are the easiest places to go?
If we can't get an arm because you're dehydrated
or you're in shock, we're gonna go in the groin.
And at this point an intern or a resident
is gonna start poking around
with a needle about this big in your groin.
Blood will be going everywhere.
They might hit your artery in their rush to find the vein,
in which case you'll get a big bunch
of blood under the skin there.
They'll then fish in a wire into your vein
and put in a catheter and stitch it into your groin.
At this point they're squeezing you full of medication,
some of which your body makes naturally under stress
like epinephrine, which if you were aware
of what a super therapeutic dose of epinephrine felt like,
it would feel like an elephant was standing on your chest
and you were about to die.
At this point the cracking ribs is still going on,
they're squeezing air into your chest,
and they've hopefully given you something
to sedate or paralyze you, but that's not always guaranteed.
And if you're even peripherally aware
because of the little bit of circulation you're getting,
it is gonna feel...
We talk about waterboarding in this country.
Oh, that is child's play compared to the torture
that you are undergoing right now.
But here's the kicker.
If you survived this so far,
and by the way, that's not guaranteed,
you may die right then under torture,
you may wake up in a clinical setting with beeping machines
and a person staring at you that you've never seen,
unable to speak, unable to move,
but aware enough that you can notice the horrible situation
that you are now in.
There may be a tube in your rectum
to take care of the number two.
A ventilator may be breathing for you,
so you have no control and you feel that hunger for air
but you have no control of your own breathing.
All of these things you might wake up to and worse.
Tubes, wires, chaos.
And it's no wonder that even people who survive the ICU
often have post-ICU psychosis
and PTSD from their experience there.
Now in the setting of all this
you might still die in that setting, and all of this
is entirely preventable by you.
All you had to do was tell someone you cared about
that you determined is gonna make decisions for you
when you can't what your values and wishes are.
If you're a 38-year-old guy
and you think that the CPR might get you healthy again,
you may tell them do everything until it looks like
the doctors are saying it's not gonna work anymore.
In which case I want you to stop, make me comfortable,
give me medicine to keep me comfortable,
maybe take the breathing tube out,
give me full-flow oxygen, and let me pass.
Allow natural death, A-N-D.
But what if you're 80 or 85 and you have dementia?
What if you have cancer that's terminal?
What if you have another terminal condition?
Would you even want to go down this route
and die like 20% of Americans do
in a critical care bed surrounded by strangers
in the coldest place you can be in?
That is entirely preventable,
and this is what infuriates me as a hospital
is seeing this ball dropped time and time again
and being forced by protocol and by law
to torture people until they die.
You can stop this.
It always seems like it's too soon until it's too late.
Pick someone to make decisions for you
that won't be blinded by emotion when the time comes,
and then tell them what your values and your wishes are
around resuscitation, around heroic efforts,
around how long you want them to try.
And if they understand what your values are
they can parse them in real time when the time comes.
And let them know you love and appreciate them
for taking on this burden.
Do it today before it's too late.