The Violence of A Second Chance: CPR and Resuscitation

When someone ‘codes’ on TV, everything is over and done with before the next commercial break.  In real life, it’s a horrendous process that generally creates more problems than it was supposed to fix. When I worked in hospitals or doing admissions at a nursing home, I often had to explain what goes on; people just aren’t familiar with what CPR does and doesn’t do.  There isn’t a good place to go for information in ‘real life’ terms.  People really don’t have the information to make informed decisions. That bothers me as a nurse.  The following may be more than some people want to know. But I’m throwing out what I’ve witnessed and learned since becoming an RN in 1985.

CPR was developed by a guy in Norway after witnessing the drowning of a young person (I believe under 20 years old) who was otherwise healthy. That was the original intended demographic for whom CPR was developed- and it’s still the group with the best outcomes.  The main cause for infants and children to need CPR is respiratory failure- which is usually easier to fix than when the heart stops for other reasons.  For most adults, CPR is needed for cardiac (heart) reasons, and the survival rate – and return to previous level of functioning– is %5 at best. For the others, either it doesn’t help at all, or the person is left in a vegetative state for years, requiring long term care in an institution.  Nobody talks about that.

When CPR is done correctly, it can fracture ribs, puncture lungs, lacerate the liver, and still lead to brain damage or death.  When someone is pumping on someone’s chest, the pressure has to be enough to move blood in an immobile circulatory system (blood vessels and heart). That pressure can also cause cells to rupture under the pressure, leading to stroke-like brain damage. People get out of being criminally assaulted with less damage. But, it’s the only way to have a second chance for someone whose heart has stopped.

With the newer ‘compression-only’ CPR (no rescue breathing, like before), there isn’t the same amount of oxygen being circulated. That’s a problem in my humble nursey opinion- but it’s the new standard being taught.  In a hospital setting, or when EMS arrives in an out-of-hospital setting, they generally ‘intubate’ someone immediately (put a tube into the person’s windpipe) and hook them up to oxygen so it can get to their lungs, which will send oxygenated blood to the body with each ‘pump’ or compression of CPR.  Oxygen can only help CPR.

If someone is ‘brought back’ (meaning there’s a heartbeat- nothing else- that is THE criteria for ‘successful’ resuscitation- CPR is no longer needed), they are taken to ICU on a ventilator, and time starts ticking. Now, with the induced hypothermia being done (purposeful cooling of the body to minimize the oxygen demands, thus reducing brain damage, and has its own set of risks), outcomes CAN be better- but that is generally associated with someone who was relatively healthy before their heart stopped. The older someone is, and the sicker they were when their heart stopped, the worse the prognosis.  That’s just the truth.  CPR is not any sort of guarantee even when it all goes perfectly.  It’s a last ditch attempt to save someone’s life. And sometimes there is nothing that will save them, or return them to their previous state of health.  But in 2012, it’s all we’ve got.

When someone is warmed up again after they’ve been ‘cooled’, blood vessels dilate- which can add to the brain swelling that happens with oxygen deprivation of any duration. The dilation is the body’s attempt to make more oxygenated blood available to the brain and heart- but it can become part of what ends up being lethal.  Yet, it often makes sense to at least try to resuscitate someone. Nobody knows who will have a good outcome- there are just general statistics. And, not to make some sort of attempt for someone who may have ‘a chance’ usually doesn’t make any sense. People want to live- though most also want to be well enough to have some sort of life. Others want to be kept alive no matter what. There really isn’t a right or wrong choice- it’s all very personal, though most people I’ve talked to as a nurse don’t want to be “on machines” or dependent in a nursing home.

When someone has multiple medical issues and/or is older, the chances of CPR bringing them back to their previous quality of life are dismal.  When I was diagnosed with leukemia in late March 2010, my blood work and overall condition were such that the nurse I saw the most on the day shift came in and had ‘the talk’ with me. She wanted to find out what I wanted done should things get really dicey.  That was tough. I knew the statistics, and I knew that I wasn’t healthy to start with before the leukemia diagnosis. But I was 46 years old…I wasn’t ready to die if there was some way to avoid it.  I had (and have) a durable power of attorney for healthcare and a living will. I hadn’t planned on having to talk about it- I always figured that if that stuff was needed, I’d already be out cold.  But, I had to make decisions. I opted to be resuscitated if it became necessary- but if things looked grim afterwards, and the quality of life was going to be one of dependence and needing an institution to maintain me, I wanted to have the plug pulled. No camping in a bed for the rest of my ‘life’, not knowing what was going on.  I stayed a ‘full code’, but with conditions for afterwards.

I also knew that being taken off of life support doesn’t always mean someone dies. Most of the time, the testing done to determine brain activity will be accurate regarding the ability to breathe once the ventilator is turned off. But some people do have enough reflex activity that they do keep breathing. The reflexes can seem very intentional, but they are just the brain doing its job on autopilot. It can be very difficult for families to see those reflexes and think that the doctors are wrong about their loved one not having any future.  Some reflexes seem very purposeful during the time after CPR, even when still on life support. It can all seem very confusing.

During that time I was initially in the hospital for the leukemia, I also had to think about the possibility of needing end of life care, or hospice.  If things got to the point where medical science could no longer help me, I wanted comfort care only.  Just make sure I didn’t hurt, and let me go home to my dog.  In that case, I would have been a ‘no code’. Hospice generally won’t take someone who is still opting to be resuscitated. Their purpose is to help people through the dying process with comfort and dignity, and support their families and friends. They are a wonderful resource for those who no longer have options for recovery.

Anyone can make very specific decisions and have them listed in a living will. It’s also best to have someone (or more than one person) designated as a durable power of attorney for health care.  That is NOT the same as a regular durable power of attorney. A ‘POA’ is for financial decisions if you can’t make them.  A DPOAH is for health care decisions  if you can’t make them for yourself.  As long as you are capable of making decisions, the DPOAH is NOT in effect. If you become incapable of making decisions, that is when someone else would legally be allowed to do so.  There are other names for the healthcare POA- healthcare proxy, etc. depending on the state (USA).  In my opinion, everyone should have both a living will and a power of attorney for healthcare (and the third ‘regular’ power of attorney for financial decisions). Otherwise, the doctors are left with what the family guesses you want. If nobody is around, they have to keep you alive until the point comes where two doctors will legally sign documents stating that you are beyond hope, nobody is coming forward to help with decisions, and you are then taken off of life support.

For any ‘no code’,  DNR (Do Not Resuscitate), No CPR, etc, a physician MUST write an order in the chart- otherwise the nurses/healthcare staff MUST begin CPR and resuscitation measures. They are legally bound to do so- even if your family members are standing there telling them to stop. There has to be a legal order in the chart. Having your wishes known is so incredibly important, so that they are carried out.

Talk to your own family about what you want done. Tell your doctor, and get the living will and power of attorney for healthcare/healthcare proxy signed, witnessed, and put into your medical record (your doc’s office and your preferred hospital). Give copies to all people named as your decision makers.  Don’t leave things up to someone else to decide.  It’s a horrible process for them to watch you deteriorating, and if they know what you want, it helps them not feel like they’re giving up on you.

Exit Stage Vertical

Yesterday , Mary Kay Meeker left this earth from an ICU bed at a hospital in Waukesha, WI (USA).   Mary Kay’s hand was taken by her husband, and placed in the hand of God as she took her last breath after being taken off life support.  In that moment, she saw glory and a complete healing of her recent critical medical issues, and the residual effects of polio that she had as a young child. She was released from the stranglehold of sickness into the absolute freedom and peace of God’s love.  With that new health and perfection of her heavenly body, she saw Jesus for the first time, and began her exploration of eternity.  She saw our Lord !  She has spoken to Jesus face to face, and seen Him as He is !  Mary Kay is now part of eternity.

While people here will miss her presence, there are so many stories about Mary Kay that are surfacing to help soothe the wound of her absence. This is a woman who never met someone she couldn’t encourage or build up in some way.  Whether it be through her work in programming at Timber-lee Christian Center, or Awana groups, her church, or as a neighbor or friend, Mary Kay was all about the glass being half full, if not overflowing.

I often saw her on stage when I first met Mary Kay as a camper.  She was doing skits and ventriloquism acts during week long sessions, that continued all summer long.  She made those skits vehicles for how to live as a Christian. Even for elementary school kids, there was something about her that was ‘real’…and she liked kids. There have been numerous accounts of how she and her husband Greg would interact with kids in a way that let them know that being a kid was good enough.  Kids crave being valued by adults.

Mary Kay was an amazing pianist.  Even with her left arm being weakened by polio, she could crank out just about any song in any key at the drop of a hat.  Her ear for music was amazing.  I never saw her play the piano without a big smile while she simultaneously led 300+ campers in various camp songs from that stage in Cross Timber.  Music was a big part of who Mary Kay was.

It is hard to imagine Timber-lee without Mary Kay.  Oh, I know it will continue to be an amazing Christian camp, with so many activities and options for kids. It will still show the love of Jesus to kids of all ages. It will still be a great place for a winter retreat or group meeting.  But one of its core members is gone.  That will hurt, and yet those who know her know that she would want things to go on as scheduled, and for people to keep reaching past what they think they can do- to spread the love of Jesus to everyone who walks along Timber-lee’s paths.

Mary Kay was all about showing people possibilities they hadn’t even considered.  She boosted the good in people, and loved those who were going through not such great times- sometimes when she didn’t even know it.  Her influence didn’t require direct conversation (though she did talk with a lot of people about a lot of things, and really listened).  She lived her life in such a way as to show people ways of relating to each other, and to God. Even when I hadn’t seen her for years, I’d remember something about MK and be encouraged. She was a ‘feel good’ person.

Those of us who are Christians will see her again someday, and know the awe and wonder of seeing Jesus for the first time.  In the meantime, Mary Kay is probably setting up various choirs and singing groups, and seeking out those who always wanted to sing but didn’t think they could when they were alive on earth.  Maybe she’s organizing the angels’ choir into soprano, alto, tenor, and bass sections , and using that new left arm to direct them in some camp songs !! She has probably already met George Beverly Shea and the Goodmans, and has them helping with the choirs !

I can see Mary Kay walking through Heaven, gathering orphaned kids and talking to each of them- praising God for each of them.  She’ll have them singing or doing skits before long, to entertain the other folks up in Heaven. 🙂  If nobody stops her, she’ll have them doing something in Swedish (the Swedes up there will LOVE Mary Kay- yah, you betcha !!).   I can see her being welcomed by former Timber-lee folks who have been up there for a while, and them introducing her to people they know.

Mary Kay’s work here is done, at least directly- she planted countless seeds that will continue to grow.  It was God’s will that she be in Heaven with Him… she may not be working here on earth, but I’m guessing she’s keeping plenty busy.  I can’t imagine her having it any other way !

Hold On To Hope, Or Face Possibilities

I’m waiting, along with many others, for news about a dear woman who went into cardiac arrest last week, and is in a coma as a result.  The day they warmed her back up from the induced hypothermia (used to minimize oxygen demands on the brain while healing from CPR), her reflexes were present. The next day, she was following commands to squeeze her husband’s hand, and raise her elbow off of the bed.  That sounded good.  Daily reports were coming in, and while nothing else major was happening, there was a hopeful tone to the reports. Then Sunday, there was no word on her condition. Monday, there was information that she was struggling, and last night, the neurologist had done a test and met with the family early this morning.  When the time is right, information will be shared about what that was about.  As an RN, I can’t think of a lot of ‘good’ since there had been little  positive news for a few days.  I remember working on a neuro floor, and when the docs met with the families, there were major, and permanent decisions to be made. Occasionally, there would be some other treatment option, but not usually.

As I’ve been mulling all of this over for the past week, I’ve had so many emotions. Anybody who was a camper or on staff at Timber-lee Christian Center in East Troy, WI would have been directly or indirectly impacted by this woman. That’s tens of thousands of kids and staff members over the decades she has worked there.  Her talent for developing fun programs to get through entire summers, each one different, is indescribable.  She also has a great sense of humor, and is one of those people who just makes people feel good. Her piano playing ability is remarkable, and even more so, since her left arm is weak- but nobody would ever know that from what she can get a piano to do.  She has been an example of what Christian woman can aspire to. There isn’t an ounce of phoniness in her. She’s the real deal.

As an 8 year old, I first met her. She was in charge of the programming for that first year as a camper. Her talents brought stories from the Bible, and how to live as a Christian to life and made them applicable. I remembered her every year I was there as a camper (7 summers), and then when I was on summer staff, she was someone familiar when I was meeting MANY new people.  I wasn’t always the easiest to have around, but she was always kind and compassionate.

This last July, I got to sit down with her and her husband at a reunion at the camp. I hadn’t been back there for decades, and while it had always been my ‘safe haven’, I hadn’t seen anybody from there since the mid-80s. I’m so glad I had the chance to talk with her, and also to have reconnected on FaceBook several months earlier. She is someone who exudes life.  And now she’s in a coma, and is struggling.  That’s not her.  Oh, she’s had struggles- but she made them work for good.

And yet, I believe in a God who is omniscient.  He knows everything- and His will is perfect for His plan.  Not my plan, or her plan- but His plan.  I don’t know what that is, or why this all has happened.  Physiologically, I understand why her heart stopped and she needed CPR.  That isn’t hard to comprehend. But what is hard to understand is how her being in a coma, and so critically ill, is helpful to God’s plan.  I have to have faith.  I know that one day, I’ll be able to ask God directly, and know His reasoning. I do believe that.  And I have to have faith in the meantime. Sometimes that faith uses a lot of kleenex.  Sometimes that faith can’t see through the tears.  But it’s still faith.  It doesn’t waver, but it also rests inside a very real person with very real feelings.

So, now the battle is this (at least for me- and I don’t believe I’m alone in this)… do I hold out for hope and God performing a miracle? Or do I get myself ready to face the real possibility that she will end her work here on earth, and join those who have gone before her in Heaven?  I have to rely on my nursing knowledge to look at where she is- and ‘she’ isn’t lying in a bed on life support. That’s the logical angle.  That isn’t how she lives. She is a very vibrant and amazing woman. I believe God can use anybody in any state to speak to others, and yet being in a bed isn’t how she has lived.  When I saw her in July of this year- just 2 1/2 months ago- she was racing around the camp in a golf cart, tending to the visitors on the grounds. Smiling. Serving, encouraging, and active.

I can’t imagine what her husband is going through today after the meeting with the doctor.  He is also a ‘lifer’ on staff at Timber-lee.  He forges iron into custom ironworks and horseshoes. Yes, there are still blacksmiths!  Now, he’s faced with an incomprehensible set of circumstances and potential outcomes to sort through. But he seeks God’s will as well.  He seeks the glory of God, regardless of the loss or changes he may also face.

In the end, those of us who believe the doctrines and Biblical principles that are an integral part of Timber-lee know that we will all see each other again, no matter what happens here in this earthly life. We have that promise and confidence in what Jesus did on the cross. That makes no sense to someone who choses not to believe in Christianity as described in the Bible- and God gives everyone the free will to decide that. He doesn’t force eternity- or Himself- down anybody’s throat. For me, it’s a comfort -though I still feel the loss of people I care about in a very human way; those concepts are not mutually exclusive.  Christianity really isn’t about either/or… it’s about more and more.  I’ll get more time with my friend. I’ll get eternity with her. That doesn’t mean that I wouldn’t miss her until then.

I don’t know what will happen. I don’t know the private matters being discussed. I do know that the woman I know is vibrant, and unstoppable. Yet, now she’s suspended in time, in a very passive state. That’s not her.  I will still pray for healing. I will still pray for God’s will to be done (which might mean He takes her). But no matter what, I will never forget her impact decades ago, or even now as she triggers deeper thought about God, and why things happen the way they do… and in the end, she has once again strengthened my faith.

And those of us ‘watching’ can celebrate her life, no matter what.

Fragility and Resilience

There are just some people in life that ‘stick’ in memories.  Even after decades of no contact, and then with a reconnection on FaceBook, they bring back all of the good stuff that they’re associated with. Not just a fun afternoon, but the totality of the experience they were a part of years ago.  For me, that was an incredible experience as a camper and then a summer staff member for a total of 10 years at Timber-lee Christian Center in East Troy, Wisconsin (USA). Even though I went to a ‘solid’ church as a kid, Timber-lee has always been my spiritual foundation. People there live what they believe. It’s not lip service, and it’s not ‘on’ when people are watching only to be turned off when the kids leave. It’s legit.  It was 24/7 immersion in Christianity that was good.  Not the negative stuff that can be associated with Christians, but an authenticity that is hard to find. I couldn’t get enough of the place, and wanted to live there permanently (they didn’t have any openings for full-time campers…).

One of the people I first met when I was 8 years old became very ill this week, and her heart stopped. She was somewhere that provided her with near immediate CPR, and EMS was called. They got her heart restarted, and the ER she was taken to figured out the problem and opted for induced hypothermia (dropping her body temperature) and a coma to minimize any neurological complications (that nobody hears about with CPR). It’s assumed by most non-medical people that when the heart is restarted, all is well. That is the outcome in a very few cases.  Recovery is a process- not an event.

A couple of things have stood out in the four days since this happened.  First, I have learned an entirely different level of prayer.  I’ve prayed as long as I can remember, but I’m not sure that I’ve ever had someone come to mind as often as this incredible woman has, or that I’ve actually pleaded to God on behalf of someone else. I’ve prayed for healing for other people, but this has been different.   My sincerity in the past has been just as strong, and I’m not sure that I can really describe how this is different. It just is.

Second, I’m realizing how important those years at Timber-lee have been.  I’ve always been so thankful for the experiences I had there- whether the week long  sessions as a camper, or the 3 month sessions on the summer staff for 2 1/2 summers.  The people I met there are entwined with the experience.  They can’t be separated, and that’s  wonderful.  When I think of one, I’m flooded with the memories of the other.  It’s a package deal.  The feelings of safety, love, fellowship, and acceptance have never been replicated. Ever.

The fragility of life smacked me in the face four days ago (as it did much more so for those who are closer- her husband, and friends and family).  The experiences at camp have been my ‘go to’ memories to ferret out good days when I was going through rough times.  This week, there is part of that whole picture that is in trouble.  The reports come in daily, and I can’t get to them fast enough. I spread them to other pages where people are waiting for news. And we’re all praying.  There is hope.

I’m not sure I’m explaining myself all that well.  I’m  a bit overwhelmed, and in some ways I don’t feel entitled to that level of emotion, as we didn’t have contact for so long.  But it’s Timber-lee and one of the handful of people that has had an impact on me since 1972.  I even wrote a ‘report’ about my first week at camp when I was 8 years old, and she is in that ‘report’.  I got to see her in July, and it was so great to be back at the camp and see people who made it what it has been in my life.  And now she’s in a coma.

As a nurse, I know the possible outcomes. I worked in a coma stimulation unit at a brain injury rehab center many years ago. I saw some horribly sad situations. But I also saw some amazing stories and recoveries.  The people I took care of had been in comas for many weeks to months before they started showing signs of improvement, and the injuries were often because of external trauma (accidents). The damage had been more extensive, and intense. They started out in much worse shape, at least structurally; many had parts of their brains or skulls removed because of the damage.   My friend has already been reacting well to commands, and her reflexes are good. That gives me much hope for her outcome. Yet, I also know that there are no guarantees.  SO, while I’m thrilled every day with the updates, I hold back because of what I know and have seen. And yet, to the part of me that is still seeing Timber-lee as only existing with the people I knew there still like they were, I can’t allow myself to accept anything less than a full  recovery.  And that’s what I pray for, as do many, many others.  This woman is cherished.

I guess when I remember Timber-lee, I’m transported in time to the age I was then, and the feelings I remember when I was there.  It’s technically just a ‘place’…but it was much more than that to me.  I saw how Christians live in a way that I wanted to emulate.  When I’ve been in situations that were literally life-threatening, my first thoughts  often go back to something from camp.  That’s my feel-good place. It’s where I felt the most freedom to be who I really was during that time in my life.  And, I learned so much from the people I met there- either as a camper or on staff.  It also played a role in why I became an RN.

My friend who is sick is one of those examples of being a Christian that has been a role model, even in the 30 years we had no contact.  Her life has had an impact on tens of thousands of lives as she’s worked at the camp for decades. When I’ve thought of her over the years, I smiled.  When I hear music that she taught the music groups, or camp songs we sang, I smile.  When we’ve had FaceBook contact, I smile.  She’s a ‘feel good’ person.  That’s a quality I respect and admire so much. And she’s a very solid Christian, in ways that encourage and inspire- not judge or demean.

So, this is a hodgepodge of words that may not make sense.  That’s OK.  I just needed to write this.  I’m praying that her recovery exceeds expectations, and she can resume her life with this being just a blip in the totality of her life.  I can’t express what Timber-lee and the people I associate with it really mean to me. It goes beyond just a ‘place’.  The experiences were  heaven-blessed.  So many times the good I got from there helped  get me through some really lousy stuff. I can’t really explain that either, except to say that I felt that the God I saw in the people I met there was more real to me because of having been there.  Maybe that’s it- they showed me God.  They made Him more real.  I knew about God from the time I was very young, and believed in Jesus as a young elementary school kid…but I met Him at Timber-lee, through people like this friend who now needs Him to surround her with healing and restoration.

This one’s for you, MK.