This is sort of a rant, but trying to find others that have had similar experiences is difficult outside the hospital. I'm a PGY1 so there's a lot of firsts this year that I haven't dealt with yet. There's this 93 year old that came to the floors with acute on chronic heart failure, pre-renal AKI c/b hyperkalemia, severely malnourished. Her heart fx is nearly nil, severe global dysfunction, multiple valve prolapses, severely dilated atria, afib w/ rvr. Her oxygen requirements were increasing in the hospital. Her mental fx decreasing. After speaking with her daughter on multiple occasions, she wants full code, no comfort care whatsoever. We tweak the pt up over a week with diuresis, control the afib, send her home with a hospital bed and oxygen (had to fight with daughter not to sign her out AMA without O2, because she thought we were causing her decline in function). Fast forward to yesterday. Same pt and daughter arrive to ED after pt has 15+ minute cardiac arrest. This was bound to happen. We were trying to make the pt comfortable during her last days, but pt's daughter wanted none of it. Pt's ribs are fractured, sternum broken. Fixed pupils, partial gag reflex, on multiple pressors. She survived. I've never been angry about a pt surviving a code. It was so difficult to look at this pt, tubed, pale, cachectic body. Thoughts of feeling ribs cracking during compressions. She's in the cardiac care unit now, but my co-residents told me she's still full code. Daughter refused to meet with the palliative care team. Sorry for the rant, but it's hard to internalize. It's strange to try to sway a pt's family member to shorten their loved one's life for quality of life. But it angers me that this daughter can't see the agony the pt was probably in before she coded. I guess she'll be kept artificially alive until her heart can't take any more stress from the pressors. Hopefully I can find peace in this pt surviving the code.
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