CPR is brutal, outrageous and few survive it. This is why I retired, writes former top surgeon
The first time I saw CPR being performed was on TV. I was in my teens – it was probably the American medical drama ER. Maybe it was Casualty.
There would still be a frenetic scene of a doctor pumping a patient whose heart had stopped.
Someone would rush in with defibrillator paddles. Someone else would shout ‘CLEAR!’
For a moment, all hope seemed lost, and then the body came alive. Relief all around. The patient was up and talking, or maybe even going home, before the credits roll. It was captivating, dramatic and glamorous.
Years later, as a young doctor working in an emergency team on hospital wards, I got to see it and do it for real – and it couldn’t have been more different.
CPR, or cardiopulmonary resuscitation as it’s officially called, is brutal and outrageous.
It is given when the heart stops – so in effect the patient is dead – in the hope that it will bring them back to life. But it almost never works, as it is usually performed on the sickest and most fragile patients in the hospital.
Their clothes are stripped off so the crash team can have paddles on their chests, and there are medical personnel everywhere.
Some look for a pulse, others clean up blood and vomit. It’s noisy. Someone shouts the number of chest compressions, the doctors growl pressing. Rib fractures are incredibly common due to the force needed to start the heart – you can hear the bones breaking.
If a patient’s heart begins to beat, they may end up with bruised or bleeding lungs. And brain and kidney damage are not uncommon – due to time spent without the heart pumping blood through the body.
In 80% of cases where CPR is successful, the patient never leaves the hospital.
DRAMATIC: The sanitized TV version of CPR, seen in the ER, with George Clooney, right
Two thirds of them die within a few days. About two percent are left in a long-term vegetative state – neither dead nor truly alive.
The only time I brought someone back, when I was working in the ER, the man was in intensive care for two weeks. Then we realized he would never recover and had to turn off the fan. It was horrible for his family.
Later, as a breast cancer surgeon, I had to discuss all of this with patients. That we want to be resuscitated if our heart stops is a routine question doctors ask when they admit someone.
This may sound alarming. But it’s important, if someone is particularly sick and not going to get better – with terminal cancer, for example – that they understand if their heart stops, CPR will only delay the inevitable. , the best.
More recently, I had to face my own potential death, having been diagnosed with breast cancer twice – the first time in 2015, when I was 40, and then again three years later.
Fortunately, my treatment was successful. But the experience pushed me to make decisions about how I would like my life to end. It was not easy.
No wife wants to talk to her husband about how she might die before he does. But it is vital that we make our wishes known.
In particular, I made it clear that if I reached the end of my life – if my cancer came back and my heart stopped beating – then I didn’t want CPR.
Of course, if I had a sudden heart attack in the street tomorrow – when I’m fit and healthy – and a defibrillator was nearby, then I would absolutely want someone to try it on me.
But that’s because I would actually have a chance to recover.
Chances are, if I’m very sick — whether I’m being cared for at home or in the hospital — even if CPR restarts my heart, I’ll be worse off. And that’s not how I want to die.
I would like to be in bed surrounded by my family, not a team of doctors trying to bring me back to life. This does not mean that I will not receive treatment. Far from there. But I just want the medical care to make me as comfortable as possible in the end.
LIZ O’RIORDAN: I’d like to be in bed surrounded by my family, not a team of doctors trying to bring me back to life. (file photo)
Of course, there will be those with long-term health issues who think otherwise. They might say: I want to be given a chance no matter what.
But this must be a decision made after considering the facts. And I completely agree. No one can tell you what to choose.
For a healthy person whose heart stops unexpectedly, CPR, if performed within minutes, offers a 10-20% chance of survival.
There is still a significant risk of long-term damage, but the benefits far outweigh that.
If a person has serious long-term health problems and their heart stops unexpectedly, CPR is less likely to be successful – the heart may restart, but the body is unlikely to recover.
And if a person has a terminal illness, is dying, and has severe lung, liver, and kidney damage, CPR is futile, in my opinion.
Restarting the heart cannot repair the damage already done by disease.
Of course, like everyone else, I was horrified to read “do not resuscitate” orders written on the medical records of elderly people in nursing homes during the pandemic, without prior discussion.
And I’ve heard of cases where doctors mis-explained things and caused distress. Not all physicians have a great bedside attitude.
In the hospital, if you’re too sick to tell someone what you want, a senior doctor may decide not to administer CPR if it would do more harm than good – and loved ones may find it difficult without in-depth conversations beforehand.
If you have a relative who has been admitted and is very ill, it is worth bringing up the subject. If the wish is to have CPR, doctors will try to honor that.
And if, after thinking about it, you think you might not want to be resuscitated under certain circumstances, you can take steps to make sure people know about it.
If you are already under the care of a medical team, discuss your wishes with them.
There is a form your doctor will fill out to keep your medical notes called DNACPR – Do Not Attempt CPR.
This doesn’t mean you won’t get treatment, but if your heart stops, you won’t try to restart it. This form is not legally binding.
If you want to make sure your loved ones know your wishes, you can create a living will that allows you to opt out of medical treatment.
It can be changed. It is only used if you are unable to communicate. This is another way to make sure your loved ones know your wishes.
You can complete it online by visiting mydecisions.com. You then print it out and mail or email copies to people who need to know.
Or you can call Compassion In Dying on 0800 999 2434, who can issue a hard copy.
You don’t need a lawyer – in England, Wales and Northern Ireland, medical teams are legally bound to follow what is written on the form.
In Scotland, living wills are not legally binding, but doctors generally honor them. And if you change your mind or want to change your form, just create a new one.
I made a living will. It was not pleasant. But I’m glad to know that I will be spared CPR – and have the death I want.