how come no one trains you for that

There are many people, who as part of their job, are required to have ongoing, regular training in cardio-pulmonary resuscitation.  Which of course made me think about the entirety of the lay public, who may at some time encounter a person who is dying, who they know doesn't want to be rescued but still needs to be responded to. And I was thinking, how come no one trains you for that?

This is my tiny effort at starting the conversation about what you should do if you encounter the situation.  You should not expect to receive a certification card in the mail when you are done reading this post. But it may make you do some more reading about it, and begin to consider how you will react.

So lets just say you are with your elderly or chronically ill relative or friend and they suddenly become unresponsive and you don't know what's happening or what to do, but you can't find a pulse and you think this person may have died, or is taking their last breaths.

What do you DO?

1. Deep breath - as in YOU take one

2. Ask yourself if it would make sense to put them through efforts at trying to revive them. We are all dying sometime, if it might be sooner rather than later for this person, would it make sense to try to resuscitate them just so they can die again? If you don't know (or are just scared shitless and can't think what to do) go ahead and call 911. No one is going to fault you for that. UNLESS the patient is enrolled in hospice, in which case you call them. When you are enrolled with hospice THEY BECOME YOUR 911.

3. The number one thing you can do if you are with someone who may have just managed to die in a way that we all say we want - "quickly", "suddenly", "painlessly", "in my sleep", is to be sure they are comfortable, if they don't seem comfortable, and especially if they look like they are struggling, you need some professional help. Same as #1 above - call hospice or 911. 

4. If the person looks comfortable and is taking a few last shallow breaths, you can be the loving presence we all hope to have as we are dying. You can be the voice of calm and reassurance, let them know you are there, you will stay with them, things will be ok. Some of us can do this naturally. It's instinctive. For most of us though, it takes training/acting. The more we are exposed to things like this, the easier it becomes. Most of you will not be exposed to it regularly. Which is why thinking through things ahead of time is essential. 

If you have a family member who you think may die in the coming months/years, it is worth thinking about this. In the moment you may panic, which will make you less effective. I am not endorsing that we all become hospice or palliative care providers, just that we be ready to care for our loved ones (or a stranger in a loving way), if we happen to find ourselves present at, or near, the moment of death. The best case scenario is to have conversations with family/friends about how they want to be responded to. Get hospice involved early if it makes sense. Hospice will help you prepare for this. Unfortunately, this is an easy topic to put off until it's too late. Thus my reminder that thinking ahead, about how YOU will respond, is so helpful. 

I have mentioned A Handbook For Mortals several times over the years. This link will take you to a site where it is now available on line. This book is a guide for facing serious illness. It is written for lay people and covers many useful topics in a thorough, readable, understandable way. I have purchased many copies of this for people over the years. Every home should have a copy, along with an atlas, a book of fairy tales, a dictionary, and a first aid book. You can buy it here.

This topic was triggered by 2 recent events. A friend telling me of the sudden death of his 94 year old mother, in his arms, at her home. I know this was hard for him and I wanted so badly to have been able to roll back the clock. To talk him through the situation. The second was a death in the hospital that caught me off guard. It involved encountering the raw, shattering, grief of a mother losing her daughter, and seeing in those moments when she was dying, the need for a strong, calm, reassuring presence, in the face of such devastation. 

If you are still reading, I apologize for the unusual length of this particular post. There was not a way to shorten it. Actually I could go on, but I will stop now. Please add your experiences and questions in the comments.

Comments

[Susan]

Thank you for writing this. We all face death, some sooner than others but, helping us recognize that this is a natural event is a good thing. Helping us help others is a major good thing!

[Janet]

thanks for the post and the link to the book

[Chris oliveira]

Thanks for posting. Here in MA, it’s important to have an MD signed DNR if someone is living at home without hospice. When my father-in-law passed, it was unexpected, but he was quite elderly and frail. He passed very peacefully one morning. Everyone knew CPR would be cruel and so they did not administer it. They also waited a bit to call 911 so they would not do CPR. When police arrived, the family was berated for waiting to call them. If they had a DNR signed by a doctor, they could call 911 without fear that they would resuscitate him. Without the document, the rescue crew is legally required to do it.

[Daisy]

Thank You

[jacki long]

Good real facts and thoughts. I have a DNR in mt legal papers, but not one signed by a doctor.

[Amy in Texas]

Thank you, Carol, for your honest thoughts and helpful words. Early on Pop and Mom both shared their wishes about a DNR. Almost three years ago my dad passed away in the hospital. The staff was so kind and respectful. I hope when it’s my time to go that I’m treated just as well.

[joan]

Carol, you say it so well. Life long nursing makes one wise and knowledgeable. I am on board with all your words. I have forwarded this blog to 23 people. You do so much good...and now the ripple effect. Thank you from Wisconsin

[carol]

Chris: your situation is the exact one I am hoping to help people with. You are absolutely correct in that if you do not have an OUTSIDE THE HOSPITAL DNR form which is signed by a physician, EMS personnel are required to attempt CPR. I am so glad you commented here. If anyone else is worried they will be in this position please get an OUTSIDE THE HOSPITAL DNR form completed with your doctor. I posted more about outside the hospital DNR forms on a post on 4/29/19 - for more information on that.

[carol]

Joan: thank you for passing this along to others who may benefit from reading!

[Sharron Carleton]

So important, many thanks... xox

[Liz in Oregon]

Your posts like this are so lovely and helpful and kind - and I love you for them. (insert heart emoticon here) As in the past, I take them in but then go back to my procrastination -- age 66 this year. Worked as a legal secretary for 40+ years...still no will nor advance directive. Granted, divorced eons ago and no kiddos but still...I do not want to be hooked up to life support. Maybe this post will get me finally kicked into gear. And I will know how to react kindly if ever called upon in the way you speak of. Thanks, sweet Carol.

[carol]

Liz: it is my pleasure :-) Carol