In the News

Prescribing the end-of-life conversation

January 11,2015

By Dr. Angelo Volandes

The Boston Globe

LIKE MOST doctors, I was a young resident, fresh out of medical school, when I had my first experience with the American way of mistreating the dying.

Taras Skripchenko was a frail, bed-bound 78-year-old man with inoperable lung cancer who was admitted to my service during my first year of residency training. Skripchenko was too confused to have a lucid conversation and lacked family members to guide his decision-making. His oncologists hadn’t spoken with him earlier in the course of his disease about what was important to him, so he was a “full code.” He had no “do not resuscitate” order on file. In short, we were ready to do everything possible to keep him alive.

“Code Blue! Code Blue!”

A nurse had checked on his pulse only to realize that he did not have one. I ran to his room and found the team already performing CPR. I clumsily jammed my hands into a pair of latex gloves and joined the ritual, relieving one of the nurses doing chest compressions, which is far more physically demanding — and brutal — than what is portrayed on television. My clasped hands pressed hard against Skripchenko’s frail chest, and all I could hear and feel were the cracking of his ribs with practically each compression. The rhythmic pumping eerily emitted a coarse, Velcro-like sound.

Skripchenko’s heart was eventually stabilized, and we transferred him to the ICU. By the following morning he had a tube or catheter in almost every part of his body, for a grand total of eight plastic intrusions, including an endotracheal tube (lungs), two central intravenous lines (veins), an arterial line, a nasogastric tube (stomach), a foley catheter (bladder), a rectal trumpet tube, and a tube placed in the sac of his heart to drain fluid. Taras was “fixed.”

(Dr. Volandes is a speaker at the 2015 Lown Institute Conference.)

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