A fun book about death
For an industry that spends so much time dealing with death, we know surprisingly little.
That's not just about end-of-life care, although the Institute of Medicine recently released a large report on making conversations around dying more prevalent. I'm talking about the science of resuscitation, a topic explored in physician David Casarett's new book “Shocked: Adventures in Bringing Back the Recently Dead.”
Casarett, M.D., a hospice specialist and professor at University of Pennsylvania, takes the reader through history: Blowing smoke up a patient's rectum, tickling his/her throat with a feather, rubbing a patient with ammonia or salt and/or throwing the person over a barrel or horse were all tactics used in 18th century Europe. He visits a cryonics factory and meets people who have paid to have their body frozen, and spends a lot of time in labs investigating hibernation and suspended animation in animals. (Casarett is graphic but sympathetic regarding the animals used or sacrificed in understanding resuscitation, even listing them in the acknowledgements).
“Shocked” has received a lot of comparisons to Mary Roach's work, such as her “Stiff: The Curious Life of Human Cadavers.” (And she has a great section on fecal transplants in her new book, “Gulp.”) I believe the authors have fairly different tones but share an ability to make me laugh out loud. Their work is great. Witness Casarett's description of being in a CPR class with a group of teenagers, where the teacher tells him to go faster on chest compressions.
“Think about the beat of ‘Stayin' Alive,'” Jim says. “You know, the Bee Gees.”
"In the few seconds it takes me to look up at Jim and nod, I register a wall of blank looks around me. I swear I can see wheels turning slowly in little adolescent heads. I also see a few of them mouth the words as if they're trying out words in a foreign language.
"What are Bee … Gees? They ask themselves. What indeed?
"It's true, that iconic song from 1977 provides the perfect beat for chest compressions. Unfortunately, this is probably not very useful information. In the year 2014, the only person at a typical cardiac arrest scene who is likely to appreciate this rule of thumb in the elderly person who is lying on the floor.”
More seriously, although still useful, is that the same chapter revisits the story of Lorraine Bayless, whom you may remember from McKnight's coverage last year. Bayless was a resident in Glenwood Gardens, an independent living facility, who collapsed. When the 911 operator asked the caller, an activities director, to perform CPR, she declined, making it a national story.
Casarett accurately takes the reader through what happened, the media coverage and asks the question: “How is it that we've arrived at the point at which saving a life — or trying to — is mandatory? How did it happen that all of us have a ‘moral obligation' and ‘a duty to respond'?”
That is a really good question for anyone working in long-term care, and should be covered in orientation for all staff, not just on the clinical side. In a touching section, Casarett follows ambulance workers responding to a resident in a continuing care retirement community who has heart failure and collapsed from cardiac arrest. You have probably seen what happens next fairly often — the EMTs are able to restart her heart and get her to the hospital, because that is what they are obligated to do.
That's a great system when it's a child who has drowned, but it's another story when it's a long-term care resident. It's hard enough to talk about the financial costs to the healthcare system when we keep patients or residents alive, but it's also going to be increasingly incumbent on those in long-term care to help weigh the emotional costs. It takes time to walk families through how a new treatment may not work, or that congestive heart failure will likely end in a resident's cardiac arrest.
To have these conversations isn't to revisit “death panels,” but to acknowledge what you already know: We may be able to bring people back from the dead, but it's not necessarily a good idea.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.