Present at loved one's last moments

Some hospitals let families stay at CPR

February 24, 2002|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Early that morning in the emergency room, with a soft "oh" and a drop of his head, 11-year-old Ryan King stopped breathing. Within moments, a young doctor straddled the boy, pumping his chest. Nurses quickly wheeled the gurney from the exam room to the trauma room. Ryan's mother grabbed her son's panda and stray sneaker and ran after them.

For a few minutes, Donna King was left alone in the hallway, outside closed doors.

But, like an increasing number of physicians around the country, doctors at the Johns Hopkins pediatric emergency department did what was once unthinkable: They let Donna King be with her son. As doctors struggled to get intravenous lines into his collapsing veins, injected him with drugs and took turns doing manual compressions on his chest, his mother climbed under staffers' arms and between IV poles. She cradled Ryan's head and put her cheek against his.

"Mommy's here," she said.

For years, at the most critical moment in emergency medicine - when someone's heart stops - the drill has been the same. Nurses rush relatives out, chaplains distract them and, later, physicians deliver the bad news. But in the past few years, many in the health care field have arrived at a surprising conclusion: It can be good to bring families in the room during resuscitation efforts.

Even though the scene can be graphic, even though most patients in cardiac arrest will die, many family members are more accepting of the death if they witness it. They see the desperate efforts of medical staff, so they aren't haunted by doubts about whether everything was tried. They get a chance to say goodbye.

At least 15 hospitals in Maryland, including Maryland General, Northwest, Sinai, Anne Arundel Medical Center and Western Maryland, are allowing the practice, mostly case by case.

About half of the 1,000 emergency room and critical-care nurses in a recent national survey reported that their hospitals allow families to be present for what's known as a "code." And the American Heart Association unanimously voted to change its guidelines to encourage health care providers to offer the opportunity.

Called witnessed resuscitation, the practice raises all sorts of medical, ethical and legal issues, and has sparked fierce debate.

`A fad'

Trauma physicians worry that relatives will become hysterical and distracting. Others fear families might witness mistakes, or what they think are mistakes, and file more lawsuits. And in an era of crowded emergency rooms and nursing shortages, some say hospitals don't have the space or staff to do it.

"It's a mistake. It's a fad. There are too many potential negatives," declared Dr. L.D. Britt, vice chairman of the national committee on trauma for the American College of Surgeons. "The next thing you're going to want is to sit in the mortician's office and watch your loved one get embalmed."

Supporters believe witnessed resuscitation is part of medicine's evolution toward more family involvement. Several studies have found that relatives observing a failed resuscitation effort reported less anxiety and depression after a death than family members who weren't there. And almost all relatives surveyed said they would do it again.

"It's a great gift," said Donna King, 42.

Ryan, the oldest of her three boys, had been fighting an aggressive form of leukemia for two years. That night in November 2000, his parents found out that the Boy Scout and budding sports statistician had relapsed a third time and needed to be admitted to Hopkins. But the Glen Arm boy wasn't expected to die for a few months, and his parents weren't prepared to lose him so soon.

Now, just hours later, Ryan was on the border between life and death. Donna King watched emergency workers put a long, plastic tube down his throat. She saw them shock him. Before her eyes, her son's fragile chest was turning black and blue.

"You see the horror of it," King said. "You get it." Someone in the room came over and held her. She didn't cry or lose control; she just prayed for strength. She stroked her son's cheek, assured him that she had his favorite stuffed animal and named all the doctors he knew in the room, people she trusted to do everything they could.

But as the minutes wore on, she anguished over whether it was right to keep going until her husband, Stephen, arrived. The doctors assured her that they could continue.

"Daddy's coming," she told Ryan. "Hold on. Daddy's coming."

Within moments, Ryan's heart restarted.

In some ways, witnessed resuscitation is the next step for hospitals that have been letting parents stay with children for broken bones and other basic care. Hospitals have also been relaxing visiting rules, and emergency departments are trying to become more friendly to consumers.

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