Ethical or futile?

I never questioned wether it was ethical to try to save a life of a patient that was a full code until today. This 49 year old woman that just underwent major hernia surgery was dying before my eyes. All the meds, blood, plasma, ventilator, CRRT, was not enough to save her from the sepsis, DIC, and ischemic bowel that had invaded her abdomen. Surgeons tried to save her by taking her back to surgery and removing the dead bowel but she was already too far gone. Before the surgeons took her, she was still able to acknowledge me and squeeze my hand. When I asked her if she was with me, she barely nodded her head. I prayed that God save her. After maxing her out on everything we had, she was still deteriorating. Death was imminent. When the doctor rounded, he said, “I will not code her if her heart stops”. He explained that it would be futile to do so and unsafe for the nurses due to her open abdomen. The thing is, her friend who is her POA, said that we should do everything possible to keep her alive. Unfortunately at the time we did not have the paperwork. Still, even without the paperwork, she was a full code and the ethical thing to do was to do everything…including CPR when her heart stopped. The doctor was pissed when he was informed of this. I was torn, as much as I wanted her to live, I did not want to have to pound on this woman’s chest as a last ditch effort for a few more minutes of miserable life. She was already purple from the neck down from motteling, and her skin was blistering and sloughing off.

Nevertheless, her heart stopped, and I did have to compress this woman’s chest, breaking her ribs and causing blood to spew out of her ET tube. It was the worst feeling ever. I was sick…deep inside my gut, in my heart. After 3 rounds of CPR and meds, we got a pulse back only for her to lose it again in a few minutes. Another round and the doctor finally called it. No friends or family were there to say goodbye. It was one of the saddest, cruelest deaths I have seen in a long time.

 I truly wanted her to survive, but that was before her spirit was gone. I knew she was gone when she returned from that second surgery. We should have been able to let her go then, but it was unethical to do so according to the law of full code. Instead I felt like I was actually causing harm by prolonging her suffering. I prayed for God to keep her alive, but I didn’t want her to live in pain and suffering. Hopefully she was gone far enough to not feel anything after that surgery. 

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