A good death

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A GOOD DEATH. We talk about this as the goal of our work with patients who are dying. We also want it for ourselves and our loved ones. Yet what is a good death, and how can we help patients experience it, especially those in the hospital?
A death that still haunts me 5 years later is one for which I didn't provide direct care, I only observed. Yet I can still see this 94-year-old man's face as the code team attempted to resuscitate him for the third time in 45 minutes.
While I observed from the nurses' station, the team got an organized electrical rhythm and pulse back. Next to me, his physician was on the phone talking with the patient's daughter, telling her what had happened and asking whether they should perform CPR if his heart stopped again. Thankfully, she gave permission to give her father “do not resuscitate” status.
I learned he'd been admitted to this ICU the prior afternoon with end-stage (stage D) heart failure and acute kidney injury. His physician had asked about his code status on admission, and the note said it would be readdressed—but the patient had been in the ICU for 18 hours and it hadn't been readdressed. So here we were, trying to delay the inevitable.
I remembered the good death my dad had in inpatient hospice, and I grieved for this man and for his daughter, who probably wouldn't be at his side when he died. She'd likely live with regret, wondering what happened and whether she could have made a difference if she'd been there. I also grieved for the nurses, physicians, and others providing interventions they knew were futile. They'd most likely be left feeling morally conflicted and distressed by what they had to do to this patient and wondering why no one had addressed his code status on admission.
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