Moral Numbness

When you read this story in the New York Daily News, it’ll be even money as to whether you succumb to sadness or anger first:

Lorraine Bayless, 87, needed medical attention after her breathing slowed down at the Bakersfield, Calif., retirement facility where she resided. She later died after a nurse there refused to perform CPR on her citing company policy.

A dispatcher’s desperate pleas … [were] met with stubborn resistance, a shocking 911 tape reveals.

“It’s a human being,” the dispatcher says in the dramatic call. “Is there anybody that’s willing to help this lady and not let her die?”

“Not at this time,” the nurse calmly replies.

… “We need to get CPR started,” [the dispatcher] says in the 7-minute call, which was made public Sunday.

“Yeah, we can’t do CPR,” says the nurse, identified as Colleen, referring to a company policy that requires employees to wait for emergency responders to arrive before attempting the procedure.

 … “Anybody there can do CPR,” the dispatcher continues. “Give them the phone, please. I understand if your facility is not willing to do that. Give the phone to that passerby, that stranger … this woman is not breathing enough. She’s going to die if we don’t get this started. Do you understand?”

“ I understand. I am a nurse,” Colleen says. “But I cannot have our other senior citizens who don’t know CPR do it.”

“I will instruct them. Is there anyone there who will (do it),” [the dispatcher] says, later adding, “I don’t understand why you’re not willing to help this patient.”

The nurse tells a colleague that she feels “stressed” over the situation and that the dispatcher is “yelling” at her to have one of the other nursing home residents perform CPR.

The temptation for pundits is always to take cases like this and extrapolate out to a broader social trend. I’d like to think that impulse incorrect in this case. I still retain enough faith (hopefully not misplaced) in the basic decency of most Americans to believe that the instinct to say “to hell with the regulations” would win out for the vast majority of people in a case where the stakes were literally life and death (in fact, that tendency to come through in the clutch has always struck me as one of the most laudable facets of the American character).

There’s still something fundamentally chilling about this, however, partially because we all know someone like this nurse: the bloodless bureaucrat whose soul has been replaced by a set of rules and regulations. For this woman, the most salient point about a senior citizen — whose care she is charged with — dying in front of her is that it stresses her out.

It angers me that we only know this woman’s first name. We ought to know the whole thing — and it ought to become shorthand in the same way as, say, Benedict Arnold. When we see someone shirking the most basic of moral duties on legalistic grounds, comparing them to “Colleen” should be the ultimate insult. She ought to be shamed — publicly, protractedly, and nationally.

People whose jobs entail responsibility for other lives — be they teachers, police officers, doctors, or those who care for the elderly — deserve our utmost respect when they do the job well. In cases like this, however — where their negligence becomes virtually indistinguishable from outright malice — there is no level of contempt too excessive.

  1. Nathaniel Wright

    While what the Nurse is doing here is nigh unforgivable, can we please acknowledge how amazing the dispatcher is on this call?

    911 dispatchers receive a tremendous number of fake calls, and calls to complain about fast food service, for the dispatcher here to display such tremendous leadership in this situation is remarkable.

    Leadership?

    Yes, leadership. The dispatcher is telling “Colleen” that it is possible to “instruct” others over the phone to perform CPR. Think about that. This is a display of heroism and true service. The dispatcher is confronted by bureaucratic obstinance, but is really trying to save a life.

  2. Alan D

    I think you are wrong on this, Troy.  I just took my CPR certification last year and it is rarely successful on someone as old as this woman.  I think the statistics are 5%.  And those 5% that survive are left with broken ribs, bruising, and whatever health problem that caused the cardiac arrest in the first place.  The daughter of the woman who died was not unhappy with the care her mother received, so there is more to the story than is reported.  I have a doctor friend who saved an older man’s life using CPR when he discovered the man unconscious in the man’s car.  Turns out he had cancer and a number of other problems.  By saving his life he allowed the man a year in a hospital with worsening health and increasing bills.  A quick end from the heart attack would have been better.  Some people choose do not resuscitate care to avoid such problems.  While the call makes the nurse look heartless, she may understand much more than we do about why it is wise to let nature take it’s course.  Now have at me!

  3. BrentB67

    Alan those are reasonable points. Additionally, the litigious aspect of our society may render CPR impractical. Given the statistics you highlight it wouldn’t be unthinkable that this nursing company has been sued in similar circumstances. Inexplicable policies are often rooted in a past lawsuit.

  4. Foxman
    raycon and lindacon: In case you’ve ever wondered how the Nazi’s recruited the guards at Auschwitz. · 10 minutes ago

    You do not know the woman’s end-of-life requests.  Complying with a person’s requests can be very difficult.  I often wondered at the ability of the nurses who worked on the bone-marrow-transplant ward were my late wife was treated to be cheerful with their patients when there was so much death around.

    It takes a special type of person to work with those who are likely to die.  Do not libel those who do this important work.

  5. Schrodinger

    I think that the real target of anger should be the company that put the policy in place that no CPR could be given by the employees. That is the truly heartless aspect. The decision should be made by someone on the spot, not by an unknown paper pusher.

    The woman who called 911 wanted to help the 87 year old or she would not have called. Resisting doing CPR because she was afraid of losing her job is understandable.

    The true villain here is the nursing home and its policy. Even if they have been sued before, this policy IS heartless and cruel to both the residents and employees.

  6. DocJay

    There are a few here who understand the reality of doing CPR, ACLS, intubating, and putting someone online support in the ICU. That is not the majority of folks here though. The costs are tremendous based on the amount of time and resources utilized. We do not have infinite resources and the elderly bubble is a tsunami. Furthermore, many who make it out of the unit are in horrible shape mentally and physically for whatever remains of their lives. The patients( if coherent) or the families fill out a DNR the moment they are home or even out of the unit rather than putting their 87 yr old mom through months of dehumanizing horror. Our current system is all based on two very awful issues. One is that the medical system is paid for doing things, whether it is the right thing or not. The second one has to do with our disgusting litigious society. Follow the rules or else, right and wrong be damned. The real issue here is why the nurse had to call 911 and I expect paperwork issues lie at the core here.

  7. Troy Senik, Ed.
    C

    I find the Kitty Genovese comparison inapt. We have a recording of the actual events here.

    Look, there are a lot of cogent points being made here about the potential liabilities of CPR, the use of DNRs, when the costs of potentially heroic measures outweigh the benefits, etc. But there’s no evidence that any of that guided the decision making process here. All that the evidence points towards is a devotion to company policy over the life of the resident. I’d be much more sympathetic if the nurse’s rationale was as humane as most of those presented in this thread.

  8. Paul Dougherty

    I can’t concieve of the type of saintly soul who could work in a nursing home and invest in a close human connection to each of  the residents under their care. It may sound callous but the reality would, possibly, be too hard to bear. I doubt there is much discussion of how the residents are going to make it out of here on their own. I, personally, cut a bit of slack to the nurse. My advise is to say a prayer for the people  involved, and for us all, who will face a variation on this theme, at some point in our journey.

  9. DocJay

    Foxman, you are correct that it is the woman’s choice if mentally able to decide.

  10. Miffed White Male

    Here’s the part I don’t understand:

    The woman resided at Glenwood Gardens’ independent living home, where employees aren’t supposed to attempt CPR on residents, unlike other sections of the facility.

    Bayless, however, did not have a do-not-resuscitate order,

    Presumably the “independent living” facility is where the people who are in the BEST of health live.  So they’ll do CPR on the people who live in the other parts of the facility, but not here?

    And what’s the point of NOT having a DNR order in a facility which apparently has an explicit policy of not doing CPR on you if you need it?  (You kdo now what the “R” stands for, right?)

  11. Foxman
    Miffed White Male: Presumably the “independent living” facility is where the people who are in the BEST of health live.   · 5 minutes ago

    With all the obfuscation in modern parlance (think: The Affordable Care Act), who knows what “independent living” means.

  12. DocJay

    Less than a week ago I had a friend of 18 years under my care pass in such a home. We actively stopped her heart medications a few days before this as she was dying from a gangrenous leg. CPR on her, had it worked, would have prolonged her life and increased her suffering immensely. She was in the less expensive, no CPR unit and had a DNR. Every case is different and arm chair quarterbacks with limited info make for good inflammatory journalism but lack in substance.

  13. Sweezle

    Do we  have all the facts or are we guessing that “bureaucratic inertia” is the culprit?  I am cynical enough to agree we live in a modern world that doesn’t value human life if it is not convenient.  Individuals, families and friends do but not our larger society. But something about this story feels very incomplete. I can almost hear the charging hoofs of litigation and it makes me squirm.

  14. Michael Collins
    The story is confusing.  I need more medical knowledge before making a judgement. It is Catholic teaching that no one is required to go to extreme measures to save a life.  It seems to me that for an 87 year old woman CPR could be considered an extreme measure, due to broken ribs etc.  The woman lived voluntarily in a section of the facility where it was the policy not to perform CPR, and she or her guardian presumably knew of that policy.   She may have chosen to live there precisely because of that policy.  

    But why no DNR and why call 911?  What exactly were the EMTs supposed to do?  I am not familiar with EMT procedure.  Could they apply electric shocks to start the heart again without doing CPR?    Going out on a limb here with speculation, but maybe someone that old would want their heart jolted into activity, while specifically opposing CPR as an extreme measure.   A “No DNR, but no CPR” policy might make sense, but  it is hard to know if that was intended.  It may not even  be  medically possible, I am speculating/asking.

  15. She

    Many concerning things, and some good points in the comments.

    My $.02:

    If there was no DNR order in place, one hopes that those around this old lady would do their best for her.

    Doing your best for someone generally doesn’t involve doing nothing and immediately assigning responsibility for inaction to “company policy.” At least it didn’t used to.

    One assumes, if ‘Colleen’s’ statements are correct, that the same ‘company policy’ would apply if the patient were her 60′s.  Are we all sure that we’d be fine with the ‘company policy’ in that case, or is it this old lady’s age that makes it OK?  (It does make me wonder why they bother to hire actual nurses, and what they’re for).

    I shouldn’t think the possibility of a lawsuit in this case weighs heavily. I speak as the daughter-in-law of an 89 year old who was given eight medicines intended for the comatose patient in the next bed.  This resulted in my MIL’s death.   Several high-powered lawyers that I spoke to told me that my mother-in-law was too old to make a case worthwhile (for them).

  16. Wylee Coyote
    BrentB67:  Inexplicable policies are often rooted in a past lawsuit.

    Exactly right, Brent.  Damned if you do, sued if you don’t.

    We make it exceedingly risky for people to do the right thing, and then are shocked when they don’t.

  17. raycon and lindacon
    Foxman

    raycon and lindacon: In case you’ve ever wondered how the Nazi’s recruited the guards at Auschwitz. · 10 minutes ago

    You do not know the woman’s end-of-life requests.  Complying with a person’s requests can be very difficult.  I often wondered at the ability of the nurses who worked on the bone-marrow-transplant ward were my late wife was treated to be cheerful with their patients when there was so much death around.

    It takes a special type of person to work with those who are likely to die… · 2 hours ago

    We spend a considerable amount of time in end of life care facilities.  Absent a DNR instruction, and there was none in this case, the folks we encounter every week would NOT have allowed a patient to go unattended without life saving intervention.  The 911 call, have you listened to it?, is all that is needed to understand what is going on here.

    Does Columbine mean anything to you.  The Jefferson County Sheriffs responded the same way.  Millions of dollars in tactical gear and training, and they waited nearly an hour, until the kids were dead.

    Auschwitz.  There are people those people.

  18. Paul Dougherty

    Fear not, judging from the high level of outrage expressed at the top of the hour newscasts, this nurse and that facility will get their due opprobrium.

  19. Civil Sense

    I think we know Nurse Colleen’s last name: Rached.

  20. Basil Fawlty

    If only the media had shed similar tears over the judicial murder of Terri Schiavo.

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