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Saturday, April 13, 2013

Code Status

Few days ago, I saw a perfectly healthy nurse in emergency department as a patient. He was worried that he had been exposed to carbon monoxide. He had a patient in hospital for a long time that had brain injury from exposure to carbon monoxide. Now he was worried for similar outcomes. I checked his blood gas, reassured him and sent him home.

Few days later, I saw Mr. M a 35 year old man with history of kidney stones transferred from nursing home to hospital for evaluation of decrease mentation.  As soon as he arrived, emergency physicians rushed to him, placed a large line on him and started fluid and antibiotics. Mr. M was cold, clammy and unable to provide any history. So I called his parents.

His mother picked up the phone and in a calm tone told me that she was aware that he was in hospital again. Mr. M had suffered anoxic brain injury at age 19 when he was working on his car and got exposed to carbon monoxide. Since then, he has developed mental retardation and has become bed bound.

I looked at Mr. M vitals. He was very sick and unstable. After the first round of resuscitation,  I call his mother again. As I was dialing the numbers, I was thinking to myself how to update the family and respectfully ask them about his code status at 2 o'clock in the morning. I thought to myself, over a decade had passed from the accident. During this time, his parent must have seen many different physicians and spent many hours in emergency department and hospitals. The nursing staff told me, Mr. M had been hospitalized many times and family requested full code during the previous admissions.

I knew Mr. M only for few minutes, and I was not sure how to approach the family about the code status. After thinking about this for few minutes, I decided to actually share my dilema with the mother. After updating her, I told her how difficult it was for me to bring this subject. I told her about my feelings. This time, she started to cry.

My shift was almost over. As I was preparing my documents for sign-off, the ICU resident came to bedside and told me Mr. M parents had decided to change his code status to DNR (Do Not Resuscitate).

Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328