The Patient Who Changed How I Talk About CPR
As a palliative care physician, I’ve had countless conversations about “code status” – the medical term for what lifesaving measures a person wants (or doesn’t want) if their heart stops beating or they stop breathing. If you are “full code” that means you would want the medical team to do everything in their power to keep you alive, including the use of CPR and a breathing machine (ventilator) if your heart stopped or you couldn’t breathe on your own. If you have a “do not resuscitate” or “DNR” in place, that means you would not want the medical team to intervene at the moment your heart stopped.
These are complicated discussions. Both for patients and families as well as the medical professionals tasked with guiding them through the decision.
But there’s one patient who fundamentally changed how I approach these discussions.
The Conversation That Changed Everything
When I was an intern, I admitted a patient with stage 4 cancer for dehydration. Based on their chart and clinical presentation, I knew that even after addressing the dehydration, their time was limited.
After completing the examination, I asked the routine question about code status: “If your heart stops, would you want CPR?”
They replied without hesitation: “Of course I want CPR!”
My chest tightened. I’d seen CPR attempts on patients in his condition, and they never went well. Broken ribs, breathing machines, tubes everywhere. And even if we “got them back” (which was rare) – they still died within hours to days.
I thought to myself, “I didn’t explain this very well.”
So I tried to use statistics to explain why I felt a CPR attempt was not in his best interests.
“I want to be honest,” I said. “If we attempt CPR, there’s only about a 1% chance that we can bring you back to life.”
Their response stopped me in my tracks: “Sure doc, but if you DON’T attempt CPR, there’s a 0% chance you’ll bring me back to life.”
The Technical Truth vs. The Meaningful Truth
Technically, they were right. A CPR attempt does have a greater chance of resuscitation than no attempt at all. But this exchange revealed a crucial problem with how we discuss CPR attempts on people with a terminal illness.
What I would learn over the years is that telling your medical team that you want them to attempt CPR at the end of a serious illness like cancer or dementia comes with significant tradeoffs that I wasn’t effectively communicating.
Finding Better Words
Thanks to this patient, I’ve learned to articulate these tradeoffs much more clearly than I could as an intern. I’m still learning, of course, but these days I approach CPR discussions differently. Rather than thinking about CPR in a vacuum, I walk patients through the context of when code status would be relevant. Consider these questions:
“When you get sicker, and it’s clear that your time is getting short, what do you want that time to look like? Would you be willing to risk spending your last days hooked up to machines to try and give you a bit of extra time, or would you want to prioritize peace and comfort while your illness runs its natural course?”
The Heart of the Matter
With a serious illness, CPR won’t change if you die, but it can profoundly change how you die.
This shift in framing moves the conversation from abstract percentages to meaningful personal choices. It acknowledges that medical decisions near the end of life aren’t just about statistical outcomes—they’re about aligning care with what matters most to each person.
That patient’s straightforward logic challenged me to find a better way to discuss these difficult choices. Their words continue to guide how I help patients and families navigate one of life’s most challenging transitions.