TAUREEF MOHAMMED

THE FIRST time I performed CPR was on Ward 54 at Port-of-Spain General Hospital. It was early in the night when the nurses alerted the on-call doctors that Mr X had no signs of life: no pulse, no breathing, no movement.

At first sight, the man looked frail. With the junior on-call doctor directing me, I kneeled on the bed, clasped my hands together, and with my weight atop, started compressions. As my hands sunk into his chest rhythmically, something unexpected happened: bones started crumbling and crackling beneath my hand.

More information about this frail man emerged. Metastatic prostate cancer: cancer had infiltrated his bones and the rest of his body. He had not been doing well. His prognosis was poor. Only a few minutes had passed before CPR was stopped and death was pronounced. I looked at the indentation my hands left on his chest -

primum non nocere, the maxim goes.

A few years later, I would have deja vu on the haematology ward at Victoria Hospital in London, Ontario. 'Advanced myeloma, multiple treatments failed. I won't prolong it,' an ICU resident said to me as I stood at the foot of the bed, looking on at the pandemonium of trying to restart someone's heart.

Bad deaths happened everywhere.

Death occurs when a person's heart stops beating and he/she stops breathing. Cardiopulmonary resuscitation (CPR) attempts to reverse death by restarting the heart using mechanical force (compressions), electricity (shocks), and drugs, while delivering oxygen to the lungs via a tube inserted through the mouth.

Thanks to television, CPR is one of the most misunderstood concepts in medicine. Contrary to what we see on TV, CPR is unsuccessful most of the time. Nine out of ten people who have a cardiac arrest outside of hospital die, according to the American Heart Association. That is not to say it is useless.

In June 2021, during Denmark's opening match at Euro 2020, Christian Eriksen's heart stopped beating and CPR was done on the pitch. Eight months later, he returned to professional football and next month he will represent Denmark at the World Cup.

But context is important.

And that's why for all patients admitted to hospital, we ask about their wishes regarding CPR. We call it the patient's 'code status.' It becomes especially critical when someone is elderly, has a terminal illness, or a serious, irreversible life-threatening condition. In these scenarios, a person may say: do not resuscitate (DNR).

Obtaining a code status not only avoids unwanted care and futile interventions, but it also provides a segue into a person's values, understanding and expectations. By asking, we recognise the patient's autonomy in directing his/her own end.

But doctors and patients and/or their advocates don't always see eye to eye when it comes to CPR. Sometimes things get so messy, the courts become involved. In 2019, the Ontario Superior Court of Justice ruled in favour of two Canadian physicia