Ok… So- this isn’t going to be a fun post. I’m as riled-up as a kicked beehive and there’s really no resolution to this story. Sometimes, I find my hands tied with no means to break free and make myself heard in the way I intend. It’s all bureaucracy and red-tape and this-is-how-it’s-always-been-done…

Is this a religious rant? A feminist rant? I don’t know. You decide.

In all honesty, I don’t understand what the hell is going on with this year. Our planet is a gunky little dust-bunny rolling around under the universe’s bed and it’s only a matter of time before someone decides to clean house.

(This old thing! I thought I threw it out eons ago!)

Things have been nutty this year when it comes to being a deputy medical examiner. This may sound crazy, but death investigation can really get redundant. After dutifully documenting 10 years worth of catastrophic decisions, it takes a lot to leave me stymied on a death scene. But 2020 is shaping up to be a real trophy-holder when it comes to weird shit..

One of the benefits and simultaneous curses of working as a deputy medical examiner is the sheer volume of people I meet. Seriously, death is known as the great equalizer and consequently, I meet people from every race, ethnicity, faith, economic status, education level, ideology etc. etc. etc. I try to be accommodating and sensitive towards all these demographics, and as I’ve already stated, not much surprises me anymore.

But sometimes, the shit I see sits with me about as well as a bellyful of salmonella.

(Yeah, I had one of THOSE kinds of shifts)

This past shift I had the occasion to professionally meet a family who left me truly speechless. Before I got there, the officer at the scene had told me a convoluted story about how our decedent was a 44 year-old woman who belonged to some kind of religion that didn’t believe in medical care. Her family had called 911 when she stopped breathing, but then the husband told the responding firefighters to stop resuscitation efforts when they (understandably) charged though the door and started pumping on her chest.

“Are they Christian Scientist or something?” I asked the officer.

“Nope,” he replied.

“Well, um, what are they, then?

“I don’t know.”

“Cool story, bro” I muttered under my breath as I hung up the phone.

Quick side note here- As a rule, Christian Scientists don’t believe in medical intervention of any kind. My first experience with this phenomena was in college while I was on student exchange in Mexico. One of my fellow American students (a Christian Scientist) sprained her ankle playing soccer. Later, at the local cantina, she staunchly refused when everyone told her to elevate and ice the injury.

“Candice,” I remember scolding her. “Your ankle isn’t injured because you’re an imperfect reflection of God. Your ankle is injured because you ran into a wall.”

She shrugged, wincing at the pain. She DID, however, accept a few generous servings of tequila and didn’t even flinch when we hobbled her home through the dark streets later that night.

Since then, I’ve been called to quite a few Christian Scientist deaths. They’re a sticky, gray area because often enough, the cause of death is excruciatingly apparent. However, because there’s no documented medical history, these deaths still have to be investigated as unexpected/suspicious. I always feel like kind of a dick, walking into people’s homes and asking a bunch of probing questions that, doubtless, sound judgmental and self-righteous. But I’m certainly in no position to judge. As much as I might disagree with their stance on medicine, I spoke in “tongues” and waved my hands over my head with zealous glee in my childhood pentecostal church. People thought I was crazy, too.

That said, I’ve seen a Christian Scientist die of a brain cancer that literally melted half his head away before it finally took his life. This poor guy had a single gauze band-aid placed over the gaping crater in his cranium- it was the only “treatment” allowed. I can’t fathom voluntarily going through such an experience. Moreover, I can’t fathom watching someone I love going though such an experience. But hey, to each, their own. I suppose they can afford all those funerals with the money they save on healthcare.

(You can’t tell me that shit didn’t HURT.)

Anyway, back to the situation at hand.

I arrived at the scene of this woman’s death and was greeted by a collection of 40+ people all gathered in the front yard. Men and women were seated in lawn chairs while swarms of children dashed about. Someone had arranged a tableau of donuts and coffee on the hood of a car and the whole scene oddly resembled a church picnic. While there wasn’t any overt laughter, there also wasn’t any blatant grief. As I got out of the county truck, the assembled company watched me with flat interest. It was as if I was there to clean the carpets or tow a car- not a fun event, but also not a horrible one. I gathered the decedent’s husband and oldest children to one side of the yard along with the investigating police officer and flushed out the rest of the story.

The family, and all of their collected community, identified as “non-denominational” when I asked for a clearer description of their religion. Which is a really good way of saying nothing at all. Kind of like when people tell you they’re “spiritual” but not “religious”… it’s some kind of weird faith approximation that manages to avoid any definitive stand. But whatever. The woman had awoken with shortness of breath around 5am and her symptoms got worse and worse until 11am when she collapsed and stopped breathing. At this point the family figured they should call someone; probably 911. As already stated, the fire department arrived and jumped right into a resuscitation attempt that actually had a pretty decent chance of success. But the husband insisted that his wife wouldn’t have wanted resuscitation and the fire department, unsure of what else to do, called their supervising doctor for some direction. This doctor, who was at a hospital on the other side of town, took the husband’s word for it and advised the firefighters to cease efforts and pronounce. Which they did.

It was at this moment in the story when the monster in the back of my head decided to start jabbering. This monster is a suspicious little troll that lives under the bull-shit bridge in my brain- the bullshit bridge being the path that any input takes on it’s way from simply being information to being something that I actually believe. Whenever anyone offers data that I find suspect, questionable or downright false, the troll crawls out of the shadows and growls “Who’s that trying to cross my bull-shit bridge?!”

(“I know what I’m talking about and YOU don’t”. “Bullshit.”)

(This troll is often called “intuition” or “gut-feeling” or even “I-know-that-isn’t-true.” All women have this troll in their minds but we’re trained to gag him and keep him quiet for the sake of politeness. As a result, I’ve found myself believing a lot of bullshit in my lifetime. And it’s total bullshit.)

In this case, my bull-shit troll was growling about the decision to pronounce the dead woman with no resuscitation. I wasn’t altogether sure this course of action was correct, or even legal. See, I can totally get down with declining medical care for religious reasons. I’m also fine with NOT resuscitating someone who didn’t want it. What bugged me about this whole scenario was the absolute lack of documentation.

When someone doesn’t want to be resuscitated, they need something called an “advanced directive” or a DNR (Do Not Resuscitate) This is official paperwork that testifies to the deceased person’s wishes. We see DNR’s a lot with elderly folks who have burned through their life’s bandwidth and they don’t want to be brought back in the event of their death. They tend to have diseases and disorders and a lengthy resuscitation/hospitalization isn’t going to do anything but postpone the inevitable and rack up a prolific hospital bill. Other people get DNR’s for other reasons. Hell, I once had a co-worker on the ambulance who had it tattooed on her wrist because she was so nauseated by the thought of anyone doing CPR on her. Whatever. The reasons don’t matter. The documentation does.

In the absence of a DNR, emergency workers legally HAVE TO at least attempt resuscitation. There are a whole host of legal reasons for this rule, mostly involving liability and protecting emergency medical crews from litigation. There are a few cases in which a DNR isn’t necessary to cease rescue efforts- for example, if the person has been dead so long that a resuscitation attempt is clearly superfluous, or if they’ve suffered such a profound injury that there’s no point… think beheadings and fire deaths.

(“Sue me if you must, I’m not doing mouth-to-mouth on that guy”)

What weirded me out, and set my bullshit-troll grumbling, was the fact that this woman was young, she had NO documented medical history, and she didn’t have a DNR. The fire fighters and their medical director decided to stop resuscitation and pronounce the woman dead, based simply on the husband’s word.

“I don’t like it…” muttered my bullshit-troll.

“Me neither,” I told him.

The world has changed quite a bit for women in the last few decades, mostly for the better. But that’s not to say that everything’s fixed and great. Some truly disturbing laws and behaviors are just barely fading in American society’s rear-view mirror, while others are still very much in practice. And lets’ all remember what’s printed on the bottoms of all those mirrors: “Objects in mirror are closer than they appear.” In other words, it wasn’t that long ago…

(“Yep, I can still see unbridled misogyny and chauvinism back there…”)

You don’t believe me? Give these little facts a backward glance:

-It wasn’t until 1976 that the first state (Nebraska) decided that it was illegal for husbands to rape their wives- meaning that a man was absolutely within his rights to force his wife to have sex with him regardless of her feelings on the matter. If that’s not gross enough for you, maybe consider that it took 17 years for the rest of the country to follow suit. That’s right… 1993.

-Domestic assault wasn’t even recognized as a crime until 1920. Even then, unless men were caught in the act, a domestic disturbance was considered a “private matter” and police would not respond to these calls. It wasn’t until the 1979 when the first congressional hearings on domestic abuse were held.

-As of 2017, a woman cannot withdraw consent for sex in North Carolina. If she changes her mind and “yes” becomes, “no”, the participating man can force her to continue and she has no legal recourse. According to state law, it’s not rape.

-In 7 states, rapists have parental rights. This means that sexual assault victims can be forced to have continued contact and coparent with the perpetrator. Way to go Alabama, Maryland, New Mexico, Minnesota, Mississippi, North Dakota and Wyoming.

-Women have had a historically difficult time obtaining birth control. Specifically, a friend recently told me that even though she knew for all of her adult life that she didn’t want children, no doctor would consent to performing a tubal ligation on her until she was 30 years old. When she did turn 30, she had an extensive list of questions she was required to answer in order to justify her choice. One of those questions was: “Do you have your male partner’s support in this decision.” Then she had a mandatory waiting period in case she changed her mind. BUT if she waited more than 3 months to have the procedure after all this rigmarole, her consent would “expire” and she’d have to start all over.

Long story short- in both recent history, as well as present day… women have a lot of people making decisions about their lives for them.

All of this enraging information aside. It is widely known that a woman is FAR more likely to be murdered by someone she knows than by anyone else. A 2019 study done by the United Nations Office on Drugs and Crime determined that 137 women across the world are killed by a member of their own family everyday- that’s one every 10.5 seconds.

So… what does this mean for our 44-year old, non-denominational mom with no documented medical history, no DNR and no paperwork granting her husband medical power of attorney?

Well, it means that, statistically speaking, the person most likely to murder her was also the person telling the firefighters not to resuscitate her. It means that her life was, essentially, at the mercy of men who never questioned who was calling the shots: Her husband.

And why would they question him? He’s a dude, they’re all dudes… they had a big, fat, “we’re-dudes-and-we-believe-each-other” convention over this woman’s dead body… and then they called another dude (Their attending medical director) to get permission to pronounce. And I just want to know if it EVER occurred to ANYONE (other than me) to question this whole situation?

Now, just to be clear- I don’t think the husband killed her… at least not directly. But I came to that conclusion after doing a thorough scene investigation and physical exam on the body- something that the first responders didn’t do. THAT SAID, I’m going to let you in on a little secret about our decedent: Her daughters told me that she had a family history of diabetes and she took her blood glucose several times per day, almost to an obsessive degree. Her blood glucose was well over 300 on every occasion (a normal level is 80-120) At times, her blood glucose was over 500, almost too high for her glucometer to measure. And her daughters were right. She took her blood glucose between 6 and 7 times per day. In my mind, this was not the behavior of someone entirely sold on faith-healing. This is the behavior of someone who is concerned for her own welfare. This is the behavior of someone who wants to live.

I could be wrong. It’s entirely possible that when she saw that lethal number continue to rise, she believed that God would protect her from diabetic ketoacidosis… organ damage… death. Maybe she believed that it was her duty to adhere to God’s will, even if God’s will was for her to die on her living room floor with her 5-year-old daughter watching.

Or maybe, that glucometer meant that she wanted something different. Maybe she didn’t entirely believe God was regulating her blood glucose. Maybe she didn’t think prayer was quite cutting it and she wanted a second opinion. Maybe she wanted to exercise some agency over her own fate. Maybe she wanted to see a fucking doctor. And maybe she asked for someone to call 911, but they refused and admonished her lack of faith. Or maybe she felt she couldn’t ask for an ambulance for fear of being labeled an unbeliever. Maybe the excruciating weight of familial expectation and religious pressure stifled even the most basic human instinct: survival.

Ultimately, we ruled the death natural- long-term complications of unmanaged diabetes. It’s still bugging me. Not so much that the woman died of an entirely treatable disease, but rather because her death uncovered what I consider to be a really fucking disturbing feature of our EMS system: Letting the spouse govern resuscitation attempts in the absence of any documented advanced directives. I mean, ok… so in this case, she died of diabetes and didn’t want to be resuscitated, maybe that’s true and maybe it’s not. We don’t really know because there’s no record of her wishes. And… what about next time? What happens when some woman is murdered by her husband for the insurance money and the husband tells the responding ambulance crew- “Oh… stop doing CPR! She wouldn’t have wanted it!” I mean… the imagination runs WILD with all the ways this could go badly. But when I called the fire department’s EMS coordinator to discuss their protocols regarding this matter, I was met with defensive denials and equivocations all around.

The fire department’s staunch stance was that they did everything right and the decision to pronounce had ultimately been up to their medical director and therefore they were exonerated from any blame. They followed their protocols. They didn’t seem to understand that I was not questioning whether or not they had followed protocol, I was questioning whether or not the protocols themselves should be re-examined. Naturally, they took my questions as criticisms and refused to look at the matter any further because the fire department can’t exist in a world where they aren’t unquestionably right.

(“It’s ok ma’am, I’m following protocol”)

In the meantime, a woman is dead because that’s what her husband said she wanted. And maybe it was… but we don’t actually know that, do we? And how will we know next time if this is how we do things?

I’m not satisfied.

One thought on “The politics of resuscitation…

  1. Interesting article! I come across a fair amount of something similar in the health and social care system in the UK… Not gender-based to my knowledge… But the practice of assuming that relatives can consent on behalf if an incapacitated individual even where there is no power of attorney!

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