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(LA Times)   911 dispatcher "Is there anybody that's willing to help this lady and not let her die?" Nurse at senior living center "Um, not at this time"   (latimesblogs.latimes.com) divider line 438
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23477 clicks; posted to Main » on 03 Mar 2013 at 9:13 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-03-03 10:06:14 PM
Do you know how often CPR is "successful"?
 
2013-03-03 10:06:34 PM
I got dibs on her chocolate pudding.
 
2013-03-03 10:07:15 PM

ByOwlLight: PsychoPhil: But the issue here is CPR wasn't appropriate, and likely wouldn't have done squat, anyway. I mean, what next, you yell at the tow truck driver for not jump starting your car when it has a flat tire?

I fail to see how it wasn't appropriate.  "She was old" is not a good enough answer.



Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?
 
2013-03-03 10:07:50 PM
NotoriousFire:
From your article, "not breathing normally" is defined as "ie, not breathing or only gasping." Barely breathing doesn't really sound like either of the two. I know you weren't connecting your point to the article, I'm merely pointing this out.

Obviously, it's a judgment call what's normal breathing. My point was that chest compressions can be appropriate even if the victim's heart is still beating.
 
2013-03-03 10:09:02 PM
Between the transcript and the whole demanding CPR be performed on someone who was still breathing, I'm gonna go with: the dispatcher is a bit of a spaz.
 
2013-03-03 10:09:39 PM

NotoriousFire: Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?


It doesn't appear anywhere that the on-scene nurse was doing that kind of an assessment at all.  If she wasn't breathing at all, it sounds like her response would have been "Yeah, we don't do that."

It may have been the right call in the end, but it wasn't like the nurse came to that conclusion.  She just said she's not helping because her boss said not to.

But, this being a news article, I'm sure there's plenty missing.
 
2013-03-03 10:09:46 PM

RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.


That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?
 
2013-03-03 10:10:35 PM

Spaghetti Eatin' Goombah: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.

I found a guy lying next to my neighbor's house (it was the pest control guy).  No pulse, no breathing, no heartbeat, ashen gray in color.  911 dispatcher talked me through CPR (had never done it before, but sort of new the basics) which I performed on the guy until the EMTs arrived.

Dude died.


Dude was dead when you found him.
 
2013-03-03 10:10:42 PM

quizzical: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

A nurse in a medical facility should already have that training.


FTA: After the nurse repeatedly refused, Halverson asked her to find a passerby or anyone who would be willing to help.  Halverson said she would talk someone through performing CPR.

octopied: Perhaps the patients there have DNR orders.

If you don't know what that is, it's for people who are viewed as so close to death that they have orders for  no CPR to be performed, as they want to die "naturally".


She did not.

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


See: agonal respiration

foxyshadis: But it was too much trouble for the reporter to ask if the 911 operator had a damn clue what they were talking about


FTA: Bakersfield Fire Battalion Chief Anthony Galagazza said Halverson followed protocol and that dispatchers give CPR instructions over the phone numerous times a year.
 
2013-03-03 10:10:45 PM

JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.


This.
 
2013-03-03 10:11:27 PM

Bonanza Jellybean: Between the transcript and the whole demanding CPR be performed on someone who was still breathing


NIH recommends rescue breathing/CPR for people with difficulty breathing.
 
2013-03-03 10:11:35 PM

NotoriousFire: Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?


As other people have pointed out, some places recommend you start chest compressions if the person is passed out and cannot be roused.  That's the training I received when I got certed.

From the sound of things, the nurse in question did not make the call to not perform CPR because the woman didn't need it, she made the call because the facility has a policy of not performing CPR.  Those are two totally different beasts.  If the nurse had said "She's still breathing, I don't think CPR is the right call at this time" it would have been a totally different ballgame and I would have sided with her.  But she didn't.  She said she wouldn't do it because of the policy.
 
2013-03-03 10:12:06 PM

djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.


Yeah, surprised nobody picked up on that. You do CPR, good chance you are going to break something. Not a big deal if it's a non-breathing individual, no pulse, in which case you can only try and keep some oxygen going to the brain, but if they're breathing and pulse beating, you don't do it. Same as you do NOT do the Heimlich maneuver on a person who can talk. You just take them from being someone with a bit of airway obstruction to someone with airway obstruction PLUS broken ribs.
 
2013-03-03 10:12:17 PM
Oh, also, is it just me or is this whole thread all kinds of whacked out?
 
2013-03-03 10:13:28 PM

Relatively Obscure: NotoriousFire: Have you missed the numerous sources already cited that question the use of CPR on a breathing individual? Barely breathing, yes, but not gasping, etc. Is that not enough for you to possibly question that the on-scene person made possibly the right call?

It doesn't appear anywhere that the on-scene nurse was doing that kind of an assessment at all.  If she wasn't breathing at all, it sounds like her response would have been "Yeah, we don't do that."

It may have been the right call in the end, but it wasn't like the nurse came to that conclusion.  She just said she's not helping because her boss said not to.

But, this being a news article, I'm sure there's plenty missing.



True, good points all around. Just to continue the discussion, perhaps the nurse fell back on that excuse simply because it was the easiest way to tell the fire dispatcher to pound sand. If the two of them (the nurse and dispatcher) got into a verbal fight over whose medical knowledge was better, that'd probably get real ugly for the "nurse." Saying it was "the rules" likely was much simplier for the nurse to defend.

/For all we know, the nursing home already paid off the family, hence why they aren't complaining.
 
2013-03-03 10:14:08 PM

ten foiled hats: Oh, also, is it just me or is this whole thread all kinds of whacked out?


I believe that it's on the Internet, so the odds of it being "all kinds of whacked out" are approximately 4,362.76%.
 
2013-03-03 10:15:01 PM

chookbillion: Spaghetti Eatin' Goombah: Birnone: I wasn't aware that dispatchers could 'talk' you through CPR.  I thought people got certified in that, taking classes and such.

I'm guessing further information will show that the 87 year old resident had other issues that would have made it a moot point anyways.  It's not like simply doing CPR saves everyone.

I found a guy lying next to my neighbor's house (it was the pest control guy).  No pulse, no breathing, no heartbeat, ashen gray in color.  911 dispatcher talked me through CPR (had never done it before, but sort of new the basics) which I performed on the guy until the EMTs arrived.

Dude died.

Dude was dead when you found him.


Yeah, pretty much thought the same thing when I found him.  Was kinda hoping something "magical" might happen, but never did.  Guy was 58.
 
2013-03-03 10:16:11 PM

NotoriousFire: True, good points all around. Just to continue the discussion, perhaps the nurse fell back on that excuse simply because it was the easiest way to tell the fire dispatcher to pound sand. If the two of them (the nurse and dispatcher) got into a verbal fight over whose medical knowledge was better, that'd probably get real ugly for the "nurse." Saying it was "the rules" likely was much simplier for the nurse to defend.


Could be, sure.  I can see that as a possibility, at least.  Doesn't seem like the best route to take, but I suppose it could happen.

NotoriousFire: /For all we know, the nursing home already paid off the family, hence why they aren't complaining.


Or, they could just be glad she's dead :P


Anyway, gotta go do some work.  Will probably check in later.
 
2013-03-03 10:16:38 PM

Fell In Love With a Chair: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather. CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

THIIIIISSSSSS
That was the first farking thing I thought when I read this article. Why in fark's name would you do CPR ON SOMEONE WHOSE HEART IS BEATING AND THEY ARE STILL BREATHING?
You DO NOT do chest compressions on someone whose heart is still beating!
You DO NOT do rescue breathing on someone who is still farking breathing on their own!

The funny part is, I haven't had a CPR course EVER and I farking know this!


That's odd, I've done CPR on a person who was breathing and had a heart beat. But I guess you would know better than those of us in emergency services
 
2013-03-03 10:16:45 PM

cynicalbastard: djh0101010: The patient was breathing.  You only do CPR on a pulseless non-breather.  CPR is not the right treatment for that situation.  Oxygen and maybe even to bag them, yes, but the nurse was completely correct not to start CPR on a breathing patient.

Yeah, surprised nobody picked up on that. You do CPR, good chance you are going to break something. Not a big deal if it's a non-breathing individual, no pulse, in which case you can only try and keep some oxygen going to the brain, but if they're breathing and pulse beating, you don't do it. Same as you do NOT do the Heimlich maneuver on a person who can talk. You just take them from being someone with a bit of airway obstruction to someone with airway obstruction PLUS broken ribs.


This is not true at all.  As a random passerby, being able to tell if somebody has a pulse and is breathing can be really crazy difficult, and usually not worth the time.  If somebody has collapsed, isn't responsive whatsoever, performing CPR is recommended.

Medical professionals are a totally different story, since they have training for that shiat.

Obviously, you wouldn't perform CPR on somebody who is responsive in some way, just as you wouldn't perform the heimlich on somebody who can talk.
 
2013-03-03 10:16:49 PM

cynicalbastard: You do CPR, good chance you are going to break something.


But it's like everyone is saying - better alive and with extreme pain and broken bones for the short remainder of your life than being dead! Plus, the old woman could sue the bejesus out of the facility for performing it. Sounds like a great plan!
 
2013-03-03 10:17:12 PM
Does no one else think this death is (policy-wise) deliberate? Sure your kids say they're gonna pick out a great place. And they do, it has tennis courts, a pool, it's even got a picturesque view, because it's way out in the mountains, "won't be a whole lotta traffic to keep you up at night anymore ma" "You won't have to worry about the coloreds moving in down the street either" "they've got 10 nurses on staff at all times" And the policy of the facility is de facto DNR. Meaning that the little bastard that puts you in wants to get at your money before the retirement home sucks it all up.

I like the idea of having the option to check into a place like this, but I'd like to know that it was me making the decision for myself, not my asshole money grubbing kids.
 
2013-03-03 10:19:17 PM

James F. Campbell: FTA: Bayless' daughter told KGET that she was a nurse and was satisfied with her mother's care at Glenwood Gardens, the station reported.

IIIInteresting.


Yep. Sounds like there is more to this than the paper is reporting, either a large inheritance or a woman who was dying and had an informal DNR that the family was on board with.
 
GBB
2013-03-03 10:19:59 PM

AverageAmericanGuy: I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.


Yeah, this is pretty much what you get when you have 2 people both trying to follow the policies of their respective work places, and those policies are in conflict.
 
2013-03-03 10:20:13 PM
But what is a life when measured against a policy? I mean, let's be reasonable, people. It's a POLICY. Which word do you not understand?
 
2013-03-03 10:20:20 PM

Relatively Obscure: NotoriousFire: /For all we know, the nursing home already paid off the family, hence why they aren't complaining.

Or, they could just be glad she's dead :P



See, I just find that difficult to digest. I'd be glad to win the lottery, but if I found a way to win even more money (the lawsuit against the facility in this case), I'd be all over it to sweeten the deal. Considering where the old woman was, I doubt she was loaded with money. And with her being in the home, the family doesn't have to see her much if they don't want to. Thus, just difficult for me to believe that's completely the case.

For the record, likely in the contract between the facility and the woman/family, there's a clause about not performing CPR at certain times (or perhaps at all). Assuming the woman/family signed this contract (which they'd have to), then they knew what to expect. If this clause was in existence, and the facility did perform CPR, they'd be in breach of contract and sued. What would you do if you were that nurse and knew that?
 
2013-03-03 10:20:41 PM
Sounds like her death panel came up...positive. YEEEEAAAAHH..

//no actual politics intended, just a bad pun.
 
2013-03-03 10:21:02 PM

JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?


It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.
 
2013-03-03 10:21:28 PM
www.jackscanlan.com
 
2013-03-03 10:23:08 PM
Dispatchers in Kern County have to go through EMD training. It's not a matter of whether a dispatcher "thinks" someone needs CPR. Depending on the answers given to the questions the dispatchers are required to ask, they may or may not tell the person to start CPR. Look up "agonal breathing" yes they may be breathing, but its inadequate, and if you can't feel a pulse, you start compressions. So, don't question the actions of a very experienced dispatcher, question the nurse who has no ethics or morals.
 
2013-03-03 10:23:44 PM

RandomRandom: JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?

It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.



I have broken so many ribs in my time with CPR.  From infants to elderly I have never seen CPR work.  Cracked chest or not.  Anecdotal to be sure, but people outside of health care still seem to think it's magic.
 
2013-03-03 10:24:12 PM
I have nothing but contempt for these so called "nurses" in these facilities. My mom was in an assisted living facility after a heart attack and subsequent heart failure (she was young, 67, but had a problem with prescription drugs, so we thought she would kill herself without supervised meds). All was okay for a year until she called wanting me to take her to the ER. I called the head nurse and asked if she had been complaining of pain or not acting well. She told me she had been complaining of some pain in her stomach, but she checked her vitals and everything was fine. She then proceeded to tell me that she "always gets herself worked up on the weekends, maybe just out of boredom". The next morning, mom was complaining so much they had decided to take her to the ER. I got a call at work a couple hours later telling me she had died in the ER. Apparently she had an ischemic bowel that was causing sepsis.

I can't believe I listened to that nurse instead of taking her to the hospital the minute she called. I probably could have sued, but mom's heart was pretty bad so really anything could have happened at anytime. Maybe just not that soon.

/ I miss her
 
2013-03-03 10:24:40 PM
This story sucks, and not for the reasons most people think it does:

1) It's making national news for a policy mandated by a single state.  Every single state in the nation has a different law, no two are the same.
2) CPR on an 87 year old frail woman is cruel.
3) The daughter was ok with this
4) Death has a 100% success rate, deal with it.
5) If we start farking with the CPR and good Samaritan laws using litigation, more people risk getting hurt.  This is one case out of millions that went bad.  Those are pretty good odds.

That being said, if the woman didn't have a DNR, then the facility is likely liable, however who is going to sue the facility?  The daughter was clearly fine with everything
 
2013-03-03 10:25:23 PM

PsychoPhil: ByOwlLight:
Withholding care when you're technically a medical professional is a kind of a terrible thing to do.

But the issue here is CPR wasn't appropriate, and likely wouldn't have done squat, anyway.  I mean, what next, you yell at the tow truck driver for not jump starting your car when it has a flat tire?


No, the issue are

1. the home had a policy of not doing CPR under any circumstances, and
2.  the nurse followed the policy of her employer instead of the expectations of strangers.

Assumptions do not create obligations; contracts do.  The home formed a contract with the state when it got licensed.  It formed a contract with the customer.  The nurse formed a contract with her employer.  The assumptions of dispatchers, TV reporters, and Farkers are irrelevant.
 
2013-03-03 10:25:41 PM
Oh and the woman didn't have a medical condition requiring CPR, as was mentioned in this thread.
 
2013-03-03 10:26:25 PM

NotoriousFire: Considering where the old woman was, I doubt she was loaded with money.


Damn, looked at the wrong link earlier. Nevermind, she was likely loaded. Minimum $2.2k per month, and Medicare not accepted. Guess she did have some benjamins... Link
 
2013-03-03 10:27:35 PM

Relatively Obscure: ten foiled hats: Oh, also, is it just me or is this whole thread all kinds of whacked out?

I believe that it's on the Internet, so the odds of it being "all kinds of whacked out" are approximately 4,362.76%.


So, bet my ass it's not just me, then?

/if I lose, DNR
 
2013-03-03 10:28:06 PM

RandomRandom: JMacPA: That's great and all, but is CPR going to make her any deader? What exactly are the negative aspects of an attempt?

It's torture, it breaks ribs, it doesn't work.

The vast majority of retired physicians in nursing home end-of-life situations do not sign releases for CPR.  They know it doesn't work and have no desire to be tortured by the practice in their last moments of life.

It's not evil or cold to deny CPR to the nursing home population.  Given that it doesn't work on them, absence of CPR is just more compassionate.


This.

A procedure that has a sub-5% chance of reviving someone, combined with a near-100% chance of causing an extremely painful injury that would most likely kill an otherwise healthy elderly person is not the sort of thing nursing homes just up and do. Most of the time their medical professionals and lawyers team up to tell them NOT to do it because cardiac arrest is a much better way to die than cardiac arrest followed by some asshole grinding your ribs into corn flakes on the shattered edges of your sternum followed by dying anyway.

So when the nursing home says "Do not do CPR on this patient" then the right thing for the nurse to do is not do farking CPR. That's how people stay employed, out of jail and away from lifelong court-imposed poverty.
 
2013-03-03 10:28:24 PM

JMacPA: RandomRandom: JMacPA: Yeah, CPR has a 2% survival rate if the person is found unconscious. 2% is better than 0%. JUST DO IT.

2% to 3% on a average human, not a health compromised nursing home patient.

As was posted above, one study found ZERO instances of success when performing CPR on nursing home patients.  Zero isn't better than 0%, it is 0%.

That's great and all, but is CPR going to make her any deader?  What exactly are the negative aspects of an attempt?


I think that even on a healthy person things like broken ribs and a cracked sternum are fairly normal outcomes from doing chest compressions. Add an old lady, which probably has some form of osteoporosis, and I would imagine the trauma from chest compressions can be rather severe. To the point that it may indeed prove more dangerous than doing nothing. I would imagine, taking their frailty into account, the best thing the nurse could possibly due was put an oxygen mask on the lady.
 
2013-03-03 10:31:06 PM

RandomRandom: CPR doesn't work very well, not well at all.

Well, it does sometimes work - but does very little lasting good. IIRC, one month after having received CPR, less than 8% of of CPR recipients are alive, most of those are in a persistent vegetative state.


CSB
I was present when a guy -- maybe 60's, 70's, seemingly perfectly healthy -- keeled over. Another onlooker performed CPR until the medics came, and the guy survived. However, he was pretty much a vegetable, and I'm told the family hated the guy who performed CPR for doing it.
 
2013-03-03 10:31:20 PM

Acravius: Good Samaritan Laws protect people who use reasonable actions in performing these duties, regardless of outcomes.


good Samaritan laws do not apply to healthcare professionals, they apply to untrained civilians doing their best
 
2013-03-03 10:32:35 PM
Folks calling for help on the phone can get irrational. I had a lady call me once, at a federal parks site, about an injured seagull at a provincial beach 50-odd miles away. I gave her the numbers for provincial wildlife and she wailed "I tried them- there's nobody answering till Monday!" Then silence. Followed by "Omigod, there's some big black birds landing near it- I think they're going to eat it!" "Probably ravens, ma'am. They're very scared of people, if you moved near they'd leave very quickly." "Oh, my- but they're huge and I've got a heart condition- isn't there anything you can do?"
I was so tempted to start singing "The Circle of Life" it wasn't funny.
 
2013-03-03 10:33:16 PM

WhyteRaven74: The nurse needs to lose her license, and the facility needs some serious sanctions if not being shut down


Because they disappointed you?  Show me laws that they broke, then we'll talk.
 
2013-03-03 10:36:31 PM
I was in the waiting room of Mercy hospital here in Oklahoma City. A guy pulled up by the doors, opened the car door and made it about half way to the doors of ER and passed out. He was laying maybe 25 feet from the doors. The people working in the ER called 911. They would not go outside and get him. Me and two other guys walked out and picked him up and carried him into the ER and he was treated. I asked a nurse WTF? She told me that they normally have ambulance crew onsite, but if they are out on a run the policy in this situation is to call 911, they are not allowed to walk out of the doors to help anyone.

/Dude lived, low blood sugar.
 
2013-03-03 10:38:47 PM

wedun: FarkinSneakyBastage: Can I please have the freedom to choose how and when I die and not rot to death in one of these depressing shiatholes they call a retirement community? That'd be great, thanks

try smoking crack, fast cars, hookers, cocaine.


All of those increase your odds of ending up in a nursing home against your wishes.  Live prudently, be realistic about your health, and keep a pistol handy.
 
2013-03-03 10:38:54 PM

The One True TheDavid: I remember when the world's population hit 3 billion, 4 billion people ago; I was entering puberty then.


Wow, you got busy fast!
 
2013-03-03 10:40:03 PM
My grandfather was 86, still grading papers part-time for the University of Toronto (he was a Silver Medallist in Maths in his younger years) when one night he told his wife that he was stopping early, wasn't feeling too good. An hour later he was dead.
That's the way anyone should go, in their own home. Nursing homes scare the crap out of me.
 
2013-03-03 10:40:31 PM

ChrisDe: Saw that on the news today. The woman that called 911 was more concerned about following the rules (no CPR) and keeping her job than the life of another person. And she was a nurse. Pretty sad, though I guess it's easy to say when it's not me being fired.


Correction: she has a piece of paper with a title on it. In reality, she's barely a human being. MOST nurses I know wouldn't think of losing their job over saving the life of a patient.

On the other hand, CPR on an 87 year old outside the hospital...never a gods outcome, oftentimes worse than death, because they revive you so you can spend there months in the ICU and die anyway. I'd give the nyse a pass if this is what she was thinking about, although if the patient didn't have a DNR order, it's her duty to do so. Ironically enough though, if she did that, she'd have to still choose rules over patient's best interest.
 
2013-03-03 10:40:52 PM

NotoriousFire: Relatively Obscure: NotoriousFire: /For all we know, the nursing home already paid off the family, hence why they aren't complaining.

Or, they could just be glad she's dead :P


See, I just find that difficult to digest.


I was just kiddin', anyway.

Lehk: good Samaritan laws do not apply to healthcare professionals, they apply to untrained civilians doing their best


No.  In many states, this is the exact opposite of true.
 
2013-03-03 10:43:39 PM

AverageAmericanGuy: I'm going to sound cold here, but the woman was in her late 80s. Sometimes its just a person's time to go.

The operator sounds like a spaz, from the way she's portrayed in the article. "It's a human being" Yes, and human beings die all the time. You can't be Superman and save everyone all the time.


This.
I hope if I'm 87 in that situation they have the common decency to just let me be.

/ Maybe just a bit of morphine, thank you.
 
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