Posted on: August 4, 2014
Written by: Coalition for Compassionate Care of California
By David J Casarett, MD
Author of “Shocked: Adventures in Bringing Back the Recently Dead.”
When 87 year-old Lorraine Bayless collapsed at the Glenwood Gardens retirement community in Bakersfield California on February 26, 2013, no one at the scene could have predicted the national media uproar that was about to engulf them. And they certainly couldn’t have predicted that they’d become the focus of worldwide attention, almost none of which was very charitable. If they had, it’s very possible that they would have made different decisions.
What did they do? They didn’t do anything. And that, it turns out, was what got them into trouble.
Shortly after Bayless collapsed in a communal dining room, a bystander used a cellphone to call 911. The dispatcher, Tracey Halvorson, instructed the bystander to reposition Bayless on the floor. Then the cellphone was passed to someone else who identified herself as a nurse named ‘Colleen.’ That’s when things get very strange. We don’t know everything that happened, but we do have an approximately seven-minute audio recording of that call, so we can fill in some of the gaps.
First, Halvorson determines that Bayless is unconscious. She doesn’t seem to have a pulse and is not breathing. As per protocol, she advises Colleen to start CPR.
“We need to get CPR started,” Halvorson says.
“Yeah, we can’t do CPR,” Colleen replies.
As you can imagine, there is a momentary pause, as Halvorson processes this new information. You can almost hear the wheels turning as she’s trying to determine whether she’s heard correctly. After all, someone has called 911. Halvorson’s working assumption seems to be that most people who dial these three numbers are interested in saving a life. So Halvorson is understandably nonplussed to hear that saving a life is not currently on the menu.
It doesn’t take her long, though, to realize that she has in fact heard correctly.
Halvorson is incredulous at first, but then she begins to try to persuade Colleen that, in this situation, CPR might be a good idea. That doesn’t have much of an effect.
Halvorson’s desperation is palpable now, and she runs through an increasingly frantic list of others who might be willing to perform CPR, all to no avail. Then she suggests calling a gardener. This is when it becomes clear that things are not going well. I mean, when you have to pull a guy away from his weed whacker to perform CPR, it sure sounds like you’re nearing the bottom of the barrel, option-wise.
Listening to this exchange is frustrating, heartbreaking, and generally depressing in part because of Halvorson’s desperation. She is obviously trying every trick in the book to get Colleen to help. She’s failing, though, and she knows it.
If you listen more closely, though, you can hear Colleen’s distress, too. In fact, the quotes above don’t do justice to the discomfort she seems to be feeling. What looks like bored nonchalance in a transcript doesn’t adequately convey her emotions. Listen to the audiotape, and it’s obvious that she’s confused and uncertain. It sounds as though she really believes that she can’t do this. Or that she shouldn’t.
It’s shortly after this point in the conversation that paramedics arrive on the scene. A few seconds later, the call concludes and the tape ends. Bayless was transported to a nearby hospital, where she was pronounced dead.
But the uproar was just beginning. Colleen was chastised by the media as uncaring and immoral. And Glenwood Gardens didn’t fare much better. In fact, headlines and media reports made this sound like an open-and-shut case of bad nursing home care.
But it probably isn’t the truth. For instance, as the wave of criticism was breaking, it emerged that Colleen was hired not as a nurse, but as a resident services director. So she truly was a bystander. And Bayless wasn’t in a nursing home, she was in an independent living facility. Essentially she was in an apartment complex. So the widespread impression of a nurse in a nursing home refusing to provide CPR was almost entirely wrong. Add to this the fact that by most accounts Bayless’ family was satisfied with the care that she received. Bayless, they said in a statement, wanted to die of natural causes.
Then Bayless’ death certificate was posted. She died, it seems, not of a cardiac arrhythmia or myocardial infarction, but of a stroke. That’s significant, because in a patient who collapses as a result of a stroke, CPR is unlikely to save a life. That’s not a criticism of Tracy Halvorson’s advice, of course. She made all the right recommendations. But in this case, it’s unlikely that CPR would have helped. So all of this negative media coverage, and all of the criticism heaped on Colleen and Glenwood Gardens begins to seem way out of proportion.
In fact, if you look at it dispassionately, the whole episode begins to seem surreal. Lorraine Bayless was an 87 year-old woman who had led a full life and who wanted to die a natural death. Even if CPR had been attempted, it would have been highly unlikely that she would have survived. Given her stroke, even if she did survive to leave the hospital, a substantial degree of neurologic impairment would be likely.
And yet there seemed to be an overwhelming public perception that Colleen and Glenwood Gardens failed.
David Casarett, MD, is a physician, researcher, and tenured professor at the University of Pennsylvania Perelman School of Medicine. His studies have included more than ten thousand patients and have resulted in more than one hundred articles and book chapters, published in leading medical journals such as the Journal of the American Medical Association and The New England Journal of Medicine. His many awards include the prestigious U.S. Presidential Early Career Award for Scientists and Engineers.