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March 5, 1997


Author Affiliations

New Haven, Conn

JAMA. 1997;277(9):696. doi:10.1001/jama.1997.03540330020006

It's 8 o'clock in the evening, and Mrs O is having chest pain again. Although she has had some transient episodes before, this 87-year-old woman has been doing remarkably well since her admission five days ago. She came through her protocoldictated thrombolytic therapy without incident, and her anterior myocardial infarction evolved free of complications. But tonight, she suddenly sits bolt upright in bed, complains that she cannot catch her breath, and collapses. When the second-year resident arrives on the scene, Mrs O is apneic, pulseless, and unresponsive, with normal sinus rhythm on the monitor. The team begins cardiopulmonary resuscitation and initiates the ACLS protocol. I watch as she is intubated. A roller-coaster ride of differing rhythms ensues and is answered with various medications, shocks, and countershocks. The struggle for and with this dying woman continues for 35 minutes. At last it is over, and Mrs O is pronounced dead at

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