One simple piece of paper could have prevented the drama surrounding the death of an 87-year-old Bakersfield woman who did not receive CPR when she collapsed at her senior living community.
Lorraine Bayless wanted to die naturally, according to her family. She would not have wanted medics, a nurse or bystanders to attempt resuscitation. She almost certainly would not have wanted to become the subject of media scrutiny, government investigations and angry accusations about caregiving.
But because she had not made her wishes legally binding in a Physicians Order For Life Sustaining Treatment, or POLST, there was frenzy and heartbreak during her final moments as a 911 dispatcher pleaded with a bystander to perform CPR. Arriving later, medics tried aggressive resuscitation, but it was futile.
"Her wishes never got documented to the health care providers," said Judy Citko of the Coalition for Compassionate Care in Sacramento, a nonprofit agency which specializes in end-of-life planning. This paper's yearlong Cost of Dying series delved into the importance of such planning.
Bayless is hardly alone: A 2012 survey by the California Healthcare Foundation shows that just 23 percent of Californians have put their end-of-life wishes in writing.
She collapsed, struggling to breathe, on Feb. 26 in the dining hall of Glenwood Gardens, where she lived independently. Women there called 911 on a cell phone, setting in motion an emergency response that is rarely questioned. The women gave the phone to a woman who identified herself as a nurse, but told the dispatcher she was not permitted to do CPR.
In a wrenching conversation that inflamed public opinion after the 911 tape release this week, the dispatcher implored the woman to find someone who could follow CPR instructions over the phone.
"Can we flag someone down in the street and get them to help this lady?' the dispatcher asked. "Can we flag a stranger down? I bet a stranger will help her."
The refusal to do CPR has led to formal investigations, calls for legislative action and an industry declaration that policies need to be reviewed.
A preliminary death certificate shows that Bayless died of a massive stroke, not a heart attack -- so it is unclear that CPR could have saved her.
"While many strokes will not lead to death, (strokes) in certain parts of the brain are deadly (and) despite the best medical efforts, the likelihood of recovery is very low," said cardiologist Dr. Cesar Molina, a spokesman for the American Heart Association. He did not know details of Bayless' case.
She had been diagnosed with a disease of the blood vessels supplying the brain, called atherosclerosis, according to her doctor Dr. Jennifer Abraham.
Her family issued this statement: "It was our beloved mother and grandmother's wish to die naturally and without any kind of life-prolonging intervention."
But there was no indication those wishes had been recorded.
"Absent documents, we will begin lifesaving measures. That is our default -- to save a life whenever possible," said Michael Petrie, director of Emergency Medical Services for Santa Clara County, who was not involved in the case. The methods can involve aggressive chest compressions, intubation, medications and other interventions.
If medics arrive and discover documentation that a patient does not want resuscitation, they can offer pain control, passive oxygen and treatment of any wounds, said Bruce Kenagy, director of Contra Costa County Emergency Medical Services.
The POLST is designed for the chronically ill or the "very elderly" like Bayless, defined as anyone over 85. Printed on bright pink paper and signed by a doctor, it is a legally binding assertion of your wishes -- alerting emergency medical personnel and others whether you want aggressive treatment, comfort care or nothing at all.
A Harvard Medical School professor said care communities also need to take more responsibility.
" 'Continuing care communities,' ... should be more active in asking residents what their wishes are," said Mildred Solomon, who is also president of The Hastings Center, a bioethical think tank.
CPR does not fix a stroke, but if a stroke victim's heart stops, CPR can help her stay alive.
Is it worth trying? That's a personal decision, but it must be shared with families and those around you, said Ellen Goodman of the Boston-based Conversation Project.
"Then those tough conversations need to be documented in some way ... so there is not the guilt and uncertainty that often lingers way after death," she said.
The Associated Press and the Bakersfield Californian contributed to this report. Contact Lisa M. Krieger at 650-492-4098.