When we asked my 90-year-old father if he would want CPR if he collapsed and his heart stopped beating. His response was immediate.
“Well, it would help, wouldn’t it?”

In his mind, it was simple. His heart would stop, doctors would intervene, and he would wake up and return to living as he normally did.

It’s an understandable assumption.

It’s what we’ve all seen. In hospital, a patient is being treated. Suddenly, there’s no pulse. The patient is ‘coding.’ Doctors and nurses come running. The ECG machine alarms, pads or gel are on the chest. Someone starts cardiac massage. Someone else should have gone to the head to control the airway, but more often than not, a doctor just fires up the defibrillator and calls “Clear”. There’s a shock, pause, maybe another shock. Then a heartbeat returns. Within one or two tense minutes, the patient is awake and often talking. There’s relief all around. The patient and their family are grateful.

But real life is very different.

I once resuscitated a man in his 70s who arrested in front of me in his hospital bed. We started immediately with chest compressions, accessing the airway to deliver oxygen. He still had a heart rhythm, but it wasn’t one that could pump blood. An abnormal rhythm that was potentially reversible with defibrillation.

Unlike in TV, there’s no fixed time limit for resuscitation. Depending on where it occurs, it can continue for around twenty to forty-five minutes, or even longer in some cases. That’s a lot of repeated cardiac massage and electric shocks.

Before we called a stop to the resuscitation, my patient’s normal heart rhythm returned. He woke up and punched me in the chest.

He wasn’t confused. He wasn’t delirious. He was angry.

Why? Because in those unconscious moments he was completely pain free for the first time he could remember. He described a sense of overwhelming peace.

And then, suddenly, he was back. Only now there was even more pain he described as horse kicks to his chest caused by the defibrillator jolts.

He told me I’d ruined everything.

That isn’t how most people imagine CPR going.

We spoke calmly about it afterwards. He had never considered what he would want in the event of a cardiac arrest. He assumed passing would just happen one night in his bed. But now he made his wishes clear. He wanted ‘Not For Resuscitation (NFR)’ documented on his medical chart.

Years later I had the conversation with my own father who was bedridden but mentally very active.

He thought of it his heart like a computer. If it’s shuts down, you just start it up again. CPR was just a reboot. And life would go on as it had before.

He wasn’t alone.

Cardiopulmonary resuscitation is physically forceful. Chest compressions need to be deep and continuous to circulate blood to the brain and vital organs.

Particularly in older patients, that often means fractured ribs.

Breathing is supported, sometimes with a tube placed into the airway and artificial ventilation.

Shocks are only used in specific heart rhythms – not every cardiac arrest. And it doesn’t always work.

When it does, survival doesn’t guarantee recovery.

A lack of oxygen to the brain can lead to cognitive impairment or stroke. Some patients require prolonged intensive care. Some never regain their independence.

Others recover well. Unfortunately, doctors can’t predict outcomes. All we know is that it’s rarely the clean reset we see on screen.

CPR can be life-saving. If there are no other instructions, it will most likely be performed by paramedics or hospital teams.

But it’s not a simple decision for everyone. Age and quality of life are some of things to consider. It’s not just about whether the heart pumps again. What matters is the condition of the brain, the underlying health of the patient, and what the person would have wanted.

The problem is that most people haven’t had that conversation. Not with their families. Many have never thought about it.

We assume someone will know what to do for us. That our partner, our children, our doctor will understand what we would want. But unless we’ve said it, they won’t know.

It’s not an easy conversation but it is an important one.

My father always loved having the last word, so I assured him that this decision about treatment in an emergency was his big chance. This time, he listened and asked questions.

He considered what mattered to him. Not just survival — but the kind of life he would want to return to. And that’s how he eventually died, on his own terms.
As for my punching patient, he ended up peacefully passing away while in hospital. This time I simply held his hand.