“please DNR me my love”
we all rushed to room 5 when the patient’s nurse yelled for help. code was not called, but we were busy anyway. after awhile, she was stabilized. although her blood pressure was barely normal, she was okay.
when everything settled and we were in a contemplative mood, we realized we were all thinking the same thing.
R, the patient in room 5 had been sick for years. all sorts of things, all sorts of surgeries. over 200 hospital admissions that usually lasted a few weeks to a few months, her body had been battered. earlier that night, when the blood transfusion was about to be started, she complained of being “very tired”. not just physically, but about the whole sick-all-the-time thing. very tired, meaning she wanted to rest. in peace. literally.
she used to be DNR (do not resuscitate) but her husband probably convinced her to change that, because just a couple of days ago, her status was changed. we have taken care of R for years now that most of us know her and her husband like old friends. we all know it is him who cannot let go. it is him who is too scared to lose her.
all the nurses i know want to be DNR. some do not even want a day on the ventilator. some want a week to see, and then be unplugged. i am one of those who do not want anything, anytime. just let me go. the sooner, the better. there was a point in my life when i thought differently because i became a mom. i thought i cannot die before my kids grow up, they need me. then i realized how arrogant that thought was, so i am back to being sure i want to be full DNR. and for the record, i want everything usable to be harvested for donation. you are my witnesses, okay?
anyway, the fact that most if not all nurses want to be DNR proves a point. i know you already figured that point out, so i won’t bore you with an explanation.
we kept talking about our wishes. then, we sort of found a dilemma. we were very certain that our spouses, just like R’s husband would not want us to be DNR. we also figured out that we feel the same way about our spouses, that unless they have a terminal illness…”yeah, we want everything done!” and we probably won’t mind all the tubes. not on our kids, on our parents, on our spouses. it’s as if we want them to live forever.
what is it about us? we don’t want to prolong our lives, poked and exposed, surrounded by machines, with tubes in every part of our bodies. but we think differently when it comes to those we love? it’s almost a clear definition of selfishness, but somehow, it also appears like love.
advance directive seems to be the solution, but not so when it is an accident.
advance directive doesn’t really matter when it is an accident because even if i have it, i don’t carry it in my purse, and i’m sure worse comes to worst when my husband is stressed by it all, he might even deny he knows about the directive. and if that happens, i won’t even blame him. i am probably inclined to do the same if the situation is reversed.
and no, giving a parent/sibling the power of attorney is almost pointless when it’s an accident. for sure, it will be the spouse who will be called first, granted the accident happens during those few times you are not with him/her.
when it comes to a code status, it’s easy to decide for myself, but to say it is extremely difficult to make a decision for those i love is an understatement. in 2001, when my mom coded, revived, and coded again, i was a wreck. i’m pretty sure that if on the second code she was revived again, i will not make her a DNR for a very long time. i probably would have sat there and wait for a miracle while the ventilator breathes for her.
how about you, do you want to be DNR?
if you do, do you feel exactly the same towards your loved ones?
if you feel exactly the same, how hard/easy was it for you to make that decision?
if you want ot be DNR but want your loved one to “live forever”, what is your “excuse”?
Yes, when it is time I don’t want to fight it. Let me go, and use what you can to make a difference in other people’s life, and creamate the rest. Dust to Dust, Ash to Ash…
Comment by Thuha — February 17, 2008 @ 9:47 pm
Put me down as DNR, and my husband as the same. I know it would be the hardest thing I ever had to do in my life, but he is very clear about not wanting to live on in a severely compromised state. I don’t even want to think about the children — but really, medicine is pretty amazing. I think once the doctors believe they’ve reached the limits of what medicine can do for a person, then it’s time to let go. I know everyone’s heard of those “miracle” cases, but the reality is that those are ultra-rare. I think even in the case of the children, you have to put selfishness aside and do what is kind and humane for someone else.
And I’m right there beside you on the donor list, as are the rest of my family. If someone else can use it when I have finished with it, so much the better.
Comment by MamaBee — February 17, 2008 @ 10:30 pm
I haven’t really thought about the dnr issue. I do believe in organ donation and I’ve made my wishes known on that. My stepdad had a lung transplant. A few weeks ago I took my teenage twin daughters for their driving permits. The license examiner asked them if they wished to be organ donors and they got this funny look on their faces and giggled no. When we left I asked them about it. Apparently at school one of their teachers told the students to never be organ donors because they will purposely kill you to get your organs. I tried explaining that that was untrue, they believe their teacher though.
Comment by Dana — February 18, 2008 @ 4:32 am
The thing that people don’t understand is the REAL statistics regarding DNR: in the hospital, CPR may bring back about 25-30% of people, of whom usually 10% will survive to discharge. If they have cancer, the survival to discharge drops to almost 0%
People are used to seeing TV shows that paint a totally unrealistic picture of CPR success rates. The reality is that most patients are not young, healthy accident victims but older with multiple comorbidites — not good candidates for CPR.
Oh yeah, I’m DNR and use what you can. My partner is the same except she want to donate her body for use as a medical cadaver.
Comment by marachne — February 18, 2008 @ 11:17 am
My hubby and I know what each other wants which is keep us free of pain, turn the machines off and harvest anything you can use, and burn the rest.
I truly hope my brother in law is never ever allowed to make that decision for my hubby, he’s a “keep alive at all costs” guy.
Comment by Vanda — February 18, 2008 @ 1:56 pm
Thank you for a different look at the DNR. I often forget how the family feels to lose their loved one. We have a patient who basically lives in our ICU she is currently on 3 pressers and CRRT, but the family is not ready to let go. Saying goodbye and honoring my love one’s wish is going to be very difficult when the time comes.
Comment by COnurse — February 18, 2008 @ 11:10 pm
i personally want to be a dnr when the time is right, and feel the same about my family members and children. i never want myself or any loved ones to be kept alive by artificial means only to prolong to inevitable suffering that will occur. in my years of being a nurse and based on what i’ve seen at work, the decision wasn’t that hard, until the time when i’m finally put into the situation personally. i will no doubt second guess at times, but ultimately will be true to my beliefs.
some of the problem i think is the docs, which is something you never mentioned in your post. they need to step up to the plate and paint a real picture to families of what will or will never happen. if they ask me, i am always willing to discuss the issue with the family to assess where they stand and what they want, which is a “chore” i believe many docs simply don’t address adequately or many i’ve seen give some glimmer of false hope. not all or most docs by any means, but there always seem to be those few who push it off onto nursing or social services.
recently we had a pt who was made a dnr literally hours before her death because her husband was not only under the impression that her “brain cells would re-grow” even though she had a recurrance of brain cancer that had metz’ed everywhere, but he was by no means ready to let her go. he was even making arrangments to take her home to care for her the day of her death. my gripe the whole time was her doc only concentrated on the semi improvement of her initial presentation of pneumonia with the husband, never the total picture, which the nurses did discuss, but because “the word” never came from the doc, then what we said was automatically discarded. it was heart breaking for staff to see the suffering this pt and her family had. her husband went from planning home care arrangements to planning her funeral. that is why i will always be a dnr.
Comment by melissa — February 19, 2008 @ 11:25 am
You know, when I was Ardis’ care taker, she signed a DNR. Then I managed to get her a liver transplant evaluation. Well, I had to get her to sign another advanced directive, this time, not DNR, because they will NOT go through a $500,000.00 operation for you if you are DNR.
I am currently in this dilemma. I am TERRIFIED of being intubated, cause I KNOW I will panic. The last time I had cavities filled, I panicked bad. I filled his chair with sweat. I had to take ativan afterward! If I wake up intubated, OMG. So, I might not be brave enough to go through a transplant after all. They say transplants aren’t for sissies.
Comment by Bobby — February 19, 2008 @ 4:46 pm
May, you bring up a very valid point. I joke around at work all the time, saying I am going to come up with a new form to replace the DNR called a DNTM - Do Not Touch Me.
The question is, when it comes to my wife, would I be able to follow a DNR? Or would I revoke it? I really don’t know the answer to that, and God willing I will never find out.
Perhaps this is just an illustration of my own selfishness. I don’t want to live through excruciating pain, or the humiliation of needing someone else to bath and/or do peri-care on me when I can no longer do it myself. Yet, I do not want to lose my wife for any reason. She is part of my soul and I could not face life without her.
Comment by PD Warrior — February 20, 2008 @ 3:07 am
This would make a fascinating research project for a graduate student…and it’s an important conversation for all human beings. Trouble is most of us don’t like to think about these moments until we’re forced to. When challenging issues like these are on the table in patient and family lives, they need support and conversation with ministers and/or social workers. These battles are too tough to fight alone and most of the time, unfortunately, the medical and nursing staff are so busy with day to day responsibilities, there isn’t time for the caring conversations they’d like to have with their patients. Teamwork seems to be the only solution to ensure patients and families get what they need.
Onehealthpro
Comment by Onehealthpro — February 20, 2008 @ 7:53 am
me and my colleagues have also discussed this issue among us and all of us, would want DNR status for ourselves. the question is, would we want it also for our loved ones? hmmm..it makes me think now…if anything happens to my parents especially my mom, i don’t think, i’ll have the courage to just say, yeah just leave her alone and make her DNR. of course, i don’t want to see her suffering but then, i’m also selfish and don’t want her to leave me….hate this type of decision making… >(
Comment by andre — February 20, 2008 @ 9:12 am
I have a HCPOA and I told my husband, and our designate to use it.
Our designate, if we are both incapacitated, knows our wishes (we discussed them AND wrote them down).
Sure I’ll take a chance for a week, but I do not want to be a useless cadaver for someone to stare at on machines, which is basically what you can be in certain circumstances. I know I have other family members who will not appreciate my wishes, but they are the EXACT reason why I stated what I want. They’d do whatever they wanted just for appearances, which is not my thing.
I had an elderly relative die a few years ago after being in an accident. His family thought he was getting better, then he went downhill and they said there was no way to save him and he needed a PEG. They refused and he died. I’ll never forget the wake, because his son was worried about this. I asked him, “Did you do what he wanted?” He told me yes. Then I told him, “You did what he wanted you to do–you fulfilled his wishes and let people know them so he could die in peace. That is a wonderful gift.”
If needed, I hope someone can do the same for me.
Comment by RehabRN — February 23, 2008 @ 5:43 am
Definitely DNR for me. I am a hospice nurse and discuss the DNR on a daily basis with patients who are terminally ill (and their families). I try to tell them gently what a real Code looks like and how it could never work for someone who is already so sick. I have had cancer patients tell me that they want to be DNR if they code because of the cancer, but not if the problem is with their heart, for example. Sigh. Television has done a disservice in this way, for sure. DNR for my relatives, too. I just know too much.
Comment by Kaliki — February 24, 2008 @ 1:44 pm
YES! i’d never want to be a burden to my family if I won’t come back 100% i’d rather go away 100%
Comment by Rygel — February 25, 2008 @ 6:14 am
I am in agreement, I would definately be a DNR and hope I would make the same decision for my family. It’s too bad that the doctors don’t advocate in the best interest of the patients. I think they are afraid of being sued down the road if they don’t do everything possible to save their patients.
Comment by Jayne — March 28, 2008 @ 3:02 pm