DNR

For some reason I cannot fathom, the following article showed up on my phone today.  It appears to have been published on KevinMD in 2016 which would have been around the time I had one of the hardest conversations I’ve ever had with the family of one of my patients.

My patient had a massive MI followed by an equally devastating stroke.  He was in the ICU of a local hospital, intubated as he was not able to breathe on his own.  He had multiple large gauge IV lines, an arterial line and a bladder catheter.

The MI and stroke were not unexpected.  My patient was overweight, suffered from hypertension, high cholesterol and diabetes.  He drank too much and despite all of my warnings, failed to take care of his body and health.

The nurse informed me that the family was waiting in the ICU waiting area and wanted to meet with me.  Family conferences are one thing I was particularly good at, but I was not looking forward to this one.  Telling his children that he was unlikely to recover from his MI and stroke and that, if he did, the chances of any meaningful life was slim to none was going to be very difficult.  Stripping a family of hope is a lousy thing to do.

Nonetheless, it was my job to give them as true of a picture of their loved one’s condition as possible and help them as best I could.   As death was emanate, I also needed to discuss a DNR order so my patient could die in peace.  My patient and I had many prior conversations about quality of life and illness; and, while he told me he was going to sign a living will and DNR papers, he never got around to it.

His family took the bad news well.  They knew it was coming.  They, too, had tried to get him to care for himself.  They knew he was not taking his medications as directed.  They knew he was drinking too much and ignoring their pleas.

Despite everything discussed, they ended the conversation with, “DOC, do everything humanly possible to bring him back.  NO, we want a full code status and will not sign DNR documents!”  I was dumbfounded, got no where after further discussion of his condition and subsequently notified the nurses he would be a full code.

Over the next few days he coded multiple times.  We used every tool at our disposal, added more tubes, broke a few ribs compressing his chest, started tube feedings, etc.  I met with the family again.

As it was apparent that we were not getting anywhere with the family and, in my mind, torturing my patient, I asked his family, “What did he do to you all to make you want to torture him?”  I know that my question was harsh and, for a moment, thought that his eldest son was going to hit me.

He was outraged, proclaiming his love for his father.  He actually eulogized him without realizing it.  “How dare you ask such a question.”  I explained my actions.  I told them that I prayed that he did not feel the pain from the fractured ribs, tubes and intensive care he was receiving.  I told them I knew they loved him but that very love was prolonging his life at great physical and emotional cost.

The answer to the dilemma we were dealing with hit me like a bolt of lightning.  “I have been taking care of your family for many years.  Like you, I want to do everything humanly possible for your loved one.  And we have, save one thing. The one thing we are not doing that we should be doing is letting him go.  I can’t let him go until you give me permission, but I know in my heart that he is ready and willing to meet his maker.”

In the end, the family found some peace in knowing that they did the hardest thing to do, they let him go.  So perhaps the next family who finds themselves in a similar situation will read this and realize that sometimes, the loving thing to do is nothing.  I’ve given you a link to two excellent commentaries on this topic.

Warning, I cry whenever I watch “Ain’t the way to die”

AIN’T THE WAY TO DIE

The family said, “Do everything.”

DEBBIE MOORE-BLACK, RN | CONDITIONS | JULY 27, 2016

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