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Do Not Resuscitate/Revive: a DNR 'order'

Started by kathykastner

19 Jan 2012, 12:45 AM

A recent conversation made me ponder the perception of quality of life. A friend told me how, when doctors encouraged a DNR (do not resuscitate) along with palliative care - after his 89-year old father suffered a stroke and developed sepsis (a whole body infection) - the decision was: "No DNR: my father's a Holocaust survivor. He's a fighter. He wants to live". Although advised that Sepsis can cause lasting damage, my pal and his sister were in agreement: keep Dad alive. Sepsis was treated but took it's toll: Dad was left without speech, paralyzed on his left side and with Dementia. I shuddered inwardly. What kind of life is that? For my pal and his sis, there was no question it was the right decision. "Dad smiles, loves hugs, happy to see us. True, he can't speak, but we find ways to communicate. We're happy."

I can't help but think I'd have tried to influence that decision toward DNR. Made me think I should be more respectful of the fact that we each have our own perception of life and its quality.

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Reply by Cath1

23 Jan 2012, 8:12 PM

Hey Kathy Kastner

I wish every healthcare professional was as astute and sensitive as are you when it comes to reflecting on how their own biases and experience may affect their decisions that could be in direct conflict of interest with the patient and/or families they come into contact with.

When my late Mom was admitted to her nursing home, she was in good health overall, considering she had what her own doctor had described as mild dementia and some other pre-existing conditions that were under control due to medications. Her health had been pretty stable and in light of that fact, I found it quite upsetting that the Home's director of care was trying to persuade me that I should authorize a DNR order in certain circumstances. I could not at the time perceive of any of these circumstances happening to my Mom in the near future, and because it was enough of a decision to have her placed into long term care, I felt overwhelmed by the immediate pressure to have this “advance directive” in place.

My Mom had been diagnosed with an aortic abdominal aneurysm (AAA) several years prior to her going into the nursing home. She was going to have it repaired the year prior but the surgeon cancelled the scheduled surgery the day before upon deeper consideration of the risks which he felt far outweighed the benefits to my Mom. I agreed, but I was sad for my Mom because just knowing she had a “time bomb that could explode at any time” inside of her, as per her insensitive family doctor's description when she was first diagnosed, was an immense psychological burden for her to carry. In any case, the director of care was giving me all kinds of scenarios that could happen to my Mom and explained to me in gory detail all the possible consequences that could happen if my Mom had to be resuscitated. Finally, she asked me in exasperation, “Well, then what would you want us to do in such-in-such a case”. I responded by saying that I would expect in any emergency that they would call 911 immediately for an ambulance, then call me, and that my Mom would be transported to hospital where any such decision would be made by me and the doctor at that time. I told her I would expect that if my Mom was in any dramatic discomfort, as she would most definitely be should the AAA tear, that she would be given appropriate medication to ease the pain while waiting for the ambulance. The director of care was disrespectful about my decision on behalf of my Mom and she didn't hide her displeasure.

Kathy, your post reminded me of that uncomfortable conversation and how I felt then and how the director of care's attitude hurt me as it clearly implied that she didn't think that I was doing the right thing nor acting in the best interest of my Mom. I recall thinking it was so strange that anyone would try to influence such a highly personal decision, especially within the first few minutes of having met the person. Considering that my Mom and I were at the beginning of a new journey into the long term care environment and had not yet had any opportunity to build a rapport with staff and management, I think it was unwise to pressure me to change my mind based on her own assessment of what she thought was best for my Mom. I was not prepared to give my permission to people I did not know or yet trust with such an important decision. In hindsight, I have no regrets about my decision and in fact, I pat myself on the back for having resisted such pressure and for having been strong in the moment to speak up for my Mom's rights and mine, as her power of attorney.

Knowing what I now know, I am grateful that I stuck to what my Mom would have wanted and followed her guidance and that of my own strong instincts. When my Mom, many months later, became ill at the Home, and I insisted that she be taken to the hospital by ambulance, I again had a conversation about the DNR order. It happened on the 2nd day of my Mom's admission to the hospital and her health was touch and go in the sense that the doctor could not say whether or not she would be able to rally back. I approached a nurse on duty and she was the sweetest and most sensitive person and she explained the directives, as per how the particular hospital interprets them, and she answered all of my questions, and I had loads, listened to my fears, and then let me have time to be alone to consider privately all the ramifications with no pressure on me whatsoever. She also assured me that whatever I decided, if I needed to change the directive at any time it would be fine.

My mother had always told me she wanted to live no matter what illness came to call upon her. She was a devout Catholic and she believed that only God would make the decision about her death. Even with dementia, even living with far less independence in a nursing home, my Mom enjoyed a good quality of life and I knew she treasured her every breath and never took for granted the gift of her life. With all this and more on my mind, as I watched my Mom ailing and frail, fading from me and life itself, I decided to sign my permission that no extreme measures would be taken to resuscitate her if she were to suffer a catastrophic event. In the days to follow as it became apparent that my Mom was not going to pull through, and even if she did, she would be greatly incapacitated by severe disability, I authorized the removal of her intravenous and she immediately took on a whole new demeanour of peacefulness and contentment. Where she had struggled to breath, she then breathed easy; where she had been uncomfortable and in pain, she was then cosy and pain free; where her brow had been furrowed, her face then became relaxed. The transformation was incredible and I am so grateful that I made the decision not to prolong my Mom's suffering.

My Mom and I and our family were surrounded by love and received wonderful and memorable support from the nurses who were literally like angels of mercy, and from a marvellously gifted palliative doctor who assured me that I was giving my Mom the best gift possible by allowing her gently to go on to her next life in heaven. When I detected that my Mom was suffering, my instinct was to alleviate it, and to not do anything to interfere with her fate, but I would have never done anything to hasten her death, as I know she would never have wanted that to happen and nor would I. The decision to let nature and God take control of my Mom’s life and her death was the most important one of my life to date, and while it was the hardest, I am proud for having had the courage in very emotional circumstances to have been able to step outside of myself and my own natural desire to keep her with us by doing the right thing for my sweet, Mom. I know she now she sleeps in heavenly peace.

Every life is unique and should be respected for its individual qualities, and that extends to respecting the choices of the person and/or family whose decisions may not always mirror the expectations of others regarding end of life. Thank you Kathy for raising this topic. I look forward to hearing how others feel about this delicate and personal subject.

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