The other day an elderly (well not that elderly but he was in really bad shape) man from a nursing home who was bedridden, contracted, had a PEG tube (feeding tube in the abdomen), bedsores, and was incontinent from an old stroke. He had signed a DNR (Do No Resuscitate) order two years ago when he first had his stroke stating additionally that he did not want to be intubated or placed on “life support”. It was notarised and witnessed. He named his son and then later his niece as health care proxies. He came in massively septic. His heart rate was 170, he had a fever of 104, his BP was low, and his pulse Ox was 80% on room air. He had bilateral pneumonia.
Sounds easy. Supportive care, fluids, O2, and antibiotics. But no, it was not to be. His family arrived and I guess could not handle his sudden decompensation. They wanted to cancel is DNR order and wanted “everything done”. I explained that apparently he had not wanted such treatment since he had signed his DNR when he was of sound mind. I also explained that family members need to think of what the patient would have wanted, not what THEY want. Still, no dice. They said he would have wanted everything done now that he was facing death. We felt pretty low and I was not enthusiastic about putting this guy through all this futile care. We were considering calling our risk management about the legal aspects of a family nullifying a legal document.
Then there was a celestial intervention. The Oxygen we were giving started to help is oxygen level. The fluids improved his blood pressure and lowered he heart rate (slightly). He started mentating and looking at us. We were able to ask him questions and he nodded, stating he understood. Then we asked him in front of his family if he wanted to be intubated, placed on pressors, and potentially get CPR were he to code. He shook his head with an emphatic NO! NO! NO!. I could almost imagine him mouthing, “Don’t you dare!!! He went up to the floor for supportive measures (not to the ICU). I really hope they let him die with dignity.
Canadian Pharmacy
I don’t think there would be any legal pitfalls of following the patient’s living will. That particular situation has already been addressed legally and does not need the help of a health care proxy.
Wow. I don’t think I would have agreed to the PEG, even.
This scenario with the family is exactly why I have made it crystal clear to each member of my family that I don’t want futile care. I have told them, basically, that if there is any indecision, then I can’t get mad at them for their choices unless I survive. Soooooo, the safe choice is to let me go.
I’ve also given my doctor written instructions, including the fact that I don’t expect any doctor to be able to predict the future perfectly, and that I’m not interested in longshots at life when the likely downside is considerable.
Is there ever a reason for a person to issue a DNR but not a DNI or vice versa?
Love the pic. When I get to that point, I’m thinking of having just “DNR” tattooed right on my sternum. I don’t want them to forget to check my papers. I don’t have any tats yet, so that will be my first. Assuming I have the nerve to get it. Is a tat legally binding? It would be a shame to go through getting one and then have it not count.
Teresa- no it’s not. Unfortunetly. When I’m old and shit I’m framing my DNR and putting it next to my bed.
Actually it might be legally binding if it were notarised and had a witness’s signature tatooed next to it! LOL
His family should be downright ashamed of themselves. The ONE thing that I have to imagine that every dying person wants is for their wishes to be respected, whether that means prolonging their life or allowing its natural conclusion to unfold. It just infuriates me when someone elderly is kept hanging on and on and on just because the family wants it.
Thanks, EE, for the tip. I suppose I will not have it done now. I’m not sure I can go for William Fisher’s plan of having it notarized. That’s gotta hurt.