Often times a “DNR” on a patient is welcome news because you know that the family (and sometimes the patient themselves) have realized the futility of resuscitative measures. It helps prevent them from going through painful and futile medical procedures and endless tests.

However sometimes you breathe deep sign of relief for more selfish reasons (I wonder if this post will get flamed by some wackos – we’ll see I guess). This selfishness if because you just know that “doing everything” is going to be a huge amount of time consuming and likely difficult work – and all for naught.

Perfect example is when a 450 lb severely debilitated elderly patient (how they made it that far is beyond me) comes in very SOB with a huge bull neck and likely nightmarish airway. You find out they are DNR and DNI (appropriately so) and relax a little. You put them on BiPAP but don’t raise your own BP to 230 systolic trying to get a damn ET tube into their airway. You don’t need to put in that central line – which would have required puncturing the needle through an endless amount of edematous fat in the vague hope of finding the IJ vein. You know this futile case is not going to drain away all your energy and back the rest of the ED up while you are out of commission. They get admitted to the floor so no arguing with that arrogant ICU fellow.

It just is better – for both the patient AND the doctor.

Ma’am I think you did the right thing. I had to intubate your husband because he came in in acute complete respiratory failure and sepsis. His premorbid condition as you know was horrible. He had cancer and was bedridden.
Your decision to have me extubate him and to make him palliative care only is what I would have done were he my loved one. He died comfortably and with dignity. I just wish more people were given that opportunity.

Sometimes I really ponder over treatment problems. I really hate those cases where both options stink. For example, elderly people in afib. Something I see all the time.
Choice A). Put them on Coumadin. They don’t embolise but they bleed like stink. Nosebleeds. Head bleeds. GI bleeds. Lacerations that bleed. Dental work that bleeds. I hate it. Certainly not an option for those who are a great fall risk.
Choice B). Don’t put them on Coumadin. Presto! No bleeding! But them they come in one day with a dead leg or a huge hemispheric stroke and end up an amputee or a vegetable.
I guess you just have to decide which bad thing is more likely to occur. I’m not sure what I’d choose we’re I the patient.