Friday, June 24, 2016

DNR

I’m a nurse in a long term care facility. It’s not always the easiest of jobs, but it’s one that makes me feel like I make a difference.

Recently, I’ve had a lot of situations where I’ve had to explain the concept of DNR (Do Not Resuscitate) to families and patients. It’s something that seems to have a bad reputation, and I wish there was a way to stop the stigma that comes with it.

In Idaho, we have a form known as a POST – (Physician Orders for Scope of Treatment). In it, the patient can decide what they want to happen if for some reason they can’t make decisions at that point. It’s similar to a medical living will, though it tends to be more specific. Each state has something similar.

Resuscitate or DNR? Now it seems like the obvious answer would be Resuscitate. Why let someone die when you could bring them back? Resuscitate means CPR, it means chest compressions, breathing, AEDs… everything possible to keep them alive. Chest compressions aren’t gentle. It’s literally forcing your body to breathe when it isn’t.

For someone who’s healthy, it’s painful. For someone who’s ninety-years-old, it could be a worse alternative. Or their body might not even be able to handle the stress. There’s a very real possibility of cracked ribs, of increased pain when they revive. If they’re intubated (tubing forced down their throat to breathe for them), and they wake up, there are many elderly patients who never come off of it. Obviously there are exceptions, but the older you are, and the higher number of diseases and comorbidities, the less your body is going to be able to recuperate from it.

Often, it isn’t the patient’s wish to stay alive. It’s their family, who doesn’t want to watch them die. It’s hard for me as a nurse, to explain to them that it’s going to be painful. I’ve had so many patients who just wish for death, but their family won’t let them go. I had one patient whose daughter, as the power of attorney, disregarded all of her mother’s wishes, putting her on oxygen, on antibiotics, on everything to keep her alive.

When faced with that kind of a decision, I think the most important question to ask is: what kind of quality of life do they have? Will they be hooked to the machine for the rest of their lives, having it breathe for them? Maybe they aren’t eating. Is giving them nutrients through a feeding tube worth it? Can they handle the stress of getting a tube placed?


It isn’t an easy decision, and every situation is different, but I hope the families remember that sometimes life isn’t living, especially when there’s nothing to look forward to. Sometimes, a patient wants to have relief, not necessarily life.