Very important info. It's also important to make sure as many people on your care team, at the local hospital you'd likely go to, in your family, and even your pastor know your wishes and have copies of your paperwork. Mum was a DNR/DNI while she and Dad lived at the nursing home. She was sent to the ER without any paperwork and was intubated. Nobody called me (her medical power of attorney) from the hospital or the nursing home, so I didn't even know she'd be sent there. It took another 3 days and tons of phone calls (and attending rounds with the hospitalist) to get her on hospice and extubated (she had dementia and an anoxic brain injury from aspiration pneumonia). We did everything right and it still fell apart.
And then we transferred her back to the nursing home so she could be with Dad, after she'd been on a morphine drip for a week. The visiting hospice nurse assured me she'd delivered enough oral Ativan and Morphine to keep her comfortable and then left. Exhausted after a week at her bedside, I left to get some sleep. When I arrived in the AM, Mum was moaning. Zero pain/anxiety meds had been given overnight; there was some administrative SNAFU and the med tech (who probably had 30 other patients that night) didn't troubleshoot the issue. Which I then had to do, on a Saturday. Nearly everything about Mum's death was a nightmare. It didn't have to be that way.
I agree with you. My mom had a stroke and when I said I wanted a DNR for her, the doctor took that to mean no IV, no food or water, just let her die. But she was fully alert. When I realized what was happening, I gave that doctor hell and let her know what it meant - no extreme life saving. Feed her. Quench her thirst. Put an IV in. She lived another month and we got to say what needed to be said. Her oldest, her “sunny boy” got to come and visit from across the country, and when he left, she made her own decision not to eat. She was gone in a week. I knew what she wanted. I honored it.
Amen. More people should realize we all have 100% of dying and that we will not live on earth forever. More importantly, as you excellently pointed out, let your loved ones know that extensive medical intervention is/is not your wish. Quality of life, compassion, and dignity are paramount. Often, I see daughters/sons/relatives keep their loved ones artificially alive when they are not ready to handle the death. Yet, we all know that day will come. Thanks for writing this important piece and sharing it with all your readers.
On an occasion many years ago, an elderly patient of mine presented to my office with complaints of abdominal pain. I took a good history, and then had her up on the table to examine her. To my surprise I found a pulsatile mass in her mid abdomen. I sent her for an ultrasound immediately, which confirmed my suspicion of the abdominal aortic aneurysm. She was elderly, had comorbidities, and was certainly not fit for aortic grafting surgery. I explained all of this to her very carefully. She accepted it with ease. She asked me what would happen to her next. I said that one day she would have a terrific pain in her abdomen, she would feel faint, collapse, and die within a very few minutes. She said that sounded fine to her. A week later that's exactly what happened to her. She was out in her garden, felt pain in her abdomen, collapsed, and her daughter found her in the garden dead. She died as she wanted to and was not resuscitated.
Amen! Thank you for this reminder, Mike.
Do Not Resuscitate is one of the kindest things doctors and nurses can do.
Very important info. It's also important to make sure as many people on your care team, at the local hospital you'd likely go to, in your family, and even your pastor know your wishes and have copies of your paperwork. Mum was a DNR/DNI while she and Dad lived at the nursing home. She was sent to the ER without any paperwork and was intubated. Nobody called me (her medical power of attorney) from the hospital or the nursing home, so I didn't even know she'd be sent there. It took another 3 days and tons of phone calls (and attending rounds with the hospitalist) to get her on hospice and extubated (she had dementia and an anoxic brain injury from aspiration pneumonia). We did everything right and it still fell apart.
And then we transferred her back to the nursing home so she could be with Dad, after she'd been on a morphine drip for a week. The visiting hospice nurse assured me she'd delivered enough oral Ativan and Morphine to keep her comfortable and then left. Exhausted after a week at her bedside, I left to get some sleep. When I arrived in the AM, Mum was moaning. Zero pain/anxiety meds had been given overnight; there was some administrative SNAFU and the med tech (who probably had 30 other patients that night) didn't troubleshoot the issue. Which I then had to do, on a Saturday. Nearly everything about Mum's death was a nightmare. It didn't have to be that way.
So true!
I have some homework to do!
I agree with you. My mom had a stroke and when I said I wanted a DNR for her, the doctor took that to mean no IV, no food or water, just let her die. But she was fully alert. When I realized what was happening, I gave that doctor hell and let her know what it meant - no extreme life saving. Feed her. Quench her thirst. Put an IV in. She lived another month and we got to say what needed to be said. Her oldest, her “sunny boy” got to come and visit from across the country, and when he left, she made her own decision not to eat. She was gone in a week. I knew what she wanted. I honored it.
Amen. More people should realize we all have 100% of dying and that we will not live on earth forever. More importantly, as you excellently pointed out, let your loved ones know that extensive medical intervention is/is not your wish. Quality of life, compassion, and dignity are paramount. Often, I see daughters/sons/relatives keep their loved ones artificially alive when they are not ready to handle the death. Yet, we all know that day will come. Thanks for writing this important piece and sharing it with all your readers.
On an occasion many years ago, an elderly patient of mine presented to my office with complaints of abdominal pain. I took a good history, and then had her up on the table to examine her. To my surprise I found a pulsatile mass in her mid abdomen. I sent her for an ultrasound immediately, which confirmed my suspicion of the abdominal aortic aneurysm. She was elderly, had comorbidities, and was certainly not fit for aortic grafting surgery. I explained all of this to her very carefully. She accepted it with ease. She asked me what would happen to her next. I said that one day she would have a terrific pain in her abdomen, she would feel faint, collapse, and die within a very few minutes. She said that sounded fine to her. A week later that's exactly what happened to her. She was out in her garden, felt pain in her abdomen, collapsed, and her daughter found her in the garden dead. She died as she wanted to and was not resuscitated.