Demystifying DNR Status
Demystifying DO NOT RESUSCITATE (DNR) Status
In my bedside nursing career, I work with elderly patients who have advanced dementia among other terminal diagnoses. Often these patients are non-verbal, unable to comprehend how to do basic tasks of eating and toileting, and sentenced to live out their days in a locked facility devoid of any quality of life. My own grandmother passed away with complications of Alzheimer’s dementia. Her passing was peaceful and supported by family members knowing her spiritual journey would continue in a better place. Much like my patients, my grandmother was a loving and thriving soul on earth. She played piano for the church, raised children and grandchildren, and always had chocolate and a listening ear available to anyone who needed it.
The recent stress of my job caused my own visit to the ER lately where all physical signs pointed to experiencing a heart attack. Luckily the diagnosis turned out to be an anxiety attack. This attack occurred after a nursing discussion regarding a patient who had several terminal diagnoses and had adamantly stated not wanting further surgeries or medical interventions. Due to the patient’s mental diagnosis, our legal system dictates any living relative can decide what should and will be done to this patient. The only known family member of the patient was contacted and continues to insist that everything be done to save the relative, regardless of the patient’s wishes and failing body. I don’t believe this family member intends harm to their loved one, I do believe the family member has been misinformed by the medical community regarding prognosis and end-of-life care.
While on the way to the hospital for my own chest pain, I began contemplating the end-of-life decisions I had put in writing years ago and informed my family members of. I have always stated I don’t want CPR performed on me, nor do I want my body hooked up to artificial means of life-support. However, I am in my mid-forties, active, have minor children, active in the workforce, and I have things I still want to accomplish on my bucket list. Surviving a few jewels of electrical shock to my heart, some chest compressions, and an angioplasty or open-heart surgery if needed, would not be any more unreasonable than choosing to endure all available breast cancer treatment options.
We’ve all seen the movies and TV shows where people are saved with CPR. CPR stands for Cardio Pulmonary Resuscitation. Essentially, the heart is “massaged” or compressed by an external manual force to push blood out of it and into the essential arteries that lead to the brain and lungs. Additionally, oxygen is pushed into the lungs via artificial methods of the airway, then the oxygenated blood is hopefully distributed to vital organs by manual compressions on the heart. These days most businesses have an AED (Automated External Defibrillator) machine available that can guide bystanders in what steps to take and/or deliver a shock to the heart that can prompt it to start beating on its own again. https://www.cprblspros.com/cpr-cheat-sheet-2023.
According to research published in the BMJ for medical professionals, “patients and visitors to an emergency department, regardless of prior healthcare or CPR experience, overestimate the likelihood of success with CPR…..When discussing CPR preferences, emergency department providers should focus on true rates of survival and outcomes in any shared decision-making conversation and should not assume that a patient or companion with healthcare experience will have realistic expectations.” Research by the BMJ indicates CPR is truly only effective in 12% of out-of-hospital cardiac arrests and 24%-40% of in-hospital cardiac arrests. If ribs are not being compressed to the depth of being broken, then chest compressions are not considered effective. CPR is most effective for saving the lives of children who have amazing resiliency and the ability to heal due to their age.
Not only is performing CPR traumatic for the patient, it’s also traumatizing to the caregivers. We are taught to let people die with dignity and do no harm. Breaking someone’s ribs and shoving their post-mortem body full of tubes and lines goes against everything we agreed to uphold according to our medical oath. Additionally, the likelihood of an elderly person recovering from broken bones, chest, and lung injury caused by successful CPR is very slim and extremely painful. Throughout healing, they remain at risk for lung collapse, other organ damage, blood clots, and pneumonia among other complications.
When did death in America become taboo? People have been dying of natural and unnatural causes since the beginning of time. Death is as much a rite of passage as birth. When we perform CPR on an elderly person with end-of-life diagnoses, we deny them this peaceful passage. There is a belief in healthcare that a window must be opened immediately post-mortem to let the spirit free. Having been present for several deaths I can tell you a spiritual passage occurs. Regardless of belief system, most health care professionals will attest to one thing; the moment the spirit leaves the body is palpable and the moment the spirit leaves the room is also palpable. Why do we jeopardize the afterlife of a soul by trying to hold onto a broken and febrile body? In my personal opinion, there is no greater sin than holding onto the spirit of another human being for the benefit of a long-lost relative who hasn’t seen them in ages. On many occasions, I have seen family members insist their “loved one” be saved at all costs because that family member is collecting the patient’s social security check. When did having a body with artificially functioning lungs and a barely functioning heartbeat become a paycheck for someone else? As much as we have seen epic advancements in healthcare, we have also caused so much torment, greed, and unnecessary torture.
I want to take this opportunity to inform you of options and tools available for preplanning end-of-life decisions for yourself and your loved ones. Several legal documents exist to help with this process. These documents are designed to ensure you get to have as much control and dignity in your exit from this life as possible. Within these documents, there are pick-and-choose menus of what interventions you want versus those you would not want. Whether you are the victim of a tragic accident or succumb to disease processes in your own body, you likely won’t have the capacity to verbally communicate your wishes at the moment. Therefore, having a frank discussion with your loved ones and care provider at this stage of your life is essential. These forms vary by state, however, they can be honored from state to state. Making sure you have filed these completed papers with your family, provider, and local hospital is essential.
This link to the National Institute of Health (NIH) gives the best explanation of each form a person should fill out prior to facing a terminal diagnosis or enduring a tragic accident. This link to the Mayo Clinic is also beneficial. To obtain and fill out these state-specific forms from home you can search a website such as this one for CaringInfo. The website typically charges a small fee once your document is completed and ready for printing and signing. I urge you to take the time now to talk with your family and fill out these documents. I consider these more important than your Will and Testament. That document discloses what will happen to your money, belongings, and minor children. The Living Will dictates what healthcare options you want at the end of life, should you be unable to communicate those for yourself.
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