Several months ago, I responded to a code at the hospital and found a scene straight out of some medical drama. The patient was in asystole -- which means no electrical output from the heart -- but the code team labored mightily, with CPR and everything else they do, and it worked.
People don't come back from asystole very often. That code team knew their stuff.
And then it turned out that the patient was DNR.
DNR, for those of you who don't hang out in hospitals, means "Do Not Resuscitate." It meant that the patient had filled out a legal form requesting that heroic measures not be taken in the event of a code (no breathing or no heartbeat). DNR means, "If you find me dying, let me go."
The subject of advanced directives and living wills is more complicated than I'm qualified to address, although I can tell you that they're important. These documents tell medical caregivers your wishes in the event of any number of medical situations. If you're in a coma, do you want to be on a ventilator? Do you want fluids, tube feeding, antibiotics, blood transfusions? Who has your power of attorney if you can't make your own decisions? And so forth.
These documents vary from state to state, but all of us should file them. (Gary and I haven't, yet; we don't have a regular will, either. Do as I say, not as I do.)
But back to DNR. For obvious reasons, if medical personnel aren't absolutely sure that someone's DNR, they'll resuscitate. If someone's coding and the information isn't right there, the default is resuscitation. The patient I just described was being transferred from one part of the hospital to another, and his records hadn't quite caught up with him when the code started. Likewise, I once saw a nursing-home patient brought into the ER, after having been intubated by the ambulance crew in the field, because the nursing-home staff panicked: that patient had a DNR order on file, but in the oh-my-god-she's-not-breathing terror of the moment, anyone who knew that forgot it, and anyone who didn't know forgot to check.
This is very hard on families. It's one thing to have accepted that your loved one doesn't want heroic measures. It's another to see your loved one on a ventilator in the ICU, after heroic measures have mistakenly been taken, and to have to make the decision to turn off the machines.
An ER nurse I know says that this happens all the time. The DNR's on file, but the people who need to know that don't. Hello, heroic measures.
I was thinking about this the other day, and it occurred to me that there should be something you can wear on your body if you're DNR, something an ambulance crew will find right away. And, sure enough, Medic Alert will store your advanced-directive information and link it to your bracelet or necklace. (I'm not quite sure from this webpage if they'll actually put "DNR" on the jewelry itself.) In the meantime, I wonder if hospitals put color-coded wristbands on DNR patients, the way they do on patients who are likely to fall. I'm sure somebody does this. If not, it would be a good idea.
This sounds ghoulish, I know, but in the long run, it's kinder to everybody.