DNR

I was shocked to learn the other day that a few of the most profoundly disabled and demented patients I care for are all full codes.

That makes me sad. The thought of having to do CPR on them makes me cringe and whilst I would do it, I don't know how I'd feel about it afterwards, especially if they survived their arrest. I think that I would have some guilt issues - because I personally believe that quality of life is what matters, not quantity.

I can totally understand a person not wanting their loved one to die. Us humans have difficulty accepting the concept of impermanence, especially when it comes to matters of the heart. We want those we love to be around us forever; we don't want them to change and we certainly don't want to lose them to disease and then death.

But, the plain fact of the matter - and of life - is that people DO change. Time takes it's toll on a body; things wear out and break and just don't work as well as they used to. Diseases develop and rob us of ourselves, of our dignity and even of our time. Yes, modern medicine has 'cures' for many diseases and treatments for even more, but at some point I think that we have to stop and take a step back and ask ourselves just what kind of life we are saving. What quality will there be for our patient or our loved one if we insist that "everything" be done to 'save' them? And, are we really 'saving' someone if we are returning them to a life full of pain and misery? How about if they don't know who they are and have no concept of time or place? What kind of a life is that?

As most of you know, I do some work for hospice and I am a huge fan of palliative care. I think that it absolutely has a place in modern medicine and is largely underrated. I believe that sometimes the kindest thing a family can do for their loved one is to sign a DNR and let them, when the time comes, slip away without having to suffer the indignity of CPR and other 'life saving' measures. Caring for a hospice patient and making what's left of their life comfortable is, to me, the biggest and greatest gift I can give someone.

I wish that more people would really look at the person they love when they're deciding whether to enact a DNR order. I think that a lot of people focus on who that person USED to be, not who they are currently. They remember their father/mother/brother/sister/husband/wife at their most vibrant, in the prime of their life...I don't think that they see the frail elderly person they are now; the person who cannot walk unaided and has to be fed a pureed diet with thickened liquids, the person who is incontinent of both bladder and bowel, the person who cannot verbalize what they want or even recognize their loved ones anymore. I wish that I could somehow make them see exactly what they're 'saving'; I wish that I could have them spend a couple of days with their relative and see exactly what quality of life they have. But, I can't...and so I watch them spend a couple of hours a week with them and then walk out of the door to go back to their own lives. I'm not saying that they don't care, because I'm sure they do...I'm just saying that they are perhaps not aware of the full reality and gravity of the situation.

Because if they were, I don't see how they could possibly refuse to sign a DNR.