Another Take on DNR

89 year-old, death not immediately imminent, but certainly on that road, septic, obtunded, dehydrated, atrial fibrillation, blood pressure in her boots, Levophed drip. Previous history of Altzheimer’s dementia, congestive heart failure, myocardial infraction, osteoarthritis, CVA, etc., etc.

She’s a full code, by which we mean that if her heart stops, we do the full monty.

Numerous family members do shiftwork at the bedside, all extraordinary dedicated. They watch the cardiac monitor, then scrutinize my reaction if it beeps or whirrs.

Will she get better? they ask. She was well up to a day ago, they tell me.

I find this hard to believe, given her long difficult medical  history. I tell them as gently as possible that she may not survive, she is too sick, that her kidneys have shut down and her heart is tired.

Dr. Sivampillai, the internist, comes in. He reads the chart, and looks  thoughtfully at he family members clustered about the patient.  He’s a lovely, conscientious man. He shakes his head and sighs.

“She’s a full code, no?,” he asks. “And on Levophed too.”

“We’ve all talked to them.”

“They need to get used to it,” he says. Sure. Conventional wisdom.

But then he says: “Give them time — they very soon will get tired of all this, this toing-and-froing, and jumping at every beep from the monitor and then we will see them make her a DNR.”

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  1. #1 by Zoe on Monday 26 April 2010 - 1623

    Those are very wise words indeed. Sometimes, the family just needs to see their loved one not getting better before they can accept the inevitable. I like this Dr. S.

  2. #2 by Terri Schmitt on Monday 26 April 2010 - 1906

    Excellent post. Thank you for sharing and emphasizing the need for DNR. Something, that probably cannot be resolved, as you so wisely point out, in an ER visit. Time is often the only answer.

    On another note. You are a great writer! Clear, succinct, and effective. I would love for you to guest blog sometime (like you have nothing else to do). I am a mediocre writer at best (even with years of writing practice) and would love to tout your blog/work. Let me know what I can do. WOO HOO! GO Nursing!

  3. #3 by JennJilks on Tuesday 27 April 2010 - 1002

    Well done, TERN. This is another story to add to my files. I am presenting at the NSM Palliative Care COnference. ‘Stories in Palliative Care’, at Casino Rama. June 9th. Their theme is right up my alley.

    But so often families do not get it. You are good to highlight a sensitive intern.

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