Wednesday, March 26, 2014

ER Stories 3: DNR (Do Not Resuscitate)

Note: These posts are intentionally vague (with no names, ages, or dates) so as to protect patient confidentiality. These stories are random and their publication dates have no correlation to the dates they occurred.

This is a sad story and it is difficult to tell, as I want to approach the subject with respect.

The first time I saw someone die was in the Emergency Room.

She was an older patient with a preexisting condition. Her family expected her to pass away soon, but her husband did not want to sign the paperwork to make his wife a "Do Not Resuscitate" (DNR for short.).

If a DNR patient's heart stops, we don't attempt CPR.


Before this day, I had never understood why anyone would want to make themselves or their loved ones a DNR. In my uninformed mind it seemed like giving up; and giving up seemed weak.


The patient came into the Emergency Room as a CPR in progress; the ambulance had already started chest compressions.
Once a patient gets to the ER, a lot happens. A doctor is there, in charge of the code and giving orders. There are multiple nurses. Some are starting IV's, administering medications, performing chest compressions and much more. There are also many other people assisting on the spot and behind the scenes, such as scribes, ER Techs, Respiratory Therapists, X-ray Techs and secretaries.

This was my first time observing a code and it was hard to take everything in. I hardly remember much of the specific procedures; what sticks out most in my memory is the patient. She is a tiny and dainty woman. She has wrinkles, but they only seem to add to her beauty. She seems like a woman with a story to tell. She seems graceful, despite the chaos around her.

She is intubated and breathing mechanically through a ventilator. 

Whatever she had been wearing prior to arriving has been cut off by the paramedics. A gown is thrown over her, but modesty is low on the priority list when one's life is at stake.

There is a lot of blood (which had more to do with her prior condition than cardiac arrest).

Strangers are taking turns pushing hard and fast on her fragile chest to try to keep her heart pumping. 

Everyone stops what they are doing and backs away when a nurse yells. She shocks the patient with a defibrillator. Her small body shakes at the voltage.

At the nurse's command that it is safe, each team member continues their task.

She is surrounded by strangers -- highly trained strangers focused on saving her life -- but strangers all the same. Family isn't allowed to be in the room during a code.

After an unknown amount of time (I cannot remember), the doctor called time of death.


To be clear, I have no right to have any say in how that woman or her family would have chosen that patient to die. 

When I saw how violent and chaotic her environment was as she was dying, though, I realized why some people choose to become a DNR. 

I now strongly believe in patients' rights (and patients' families' rights) to choose their end of life wishes.

ER Stories 2: It's a Boy!
Next Wednesday, April 2nd:ER Stories 4: Medical Gore

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