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Tough Topic - DNR
Old 01-03-2020, 10:46 AM   #1
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Tough Topic - DNR

This follows the previous post on the book Being Mortal and different goals for patients, families, and doctors:

ďThe 365-day problem is real, and if you gave truth serum to every transplant doctor in America, including me, and you asked if we didnít all keep an eye on it, and if we said we didnít, that would be a lie,Ē

https://www.propublica.org/article/t...-doctors-didnt
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Old 01-03-2020, 10:51 AM   #2
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For those of us who don't read the whole long article, care to summarize your main takeaway and the point(s) for discussion?
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Old 01-03-2020, 11:08 AM   #3
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This is why we did advanced medical directives when we did our estate plan. But luckily, my spouse and I are both in medical information/education, and know quite a lot about it, so we also don't have to worry about not having an advocate unless we're both incapacitated at the same time.
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Old 01-03-2020, 11:21 AM   #4
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For those of us who don't read the whole long article, care to summarize your main takeaway and the point(s) for discussion?
Summary: Andy Jurtschenko told his children that he didnít want to be a burden on them. But after he suffered brain damage during a heart transplant at a New Jersey hospital, his medical team deflected their request for a DNR.

My take-away: Doctors have goals & metrics (1 year survival) which could run counter to patient and family wishes. Being aware of this motivation sets the stage for more proactive planning.
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Old 01-03-2020, 12:09 PM   #5
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My take-away: Doctors have goals & metrics (1 year survival) which could run counter to patient and family wishes. Being aware of this motivation sets the stage for more proactive planning.
Or, more generally, be sure to discuss your wishes with your family or whoever is closest to you, and when the time comes actively advocate for each other as best you can. It's often unfair when the squeaky wheel gets the grease, but in nursing homes or hospitals, it's also quite true. There's a reason that "patient advocate" is actually a full-time career!
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Old 01-03-2020, 01:46 PM   #6
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My father had terminal cancer and a DNR. When he coded the Dr. still asked me if I wanted him to have CPR.

WTF! I said no of course but I was pissed for years that he asked me. And I am a nurse.

Make sure your family is aware of your wishes and willing to advocate for you.
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Old 01-03-2020, 01:53 PM   #7
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I went through this with both parents.

Mom: Alzheimer's, paralyzed from a stroke, wheelchair bound, heart disease, 92 years old.

Dad: Had a stroke, fell down a flight of stairs, couldn't talk or swallow, and was mostly in a coma for the last 3 weeks of his life.

I'm still angry over the way I was treated when I presented living wills and requested DNR's on each. They did their best to make me feel like I was personally shooting them in the face.

After it was all over, a hospice counselor told me to write letters, describing what we each consider quality of life. And, how strongly we feel that if that quality of life can't be adhered to, then our family should ask for a DNR with no guilt whatsoever. This shows, that in addition to the living wills, we have put some thought into this and want it to be as easy as possible for our children.
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Old 01-03-2020, 02:00 PM   #8
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Originally Posted by Vacation4us View Post
My father had terminal cancer and a DNR. When he coded the Dr. still asked me if I wanted him to have CPR.

WTF! I said no of course but I was pissed for years that he asked me. And I am a nurse.


Sometimes family have a change of heart in the crisis of the moment.

Iíve known several obstetricians who will ask a woman moments before performing a tubal ligation (to prevent future pregnancies) whether she still wanted the doctor to proceed. It seems odd to ask when the women signs the consent for permanent sterility a minimum of 2 weeks in advance, to give her plenty of time to reconsider. I have heard of one patient who withdrew her consent in the operating room.
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Old 01-03-2020, 02:20 PM   #9
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There are hospital 'cultures' so the patient and family need to address that before any surgery. My SIL had a lung transplant. Before they would put him on the transplant list he and the rest of the family (wife, parents, even the kids' nanny) had to attend several classes where treatment, risks, and care were discussed. That would be the time to address end of life issues and sign a DNR and health care power of attorney. Evidently this transplant team takes on high-risk patients, one would think that they have confronted this issue.

If I were in the situation this family found themselves in I would ask for discharge to home or a skilled nursing facility and then commence hospice care. DO NOT CALL 911 for a patient with a DNR, do not go back to a hospital. Let nature take its course.
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Old 01-04-2020, 05:32 PM   #10
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This is why I view DNRs as terrible substitutes for a health care POA.

The patient should have had a health care POA prepared before undergoing surgery.

That would have left their appointed health care agent legally in charge of the decision to pursue medical interventions.

All the drama could have been avoided...most likely, dad would have died from the complications of the surgery itself instead of being forced into an existence he specifically wanted to avoid.
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Old 01-04-2020, 05:52 PM   #11
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DNR doesn't stand for Department of Natural Resources? Who knew? I only checked this thread out because they're looking at changing the slot limit on walleyes on our favorite northern Minnesota lake.

BTW, I did not resuscitate my limit of walleyes this past September and am enjoying some delicious filets for dinner this evening.
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Old 01-04-2020, 11:19 PM   #12
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My mother had a DNR directive at her continuing care community as she had a very bad heart for 15+ years and was very frail. When she suddenly left this earth at age 91, the EMT's didn't get the message, and she was treated very roughly. It was just a wasted effort on their part and something she didn't want.

These are just so difficult of decisions for all parties involved.
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Old 01-05-2020, 12:38 AM   #13
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My MIL has a POLST notice on the fridge. That "should" stop any EMT from serious lifesaving measures. However a DNR filed away at the lawyer office probably won't
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Old 01-05-2020, 06:04 AM   #14
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My MIL has a POLST notice on the fridge. That "should" stop any EMT from serious lifesaving measures. However a DNR filed away at the lawyer office probably won't
Very good idea for most people. If you're not familiar with the term, there is an explanation here: National POLST.

My father had an advance directive but it was done in New York and he entered a hospital for the last time in Ohio. The doctors ignored it and he had to spend another four months in misery as a result.

On my mother's final trip, the ER doc was much better. He looked at her record and said to me "I see that she has a DNR on file, so we won't do anything except keep her free of pain unless you want us to." I wanted to hug him.
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Old 01-05-2020, 02:54 PM   #15
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My MIL has a written DNR. It is quite specific of which procedures can be performed and which cannot. It has been discussed and all the kids on same page. Hopefully no issues.
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Old 01-05-2020, 03:10 PM   #16
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My F had a healthcare POA and I pulled the plug long distance. The Dr called me himself and I told him that I understood that this meant my F would pass. I know what my father wanted.

I discussed this issue with my clients in front of their children and spouses all the time. It is easy for me to talk about about this because I have done it a lot. 99.9% of those folks wanted the plug pulled if they did not have a good quality of life. The only question remains is what is a good quality of life. For me: Can I hug my grandkids and lift my wine glass. And yes, I have my healthcare POA in my new state, Do you?
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Old 01-06-2020, 10:08 AM   #17
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Recently listened to "Being Mortal" on audiobook. I recall the word "torture" used for the elderly a few times.

-Dogs get humanely euthanized to avoid further pain and agony.
-Spies get suicide pills to avoid torture.
-When a horse breaks his leg, he gets humanely euthanized.
-When a criminal runs from a cop he gets shot.
-When a murderer is on death row, he gets humanely euthanized (big discussion ongoing to make sure any method is humane).
-I told my husband, avoid the medical community and humanely put me down. But then he risks going to prison for murder. I guess the only answer is suicide. I often think of my friend who had a debilitating stroke. She was allergic to peanuts her whole life and lived into her 80's avoiding peanuts. Then, she ate that peanut butter cookie. She passed before the medics could get to her.
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Old 01-06-2020, 10:21 AM   #18
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We both have advanced directives and health care POA, and have reviewed our wishes with both of our kids. As we age, I will make sure, as best as I can, that we have POLST forms prominently placed on the refridgerator (where EMTs are supposed to look) and copies with our PCP.
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Old 01-06-2020, 10:21 AM   #19
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Although DW & I have discussed this in detail, (we both know what the other will 'accept' and/or will not accept, and trust the other to make the appropriate decisions if/when the time comes), I recall being admitted to hospital last year with what subsequently morphed into sepsis.

Admitting doctor asked about DNR, and I, (albeit 'fuzzy' and not aware of the potential magnitude of the situation), said that I wanted to live.

Now, being better informed about, and having experienced (relatively 'minor') sepsis, if there is, 'God' forbid), a recurrence, DW knows that, if a certain line is crossed, to order the plug pulled.
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Old 01-06-2020, 10:55 AM   #20
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We both have health directives.

Medical assisted suicide is legal where we live however certain conditions must be present.

I would most definitely consider this option depending of course on the circumstances assuming I was judged to be of sound mind at the time of the decision/request.
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