On the way to the hospital, your patient’s condition suddenly gets worse. His vitals tank for no apparent reason and your monitor shows asystole*. You put your hands on the person’s chest and think to start doing compressions while your paramedic partner pushes epi, atropine, and all that other good stuff. Your partner touches your hand and goes, “Don’t. He’s DNR.”
“Do not Resuscitate”, or DNR, is a decision that a patient makes when he or she does not want anything drastic done. You see, there are two stages of death: clinical death comes before biological death. Clinical death is when the heart stops beating and the person stops breathing. Biological death occurs when irreversible damage occurs to the body and its organs/tissue due to the lack of circulation. Normally, if a patient begins to slip towards or ends up clinically dead, healthcare providers will do everything they can to bring them back. In the case of DNR, once a patient heads toward or ends up clinically dead, they wish for us to stop everything and let them go.
Why am I writing about this? An old friend of mine posted on Facebook about hating DNR and feeling like we as healthcare providers didn’t do enough for this person. The situation I mentioned above is not that uncommon, whether it’s in the field or in the hospital itself. What she felt is, I think, not that uncommon among healthcare providers and I just wanted to share my thoughts and feelings about it.
Death is inevitable in the healthcare profession, DNR or not. We care very much about our patients, and even if we’ve known them for 5 days (such as in the long-term wards in hospitals) or just 5 minutes (such as during rounds or meeting a patient in the field), we – well I know I am – are willing to give everything to preserve the lives of our patients. The hard truth is that patients die. Even without a DNR, all the drugs and procedures and compassion in the world can’t prevent death.
That being said, no matter what, I feel that we will always feel like we haven’t done enough; even if we followed every protocol to the letter, did everything correctly, tried every treatment, spent hours researching alternative therapies, we feel helpless in the shadow of a patient’s death and this feeling of “we could have done more”. It is inevitable.
Here’s the thing and here’s what I believe: the moment every one of you decided to become a healthcare provider, you made the lives of every person you have met, are meeting, and will ever meet that much better. Whether it’s as simple as giving a 2 year old a band-aid, hauling someone off to the hospital because they’ve drank too much, or rushing lights and sirens to the nearest hospital to get that lifesaving surgery done, that person is better off now than they were before you saw and treated them.
Thus, even if you feel helpless watching your patient lie there because of a DNR order, just remember that you have done everything you can and hope that they leave this world quickly and painlessly. Remember that by simply accepting a patient into our care, we’re giving them a fighting chance that they didn’t have before.
Everyone has different mechanisms of dealing with patient death. Do what you know you have to do before returning to the field, hang in there, and keep on keeping on. Grieve for the person in your own way, but remember that many more people out there need us to be our best.
You are a hero for doing what you do. Always remember that and keep doing what you’re doing.
(Photo credit: Anesthesia goes to Hollywood)
* For those of you that do not know, asystole or “flat line” means that CPR must be done, drugs should be pushed, but shocking the heart is useless.
- Do not resuscitate doesn’t mean the doctor doesn’t care (telegraph.co.uk)
- The hardest discussion (mommydocfarmer.com)