DNR: Do not Resuscitate

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.

A few thoughts on Emergency Medicine

I served as a medic in the Singapore Armed Forces for 2 years; I served as a New York State Emergency Medical Technician for 3ish years while serving at my college’s emergency medicine squad. I just wanted to write about a few weird things we do in EMS and just a few things about EMS in general.

Sacred things that do not remain so while on call

Eating, sleeping, showering, pooping. These are all things that many people deem too precious to be interrupted – I like to think of it as “me time”. Something that should be done in one sitting or session. Right? When you work emergency medicine, those things suddenly lose their “me time” holiness and their time is stolen away by your patients.

Generally, this is how we feel when this “me time” gets cut into:

Don’t get me wrong – many of us do what we do to be able to help our patients and this is just one of the side effects. Any momentary annoyance is (hopefully) never directed at them, but what these little interruptions do is instill a sense of fear in us every time we sit down to do these activities while on call.