The patients we treat, and the lives we can and can’t save

Disclaimer: Any names or places I use in this entry have been changed in accordance with the laws outlined by the Health Insurance Portability and Accountability Act (HIPAA) to protect my former patients’ anonymity.

I would be lying if I said I remembered every patient that I’ve seen. I’m pretty good in that when a patient sees me afterward and smiles silently at me, I’ll remember what I did for them; otherwise, my mind is a large mush of cuts, bruises, fainting, backboarding, intoxication, and sprained limbs. There are several people that always stick in my mind, and that I find myself thinking of sometimes.

Just like in real life, I remember all my firsts. Most of these were in controlled, practice settings, so the memories are not as strong, but they still keep a special place in my brain. The first person I set an intravenous needle into was my buddy in my platoon in medic school. The first person I took a real patient history on was a recruit who was reporting sick for a fever. Notice how I said “most of these”.

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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.

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