Do Not Resuscitate

He has congestive heart failure. Kidney failure. Liver failure. He’s 87 years old, and his body is shutting down. When the doc talked with him in the ED, he said he understood that nothing more could get done, and he will likely die shortly. After he’s admitted to the floor, I go in to put the DNR (Do Not Resuscitate) sticker on his wristband, and he’s changed his mind. “I’m not ready to die, do everything.” Full code. The doc is pissed. “He said he was ok going DNR! You know we’re going to code him a few times, then he’s going to die tomorrow anyway! This is ridiculous!” The patient was adamant. BP is 70’s over 40’s, heart rate in the 120’s. Transfer to the unit. He coded at 3 AM. Resuscitated successfully. Coded at 5 AM. Resuscitated. Then he was done. Returned to DNR status, and passed away an hour later.

Do Not Resuscitate is getting tattooed across my chest when I turn 80. DNR is not giving up, it is choosing how you die. You can die with friends and family around you, preferably at home, or in a noisy hot room with a dozen strangers crowded around, pushing on your chest and electrocuting you. At a certain point, resuscitative efforts are futile treatment. As nursing and medical providers, we should not be providing futile care. If it has no chance of accomplishing the goals of the patient, it seems unethical to continue treatment.

It is bizarre to me that resuscitation is essentially the only treatment where we will treat despite an oriented patient’s stated desires. If a patient tells me they want to be DNR, then code before we get an order from the doc and get it verified by two nurses, we’re supposed to treat the patient as full code. Same for anyone down and unresponsive – they are full code, unless the family can present a physician order saying they are DNR on the spot.  If that happened to me, I hope someone sues on my behalf!

 

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