DNR or POLST end of life decisions

[barbc56]

or waking up dead. I'm good with either.

 

[jimells]

I'm not worried much about waking up after CPR - Wikipedia says only about 8% survive ("Bystander Conventional CPR").

I attempted CPR on a salesman at the farm equipment dealership I worked at 20 years ago. He didn't survive. I was struck by just how useless most people are in any kind of emergency.

I was working in the shop when Dean collapsed up front. When I got to the showroom, there were people standing around, looking shocked and fearful, while Dean lay face down on the floor. No one could even figure out to turn him over! Without some authority figure telling people what to do, they do... nothing.

My own experience with these kind of documents does not inspire confidence. My mom and stepdad both worked as nurses for many years, and my mother is a real stickler for filling out all paperwork and following all recommendations, etc., and that certainly applies to these "living will" documents.

When my stepdad collapsed at karate practice it was all for naught. The ambulance took him to the local Catholic hospital which apparently ignores these kind of documents. They worked on him for a very long time before restoring circulation, by which time there was extensive brain damage, and hooked him up to all the machines despite his written instructions.

It was a big deal to get him disconnected so he could die in peace. During a large family meeting at the hospital I practically had to torture the neuro into admitting that my stepdad would never recover. Once she acknowledged the reality of the situation in plain language, it was obvious what decision had to be made, and they moved him out of the ICU.

After the vent was removed he gasped for breath for many hours. I consider it cruel that they wouldn't give him enough morphine to end his suffering. Even our pets get better end-of-life treatment than humans on Medicare. I can't help thinking that hospitals are loath to let cash cows, errr, ICU patients, expire before the insurance is all used up.

 

[minkeygirl]

@heapsreal what I worry about is being resuscitated and ended up being a shadow of my former self. Since I'm basically worthless now, what would it be like if I got sicker?

I keep a list of meds and my doc on my phone. Although all my meds are in plain view. Do you guys check phones?

So basically you say, you have to look for the DNR first before you start CPR? Chest tattoo would work! Or permanent magic marker.

 

[heapsreal]

@minkeygirl cpr is started first unless someone hands us a dnr as we arrive. We dont really go searching unless they look terminal with history of cancer etc or if they are very old and appear to have had a poor quality of life. We weigh each case up.

 

[heapsreal]

@jimells thats sad. Where i work the hospital system ate quite good and take into consideration what their quality of life will be etc.
most paramedics will say when they are older they dont want to be resuscitated .

Although I can remember a few cases where i thought the patient had been down too long and will probably be a vegetable , one in particular this year, she walked out of hospital the next day. She was elderly and drug overdose. Its rare.

 

[minkeygirl]

@heapsreal so they wouldn't look At me and realize I actually am a decrepit old woman with no life ?

My plan is to take the hot pink form and tape it to the side of my entertainment center. You open the front door and it's right there. You'd have to be blind to miss it.

Or paint my front door pink with w big DNR on it! That'd work. A sign that says "I have CFS. Let me die". Please.

 

[minkeygirl]

I remember watching a medical show years ago. I guy was on vacation with his wife in Hawaii. She was shopping while he went surfing.

He hit bottom and broke his neck. They told them do not operate. They couldn't get a hold of his wife. But the doctor thought surely he didn't know what he was talking about, ignore him and operated.

He ended up paralyzed from the neck down. That is what I'm trying to avoid.

@heapsreal Thanks for your comments. Your last one helped me make my decision. No CPR.

 

[minkeygirl]

I was looking at the POLST form again and it is more specific than the DNR.

I'm pondering some of the options, which way to go after I say no CPR. Medical intervention I'm thinking 3. Where I'm wavering is artificially administered nutrition. 2 or 3.

Medical Intervention

1. Full Treatment - Primary goal prolonging life
2. Selective Treatment - Goal of treating medical condition while avoiding burdensome measures
3. Comfort Focused Treatment

Artificially Administered Nutrition which includes feeding tubes

1. Long Term artificial nutrition
2. Trial Period
3. No artificial means of nutrition.

Also, make sure your advanced directive is up to date. Mine has the wrong PCP, and some other misinformation, like it's ok to donate my organs.

I'm curious what others think, and @heapsreal

Please tag me

 

[barbc56]

@minkeygirl @heapsreal

Thanks for this information. It's very helpful. I haven't been on this thread in some time so if I missed anyone else's post, this also includes you.

A friend of mine recently related a story. Her husband died about fifteen years ago and requested DNR. He collasped at home and when the paramedics came they started CPR. She kept shouting his wishes were DNR but the paramedics couldn't hear her because of the utter chaos. The DNR paperwork was close by and when she literally shoved the papers in one of their faces they stopped.

In all fairness the medics were well meaning. It's their training and they may not have the time to ask about a DNR. She now wishes he had worn a bracelet with a DNR when he was diagnosed as terminal. It took a long time for her to come to terms with this as she felt it was her fault. It wasn't. It was just the nature of the situation.

By the same token, I was staying with my mother when she had a heart attack and when the paramedics arrived she had no blood pressure and they couldn't feel a pulse. They gave her a shot of epinephrine (?), she stablelized quickly before going to the hospital and ended up living five more years.She actually beat the odds as unlike what we see on TV and the movies, the chances of being successful are slim.

A friend chose pallative care but requested no food or water.

It's a difficult situation. I don't think I would actually wear a DNR braclet/dog tags at this point. But would not hesitate under different circumstances.

My two cents worth.

Barb

ETA

After the vent was removed he gasped for breath for many hours. I consider it cruel that they wouldn't give him enough morphine to end his suffering.

How awful for your father and family. There are doctors who do this. Even if the situation is hopeless and there's a chance administering more pain medication could be fatal, in the long run if it helps someone pass peacefully, I think that's an act of compassion.

But it doesn't apply in all cases.

There're no easy answers.

 

[heapsreal]

@minkeygirl
i dont know much about the different interventions which are more to do with more chronic care of patients like eating and drinking etc. Im only with the patient for a short time, so really only involved in the resuscitation stuff.

@barbc56
many scenes, like you said are kaotic and just a verbal dnr isnt enough unless its the patients dr or theres paperwork . Most of the time we dont ask automatically unless they are in a nursing home or told they have cancer etc. Time is of the essence i guess?

 

[minkeygirl]

I actually think if I'm home I'll be long dead by the time someone gets here. But things are different for is than the regular population. I sure don't want a bunch of broken ribs.

And how much worse would it be for me/us if we survived a heart attack. How much more of my life can I lose?

But just in case, it's gonna be posted.

I actually looked at DNR bracelets on eBay and they're ugly.

Maybe a trip to the tattoo parlor is in order. OUCH.

I just think this is an important discussion.

 

[Sushi]

Or paint my front door pink with w big DNR on it! That'd work. A sign that says "I have CFS. Let me die". Please.

In the US you can get File of Life documents. They include: 1) a red sticker for your front door to alert paramedics, 2) a refrigerator magnet packet with medical information, 3) a wallet packet with the same information. If the paramedics see the red sticker on the door, they will look on the fridge (we hope!)

Your local fire dept should be able to supply these or you can go to: http://www.folife.org/
I think your county has to participate but I've lived several places where they did.

 

[minkeygirl]

@heapsreal what does this mean? She has DNR on her chest

 

[minkeygirl]

Thanks @Sushi

That Doesn't reference DNR on it. It'd be easier to post the hot pink form Somewhere right when they walk in. No missing that. And a tattoo

I also saw someone said no trach.

 

[Sushi]

Here is the door sticker:

Here is one of the packets:

You can tuck a lot of medical documents into the packets, which have pockets for this.

 

[minkeygirl]

I saw that but if for some reason the locals dont know about it, I'd rather have a big fat DNR right in their faces.

Then no guesswork, tripping over my body to read through medical paperwork

But a big DNR sign for the fridge would be good.

 

[minkeygirl]

Oh. If you have a cell phone. Put ICE next to your emergency number.

In Case of Emergency. They may look through that and call for instructions.

Too bad mine misplaces his phone every other day. Lol

 

[minkeygirl]

@barbc56 found this today. I think I'm going to get a sign for my front door that says no Cpr and have my papers in a nearby drawer

https://www.compassionandchoices.org/tag/do-not-resuscitate/

 

[PatJ]

@heapsreal what does this mean? She has DNR on her chest

I assume P.T.O with the arrow, on her right shoulder, means "Please turn over" to see the DNR tattoo on her chest.