How do you make a decision that literally affects the life of someone you love? How do you make the decision to allow medical professionals to write just three, small letters in your loved one’s notes with those three letters have your loved one’s life in their grasp? D. N. R. Do Not Resuscitate.
For quite a few years, my nana has suffered with frequent chest infections. She has COPD (Chronic Obstructive Pulmonary Disorder). She was hospitalised with pneumonia a couple of years ago. I’ve never seen her so sick, or been more afraid of losing her. Not even when she had half of her bowel removed due to cancer a few years before that.
Three nights ago, my nana fell in her bedroom. It was about midnight when I arrived at her house with my mum. My auntie, with whom my nana lives, had managed to get my nana relatively comfortable on the floor. She was laying propped up by pillows. She was complaining of extreme pain at the bottom of her back and couldn’t move. She made me promise not to call for an ambulance. She’s terrified that if she goes into hospital, she won’t leave there alive. The only reason I kept that promise was because she told me that she hadn’t felt dizzy and she hadn’t hit her head when she fell. How stupid I was to keep that promise knowing that my Nana has osteoporosis and has had a number of vertebrae crumble over time. I should have convinced her that it was best for her to be checked out by medics knowing her history and the pain she was in at that moment. Instead, two full days passed with my mum and auntie being my nana’s primary carers. They literally carried her each time she needed the toilet. Carried her while she was in agony.
My nana’s GP came to see her the day after her fall and prescribed bed rest, but said that if the pain worsened, she was to go to hospital. Yesterday morning, that time came. Nana’s pain was worse and radiating outside the original area. Her chest had also begun to rattle, a telltale sign that she has a chest infection. At midday yesterday, my nana, mum and two aunties were in A & E (or E.R., for my American friends). I arrived shortly after. A doctor diagnosed my Nana with a chest infection and “two small broken bones in the groin area.” He broke my nana’s heart by telling her that she had to stay in hospital until she could walk. Hours and hours passed. Shifts changed. New medical and nursing staff took over. My nana met a second doctor who was extremely apologetic that she’d been there for so long. She also said that Nana didn’t have a chest infection; she has pneumonia again. Those two little breaks in her groin? No... they were actually two severe pelvic fractures.
Ten hours later, my nana arrived on a ward at a different hospital. Jump to today’s diagnosis. Pneumonia and not one, not two, but three severe pelvic fractures. She had a CT scan but the results aren’t back yet at time of writing (10:45 PM). She’s had more blood taken than a city full of vampire victims. She’s been as high as a kite on morphine and her antibiotics. When I saw her yesterday, she looked dreadful. Old, fragile, exhausted, sick. Today, though, she was much brighter. Still sick and still unable to move, but her sense of humour was back; that twinkle in her eyes. Then a brick was thrown. A brick with DNR emblazoned on it.
A doctor, who can’t have been more than 25, took my mum and aunties into a private room, leaving myself and my cousin with my nana. When they came back, they had faces that betrayed them. I knew something horrific was about to come out of the young doctor’s mouth. She sat next to my nana. Spoke of her frailty and the pneumonia. From then, everything became a blur. Inaudible speech. A tear burnt my cheek as it trickled down and I felt dizzy. Faint. The doctor was telling my nana that if she were to crash (to go into a cardiac arrest), that it wouldn’t be in her best interests to try and resuscitate her. By law, they have to try resuscitation at all costs unless a person has instructed them not to. This young doctor was telling my nana, who is hearing impaired, that they would not try to save her if her heart stopped, and was “that OK with” my nana? Of course my nana said yes. She’s of the generation that believes doctors are always right. Always the smartest people in the room and that to challenge them is to be disrespectful. This young doctor was, in effect, telling my nana on a day when she felt better that they would give up on her. The fact that she had discussed it with her daughters told my nana that they would give up as well. Why? Because of how fragile my nana’s bones are. Now, anyone who has been trained in CPR (like me) knows that ribs often break during compressions; such is the force that is needed to keep the heart pumping. Anyone with that training will also be of the mind that a broken rib is far better than a person dying due to compressions not being done properly, if at all. Is the possibility of a broken rib a good enough reason for the medical team to impose a DNR or my nana?
In recent years, my nana has been extremely aware of her own mortality and experienced a deep depression when she had bowel cancer. It took three years for her to regain the confidence to go out on her own. I’m terrified that my nana will give up. I’m terrified that depression will return and she’ll believe that this is it. If she hits that wall, we’ll lose her.
How does someone make the decision to persuade another human being that trying to save their life isn’t in their best interest? If my nana was at death’s door and we knew that she wasn’t going to make it, then I could accept that conversation. Not today, though. Not when she’s fighting, being mischievous, receiving medications to make her better. Are conversations like this ever premature or poorly timed?