Personal blog of christian
writer & fallible mom
Katy McKenna Raymond
in Kansas City, Missouri
Katy is represented by
Greg Johnson at
WordServe Literary
Read more Katy at
LateBoomer.net
Recent Posts
- Try
- Becoming Brenda Starr
- Off Beat
- Scattered
- That’s It
- So I’ve Finally Signed With An Agent. Now What?
- The Spoon
- Sciatica
- Sweetheart
- A Woman’s Train of Thought Has No Caboose
- However much we own, we are all still living on borrowed time
- After all, when restaurants shrink portions, they don’t shrink prices.
- As with everything in life, balance is key.
- Slow down, you move too fast…
- Yeah, I know. I have issues.
Syndicate
E me at katy @ ngenius.com
Between A Rock and A DNR
“Make sure you’ve got DNRs in place,” a friend of mine advised recently. “That way you won’t have to make horrible decisions when the time comes.”
This friend couldn’t possibly know all the particulars of our situations with The Moms, but suffice it to say, DNRs Backwards ‘R’ Us. With the emphasis, more often than I’d like to admit, on the Backwards.
Both of The Moms have black-and-white, lethal-looking signs clearly posted in their nursing home rooms, apprising staff and paramedics that they are NOT to be brought back to life should they completely and fully expire. That’s the essence of the Do Not Resuscitate order, a step both my mother and my mother-in-law chose to take for themselves back when they were of sound mind and which we, their representatives, verify and re-verify at every hospital, ad infinitum. (A hospital will not honor a nursing home’s DNR, and vice versa. And, living in a big city, we are often diverted to different hospitals than the ones that have our mother’s files, such as in the case of an emergency room already being filled to capacity.)
A DNR form, no matter how explicit and final its wording (deceptively leading you to hope you’ll never have to think about THAT again), can end up being the wrenching decision that keeps on taking.
I’ve even had the onerous experience of using my body as a shield against heroic efforts, propping my weary self up in my mother’s hospital room doorway all night long, when the hospital where she was admitted was unfamiliar with her wishes and could not get a doctor to sign off on her DNR until the next morning.
“If she ‘codes,’” the nurse informed me, “we have no choice but to bring a crash cart in and attempt to revive her.”
“But most of her ribs have already been broken,” I protested. My mother has Osteoporosis of Unusual Severity. “She does not want to be revived and I can’t allow you to crush her fragile bones doing chest compressions.”
“Then I suggest,” she said, “that you physically block the doorway. Because if anything happens before you produce the paperwork or the doctor signs a new form, we WILL use the crash cart.”
I have learned the hard way, over the course of ten years, to never leave home without copies of DNR papers. Sure as anything, if I head to Walmart for a gallon of milk, I’ll get the call to meet the ambulance—-carrying one or the other of The Moms—-at the hospital. And the FIRST thing I’ll be asked as durable medical power-of-attorney is to produce documents related to end-of-life wishes.
It was bad enough (and, I guess, a little creepy, but there you go….) when I just kept grab-and-go copies in plastic sheet protectors on the fridge, next to random pictures of the kids, the dog, and the grocery list. Now I keep DNR papers in the glove boxes of both cars, along with proof of insurance and evidence of timely oil changes, because a daughter just cannot be too vigilant.
But I’ve got to say, there’s a LOT of wiggle room between a rock and a DNR, and that’s the spot I’ve found myself in too many times now to count.
If you’ve never found yourself in the position of saving an elder’s life, trust me. It could happen to you, and before you know it, producing DNR papers will look like child’s play. In fact, it’s downright EASY, by comparison, to insist that those in the medical profession honor your loved one’s written wishes. What’s NOT easy are all the scores of decisions you may end up making between now and when that DNR gets put into play.
Say, for instance, your parent lived in an assisted living facility or nursing home, and in the process of being transferred from the bed to the wheelchair, she gets dropped. You could pretend that you don’t fear a head injury when your mom tells you the story, including the part where she felt the back of her head hit the hard floor. You could act as if you aren’t cognizant of the fact that the employees at the facility don’t seem to be noticing her developing symptoms in the 24 hours after the incident.
There’s a reasonable chance your elder could die after such an event, unless you intervene and insist she be evaluated at the hospital and treated for any injuries incurred. So what do you, a person with a reasonably refined conscience, do? If you act to “save” her and succeed, you may be inadvertently prolonging her suffering, should her head injuries be the type to result in long-term mental disability.
Most nursing homes, once your parent becomes a resident there, will present you with the option of signing papers indicating your decision to not “send her out” when she becomes more critically ill. In other words, even in the absence of your parent needing or wanting hospice care, you will have pre-determined that should she become so acutely sick that you would have formerly taken her to the ER, you will now simply let her die (or live, if God so chooses….) in place.
I struggle with this. How do I, a mere mortal, know in advance whether a particular onset of illness is something easily curable with judicious and prompt medical treatment, or whether seeking that treatment will cause more ultimate harm than good to my loved one? How do I decide ahead of time that Mom will no longer be going to the hospital, ever, under any circumstances?
Two years ago, when Mom’s blood calcium rose to precipitous levels and caused her to behave as if insane, I overruled the nurse on duty at the nursing home (who had chosen to ignore my mother’s worsening condition for 12 hours….) and called for an ambulance. It did not take long for the ER docs to find the problem and begin the appropriate treatment, which completely reversed the condition. However, during the days Mom spent gaining strength as an inpatient, the hospitalist assigned to her delivered a speech to Mom (in the presence of her children) which confused Mom all to heck.
“Mrs. McKenna,” said the doctor, “you really need to decide that you will stop coming to the hospital. You are receiving good care at the nursing home. Just stay there.”
I said, “Excuse me, doctor, but my mother would have died of neglect at the nursing home, of a condition that was reversed without any complications once we arrived at the hospital. Is that really what you’re suggesting is in her best interest?”
The doctor said, “Well, perhaps in this case, she should have been brought to the hospital. But not in the future.”
The moral of my story is this: If your loved one wants to sign a DNR, you will have one piece of a very complicated puzzle in place. But understand the DNR’s a piece that may be free-floating on the card table for many years, while you try to fit 999 other pieces around it, one-by-one.
You may end up saving your parent’s life more than once, and perhaps even once more than she would have liked.
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