How Will You Choose to Die?

There will come a time after being diagnosed with a terminal illness that your doctor will ask whether it is your wish to have a Do Not Resuscitate Order (DNR). By signing a DNR you acknowledge that in the event that your heart stops beating, no life saving measures, such as CPR will be performed. Hopefully your doctor will take the time to discuss what the realistic expectations for life saving measures will be in your particular case.  As a hospice nurse I know that each of my patients are closer to death than many of the rest of us have to fear. Unfortunately, although my patients are in the various stages of dying, not everyone is prepared. Many find it difficult to talk openly with their loved ones about what their wishes are because no one around them is comfortable listening, or discussing death with them. For some, discussing death is admitting defeat, or being disloyal for not having enough faith that the person can ‘beat it’. One such patient and family come to mind. An elderly woman in her 70’s came to the hospice house directly from the hospital. She had been at the house a week when she became unresponsive. Not unexpected considering her age and steady decline due to her disease over the previous weeks. Her family had not signed a DNR, and no one had been chosen as a health care surrogate. There was fighting amongst the family as to what to do. Some of the fifteen gathered there that day around her room accepted that she was dying and some did not. There were tears and angry words inside the room and in the hallways. After a morning and afternoon of arguing among themselves, the decision was made to have this woman transported back to the hospital. The EMTs came and put her on a stretcher, rolled her out to the ambulance, drove the 45 minutes through rainy rush hour traffic to then take her into the ER and transfer her into a bed. The ER doctor told the family that the woman was dying and that there was nothing the doctors could do to reverse that. The family still refused to sign a DNR and launched into a list of demands they thought would keep this woman alive. They wanted an IV for fluids, so a nurse placed an IV. Staff came into the room every half hour to take her vital signs. Family wanted CPR performed in the event her heart stopped beating. Only five persons were allowed in the area around her bed, so the other ten family members took turns coming in and out. A curtain separated the woman from the crying child on one side and the moaning person to the other side of her. Still the woman remained unresponsive and dying. After two hours it began to sink in that this woman really was never going to wake up and would die at any moment. So this time, with all the family in agreement, a DNR was signed. Per the family’s request, a second ambulance was called to transfer the woman back to the hospice house. The woman died as they were wheeling her down the hall back to her hospice bed. Her family all gathered in the room and took their time saying their good byes. Her daughter said to me “ We brought her back here because she told all of us when she first got here how much she liked it here because it was so peaceful. No more hospitals, no more tests.”

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