Grammas and DNR orders :(

Miscellaneous and Personal Stuff I Must Share
1

The doctors said we should consider one.

My grandmother is 89 and has been ill since New Year’s. Constipation, anemia, breathing troubles. Last Friday - my 30th birthday - she was admitted to the hospital, to Cardiac Care, because they thought it was her heart.

On Saturday they drained 2 liters of fluid from her lungs.

On Sunday she was ok, but tired, and they started giving her what would end up as 8 units of blood. When I arrived at the hospital some cousins (grampa’s neices and their kids) were leaving. My cousin hugged me and said the strangest thing: “I’m glad you’re here now to take care of things.” I’m not sure what I think of that.

Same on Monday.

On Tuesday she stopped breathing and they put her on a respirator; I spent the night at the hospital, just keeping watch. It was not a pleasant night. Gramma was extremely restless, asleep for 20 minutes and awake for 10. Passing blood clots. Too weak to write and couldn’t talk. :frowning:

On Wednesday morning they did an endoscopy and cauterized a 2 centimeter bleeding ulcer - hence the 8 units of blood. I went to see her after work and, while she was still hooked up to the vent and who knows how many wires, she looked the best she had in weeks. Except. The docs put her on a broad spectrum antibiotic to combat what might be the beginning stages of pneumonia.

On Thursday she was doing well enough that they tried to wean her off of the vent. Her heart rate increased, her blood pressure dropped, and the vent was turned up to 100%. I went in to see her around noon and she was looking very bad. A Lutheran minister gave the daughter of a Baptist minister communion. (Actually, she’s been prayed for by just about every denomination around here except Jews, but I don’t think gramma knows any. Someone even had a Catholic Mass done for her - does that make her an honorary Catholic? Gramma’d get a charge outta that.) I stayed at the hospital til 9ish then went into work late that night, and spent a few hours early Friday morning with her. Again, she was doing well enough that they let her out of the hospital bed to put her in a contraption that kinda looked like a cross between a hospital bed and a recliner.

Friday night I slept. Finally. I called the hospital before I went to bed and was told that her breathing was almost back to normal. She was still on the vent, but it was only breathing for her on those occasions when she didn’t.

When I woke up this morning I called the hospital and was told that she was mostly ok, but sleeping, and came in to work to make up some of the hours I’ve been missing.

I just received a phone call from my mother, and she and my aunt are going to make supper out at the farm tonight and the family is going to sit down and talk about a Do Not Resuscitate order. At the same table at which we’ve had countless Christmas and Easter and Thanksgiving and anniversary and birthday and ‘because relatives are in town’ dinners.

I already know what we’re going to decide, but it doesn’t make it any easier.

2

I’m so, so sorry.
It’s a terrible decision to have to make, and I would not like to be where you are.
:frowning:
{{chique}}

3

{{{{{Rachel}}}}} I know how much your grandmother means to you and I know nothing I say can make this any easier, I know you are going through hell right now. You know that we are here if you need to talk and I know that can be a big help. Be strong and remember this community is a great source of support.

Keith

4

Working as an RN on both a Hospice floor and an ICU, this is a subject that I am very familiar with. It doesn’t make it any easier making that decision for your own family member though.

Just know that DNR does not–I repeat not–mean no treatment. In my practice we do everything possible up to the point of CPR and intubation.

There are different levels of course. Sometimes when a patient comes in for imminent death only comfort measures are provided. This means bathing, hydration and/or nutrition,if desired, and of course pain mangement in addition to oxygen & breathing treatment if needed.

I know this is a difficult time for you and all of your family. I’d like to encourage you to discuss your concerns with the Drs, Nurses, and other staff caring for you grandmother. No issue is too trivial if it is bothering you.

{{{{{chique}}}}}}

5

chique, darlin’, I’m sorry. I can’t even imagine what I’d do if it were my grandparents. You’ll do the right thing for her.

6

{{{chique}}}
As ususual, I don’t know what to say, but I am thinking of you and your grandmother.

7

Is this the Gramma with whom you watched the Vikings games?

Sorry to hear about her troubles. What is the prognosis from here on out, if she does recover from this illness?

-----:frowning:
—////\\

8

(((chique)))

My great-grandmother, who is 97, spent about 4 weeks in the hospital last summer. Her kidneys had failed. Then the weirdest thing happened–she got better. 97 years old, and she got better. My whole family was utterly amazed. We’ve been bracing for her death since 1988, when my great-grandfather died. It’s not that we want her to–quite the opposite. We want her to live forever.

One of the first times I went to visit her in the hospital, I saw the “DNR” on the outside of her chart. I made a guess as to what it meant, but I asked my mom about it, just to be sure. My guess was right, and my mom told me that it was my grandmother who had requested it. Seeing as how my grandmother is not in good physical health, but still mentally quite sharp, no one even thought about arguing her choice. And at the time, we were looking at kidney failure, and my grandmother had no desire at all for dialysis. As she put it to me herself–“if I were you, young and strong, with children still to raise, yes, I’d go through dialysis. But I’m almost 100 years old. And as much as I love my family, there isn’t much of anything left for me to really do here.” I couldn’t argue with that at all.

But still, seeing the “DNR” on her chart was a shock. I’m 33 years old, and I still have my great-grandmother. I’ve taken it for granted that she will live forever, I guess. It’s a hard thing, knowing that she won’t, but the DNR decision was one that she made. But if the day should come that she can’t make it herself, I know that we’ll make it for her, and we’ll abide by her wishes.

Again, (((chique))), and if you ever want to talk, feel free to email me.

Love, Cristi

9

I’m very sorry, chique. I’ve been on the periphery of such decisions, and I know they are very hard.

But…maybe I’m confused, but didn’t you say your grandmother has improved? I guess I don’t understand what this family gathering is supposed to decide–if she’s capable of making a decision on this, that’s the one the hospital would have to follow.

10

I’m so sorry chique. I have a couple of questions. Has your grandmother ever talked to anyone about a situation like this? Has she filled out a living will of any type? This is going to be one of the hardest things you’ll have to do in your life. I will say a prayer for you, that you will remain strong throughout.

{{{{{Chique}}}}}

11

Dearest Rach-

As you know, I lost my mommy to cancer three years ago. I loved and adored and depended on her. My life is diminished by the lack of her in it. I have no one to turn to for the things I used to turn to her for. I still cry, and I still mourn. The fact that I know she is in heaven is comforting to some extent, but I really, truly would prefer to still have her here. I would have kept her here, even as sick as she was, because I selfishly wanted her to stay. For me, not for her. I am ashamed to admit it.

The thing is, she was uncomfortable. She had cancer, and had fought all the battles with it that she felt like fighting. She made the decision to let go, to be with God.

Rach, I was NOT, and still AM NOT ready to let her go. But SHE was ready to let go. She felt that staying here on this earth would only entail more pain, more physical hurt. I don’t know your gramma’s situation, but she needs to make this decision for herself. If your gram is going to recover and have a good quality of life for more time with you, then it will happen. If it is HER time to be with God, then it is time for you to let her do what she wants to do. What SHE needs to do. And as much as it hurts, you have to let her do what she needs to do.

I ache for you, love, I actually ache for you physically. Because I know what you are going through, and I hurt so much for the pain you are going through. I wish I could say something to help, but I know that nothing I can say will make you feel better.

You are strong, Rach, and you will do what you need to do. It will hurt, and hurt badly, but you will do it because you love your gramma and you want her to be at peace. I pray that you do not need to go through this at this particular time…that she will have a miraculous recovery, and that all will be well. But if you do not have a miracle, and your gramma goes to be with God…you will survive. You will remember all of the wonderful things that she shared with you, and you will be strengthened.

I love you, Rachel. You know where to find me, please make use of that email address.

Scotti

12

I lost my grandfater a little over ten years ago in what would have been similar circumstances but the DNR was made clear up front. He went into the hospital with peumonia and was diagnosed with lung cancer. Everyone freaked over the cancer but didn’t listen to the doc when he said grandpa didn’t have the strength to fight the pneumonia. Fortunately we all knew that he absolutely did not want to be put on life support so the choice for a DNR order wasn’t easy but we knew it was his wish.

Chique, you and your grandmother are in my prayers.

13

Words fail me. And even if they didn’t, I know that there’s nothing I could say that would make you feel any better right now. I hope your grandmother isn’t suffering too much, and I’m glad she’s surrounded by you and your family.

You’re a good friend Rachel, and it’s been a pleasure getting to know you better these past few weeks. Know that you can always count on me for a shoulder to cry on, or an ear to listen. And if need be, a joke to make you laugh. Meanwhile, I’ll continue to send good thoughts your way, and wish the best for your grandmother.

long, warm hugs

  • Morphy
14

I lost my gramma in November. It was a sudden illness. She was getting better nad better every day, then she fell asleep and didn’t wake up. A few days before she went, my mom and Gram’s doctor talked with her about a DNR order. My Gram said that it was fine, and whatever God wanted was okay by her.

Whatever you decide, it’ll be okay. I wish I could tell you that these situations and choices are easy, but I’d be lying. I am so very sorry for what you are going through. Grammas should never get sick and should never go away.

I can’t keep talking about this right now, or I’ll start crying. But if you need to talk or anything, please email me.
I’ll be praying for you and your family.

15

Chique,
I am so sorry that you and your family have to go through this.
Be strong
Rose

16

{{{chiquelette}}}

All I can say is I know where you are, and I’m sending prayers and warm fuzzy thoughts your way.

I’ll light a candle for you & your gramma tomorrow morning.

Java

17

chique, I am assuming that because you family is discussing a NFR order, your grandmother is mentally incapable of making the decison for herself. Am I right?

If this is the case, then I contribute the folliwing as a disspassionate observation from a paramedic’s point of view.

Leaving aside your obvious emotional attachment to your grandmother, think about her current medical crisis, and her pre-existing diagnosed conditions. Also remember her advanced age. Given what she has been through since her admission to hospital, it is a distinct possibility that she may never be discharged.

I support the comments mermaid made. Be assured that a NFR order is only enacted when a person goes into respiratory or cardiac arrest. Until then, all reasonable measures that relieve discomfort are implemented.

From my 20 years experience in prehospital emergency care, it is extremely rare that anyone who is 89 years old is successfully resuscitated. The body’s machinery is just too worn out to recover. Those elderly patients who are revived often have a severe deterioration in quality of life, and many would have preferred to have been allowed to die with some dignity instead.

If you were in the same situation, would you thank the doctors for resuscitiating you back from the point of death to live in a vegetative state? I am not making an argument for euthanasia here - I am just asking you to consider the alternatives.

If you take into account your grandmother’s current physiological state, her chances of a successful resuscitation from a complete cardiorespiratory arrest are virtually nil. As you have already noted, she does not do well when the ventilator is removed - because she is already in a partially resuscitated state.

By discussing the NFR order as a family, you are making a positive move towards the time when Grandma is unable to continue without CPR. Whatever you decide upon together, it is better to have a considered decision ready, rather than react on the spur of the moment.

I hope what I am saying does not sound callous, but a realistic evaluation of what to expect. Please accept my best wishes for you and your family during this difficult time.

18

You guys have no clue how much the virtual hugs help. At all. Thank you. And thank you for the kind words and advice, as well.

The dinner talk was canceled due to weather so a lot of phone calls ensued.

Gramma’s already on a ventilator and has been since Tuesday, so that’s not an issue. I said in my OP that I already knew what we’d decide - no CPR and no shocks to get the heart going again, if it fails, but drug treatments (i.e., lidocaine and atropine (sp) if her heart needs it) are ok. Right now she’s on cardio-something cos her heart rate briefly spiked to 190 and then continued to fluctuate between 120 and 170. They’re weaning her off that and starting her on something similar. The problem with those drugs is that they lower her blood pressure, so she’s on still more drugs to keep THAT up.

Also last night a new wrinkle developed: Her catheter is causing bladder spasms, which constantly give her the feeling that she has to go RIGHT NOW. Not painful, but one more aggravation.

All of which means I got an hour and a half of sleep last night because the weather trapped people at the farm and my sister and I were the only ones around. Which prolly means this post is as disjointed as all hell.

The reason the DNR was brought up was because, when they tried to wean her off the vent yesterday morning, her heart went wonky - the stress she’s under is weakening it.

Yes, she’s lucid; no, she doesn’t have a living will; but she’s been telling us she’s going to die at any minute for the last 20 years or so and her wishes are well-known. I wasn’t around when the vent was put in so I’m not really sure what the deal was there, but from what I’ve gathered it was supposed to have been a temporary measure as she had, up until Thursday, been pretty strong.

I’m home for a bit to shower and change, then into work for a few hours, then back to the hospital.

19

{{{{{{{{{{{Rachel}}}}}}}}}}}}}}

I’m so sorry to hear about your gramma.

Robin

20

chique,

Two of the most important people in my life were my grandparents, when other guys were out partying and drinking on the weekends I would travel 80 miles to see them knowing that the time I had with them was all too short. A few of my friends would often join me as they told me that they (my grandparents) were fascinating people and anyone was welcome in their little country home.

My grandfather passed away at the age of 86 leaving my grandmother without her husband of 56 years. I didn’t think then she would last very long but she lived another ten years until the age of 90. She was hospitalized due to heart problems and the diagnosis from the physicians was that her body had simply worn itself out.

The last time I saw my grandmother I took my baby daughter with me and my ‘Gran’ joked that she had lost track of how many grandchildren and great granchildren she had. She held Alexandra in her arms and I couldn’t help notice how they looked alike. We both have Grandma’s ears.

My sister took my daughter so Gran and I could talk alone and she told me that she was very tired and was ready to go and join her husband. She said she had done everything she needed to do on this earth and that she just wanted to sleep. She told me that she had signed a DNR when she was admitted, she knew she wasn’t leaving the hospital.

We both knew this was our last good-bye and it was not without a few tears. (I found out later that she had had this talk with almost everyone so that they would know her wishes).

I tucked her into bed and held her hand until she drifted off to sleep. I kissed her on the forehead and then made the 80 mile trip home knowing that the next time I travelled there we would be laying her to rest next to my grandfather. She passed away in her sleep a few days later, as she wanted to.

She remains with me every day, I see her when I look at my daughters and hear a little of her soft Scottish accent in my own speech. My only regret is that my girls will never know the wonderful and warm person I called Gran.

My thoughts are with you…