New York-Presbyterian / Weill Cornell Medical Center

The BBQ Pit
21

No, of course they don’t go in through the sternum for that.

But what these doctors (or nurses, or administrators) will say is, when presented with an elderly and/or otherwise unwell patient, is something like “if your father, who I know you care for very much, went into cardiac arrest, or had a stroke, or something like that, you woudn’t want him to suffer, would you? Because we’d have to crack his sternum and open him up to treat him for that, and well, at his age, is it really something you want to put him through? Just sign this paper – no, no, don’t bother taking the time to read it, we’ll take care of everything – and it will be so much better. Just sign the paper. Really, you should sign the paper and give us the DNR. You should sign it. Now. Don’t you care about your parent? Sign the paper.”

That’s how it goes. I’ve had this same conversation more times, at more hospitals and other facilities, than I care to remember.

22

Routine transportation to doctor’s appointments is handled by the memory care facility where my father lives. They’ll book the vehicle, get the resident ready and dressed, and, if necessary, send an aide along (you’d be surprised how many residents have families who never even visit, let alone go with them to the doc, the hospital, whatever).

Of course, they charge for each ride.

In this case, though, it was my father’s ride back from the hospital, so Weill Cornell arranged the ride.

23

Not necessarily. I’ve seen it too, in at least one elder-care home in California.

24

While I fully agree that pushing people to sign a DNR is not acceptable, demanding that people have a Advanced Directive is just common sense.
I hope people aren’t conflating the two.

25

Unless he had something to really be proud of.

26

My Advanced Directive specifically states I do not want resuscitation.

In surveys people typically guess that resuscitation is successful 75% of the time. In reality it is closer to 10%, and that is with an otherwise healthy individual.

It might sound callous, but a doctor urging a DNR order is actually looking out for their patient, IMO.

27

Absolutely, all the end-of-life stuff should be worked out while the person in question is competent and able to make his or wishes known.

And all that stuff has been. I’ve got all the paperwork, signed, witnessed, notarized, everything.

But institutions push for blanket DNR orders that give all discretion about end-of-life decisions to the institution. And they’re not getting that from me.

And the DNR push (at every institution) is just unseemly.

I posted back in 2019 (link below) about a rehabilitative medicine place that pushed hard for a DNR. My father had just come out of the hospital for a UTI (like PB_J’s relative), which can make people already suffering from dementia quite loopy. He was released from the hospital to the rehab facility, and literally as they were helping him from the ambulette stretcher into his bed a nurse was pushing me for the DNR, right in front of him. And I mean pushing, relentlessly, to the point where the old man started to freak out and we (my brother was with me) had to ask the nurse to leave the room.

Also, in that other post, I didn’t name the place. I don’t know why – that was Village Care Rehabilitation & Nursing Center, in New York City. They actually did a pretty good job on the rehab stuff during my father’s stay there. But see my earlier post -

https://boards.straightdope.com/t/vultures-preying-on-the-elderly/839710?u=saintly_loser

28

Real CPR, not the TV kind, is frickin’ traumatic to the person getting it. There’s a disconnect between what the medical people see and what the general public thinks it is.

I find it questionable to do CPR on someone near the end of life, especially if they’re fragile (especially with fragile bones - flail chest in an octogenarian is not a good thing at all) and heal slowly/poorly. If there is no DNR then the medical folks have to perform this unlikely-to-succeed procedure that is likely to cause significant injury if it does work on someone who has little life expectancy.

However, the general public, including patients, hear “DNR” and think they’re going to just let me die!!! A DNR means (or is supposed to mean) that if your heart stops they won’t try to reverse that but otherwise they’ll still treat you. I mean, heck, my mom walked around for 20 years with a DNR in her purse, underwent medical procedures with a DNR, waived the DNR around everywhere she went that was medical (mom REALLY did not want CPR again. Or several other medical things ever again and carried around the paperwork to make sure they wouldn’t happen again. And they didn’t.)

But, again, pressuring people to sign one while in an highly emotional state with a dollop of fear on top is NOT, in my mind, ethical.

Also, sometimes the paperwork ISN’T just DNR, you do have to read it. Fine print, usually. In a highly emotional state with a dollop of fear on top.

I’m probably better informed about end-of-life, medical directives, DNRs, DNI’s (another thing mom never wanted again) and the like than most laypeople and I can find it very confusing and stressful.

There’s all out medical care.

There’s palliative care, which is not concerned with curing but with comfort.

There’s hospice, which is end-of-life, and has palliative care but I’ve also seen hospice situations where they just don’t treat anything, even when it would make the patient more comfortable or give higher quality of life, they just dose with painkillers and tranquilizers. So… there’s quality hospice and shitty hospice, just like every other medical thing.

There’s DNR, which might be signed by someone fully conscious, upright, walking, and seemingly healthy. If said person falls over with a heart attack then medical sorts will not attempt resuscitation, yes, they will “just let them die” but that is with the consent of the patient (or appropriate medical proxy), without one it’s full-out try-to-bring-them-back, smashed ribs and cracked sternum and all. Meanwhile, such a person can still have surgery, antibiotics, chemo, etc. But I would definitely say that it is VERY important to actually read anything before you sign it.

There’s DNI which is Do Not Intubate. My-sister-the-doctor, who has severe heart problems and for whom covid is almost certainly not something she would survive, currently has one of these. But that is a choice she made, with the medical knowledge she has about both resuscitation and her own health. In the event she gets severe covid she doesn’t see the point of wasting medical resources on herself when there is almost no chance they would do any good whatsoever, especially during the height of the epidemic. (Yes, she’s fully vaccinated - we’re hoping she doesn’t have to go through covid at all, but that is she does catch it at this point it won’t make her seriously ill.)

But yeah, the way consents and DNR’s are approached at times look like they were devised to cause maximum distress and panic.

I don’t really have a good answer to this. Me, I’ve got my medical and financial proxies in place for “just in case”, and I’ve discussed my feelings about things with those who may have to make these decisions for me. A lot of people don’t do this, so when the shit hits the fan decision making gets to be a mess.

29

The medical community, as with any other, has staffing of all types. Some are competent, others are not. Some are dedicated, others are there for the check. Compassionate vs. none at all.

I will give a hypothetical example of what worries me. Let’s say an elderly person is a diabetic…even a mild diabetic. Blood sugar is controlled by diet and oral medications. That person now enters a rehab or memory care. For ease of monitoring, that person is put on insulin instead of oral medication for their diabetes. However, insuli n was given and the patient did not eat their meal. They are later found unresponsive by a CNA. (due to low blood sugar). CNA at first thinks they are sleeping. Then finishes whatever he/she is doing and reports to the nurse that so & so is sleeping in an odd position. Nurse goes to see, notices something is wrong. Well, patient is a DNR! So be it.
I know this is extreme (but it has happened). All this patient needed was glucose…the delay was serious enough to cause further debilitation.

30

I’m confused- if all the person needed was glucose, what doe s a DNR have to do with anything ? DNR means do not resuscitate and would be meaningless if resuscitation wasn’t necessary. If the nurse was so incompetent that he or she couldn’t tell the difference between someone who is non-responsive because of low blood sugar and someone whose heart has stopped beating/stopped breathing , that’s an issue that has nothing to do with whether a DNR was signed.

31

(emphasis mine)

As a rule, people in rehab places or memory care facilities are not being cared for by nurses. Or even CNAs. They are being cared for by aides, who have no medical training at all.

There may be one nurse on duty at any given time in a facility. I certainly hope so (although the more I look into it, I’m pretty sure there isn’t a nurse on premises 24 hours at my father’s residential facility, especially since the management gets evasive if asked a direct question). There is not, as a rule, an in-house physician on duty.

So an aide may mistake someone who is unresponsive because of a missed dose of something as just sleeping. And then the problem starts to snowball.

32

I’m sorry for the confusion.
My intent was to explain that sometimes (not always) a DNR could be interpreted as “no intervention,” when really a minor intervention could have solved the immediate problem.
I am a firm believer in a DNR, however I do believe that more, and ongoing, explanation/education is needed for all carers and families.

33

I am too. Everyone should make their end-of-life wishes known to those who will care for them at that point. I have, to my wife (my children are far too young to have any part in those decisions), and my father has, to me. And we’ve drawn up and executed the necessary documents.

What I object to is the push by institutions to execute their documents, drafted by the institution, without reference to the wishes of the patient or the patient’s family, concerning end-of-life care. And it really is a push – the pressure is intense.

34

I understand that- I was going with the example given which involved a nurse who apparently decided that a DNR meant no intervention at all.

35

I just took care of all that with my lawyer, and I was very clear about my wishes — which include transferring me to a jurisdiction where assisted suicide is legal if I am incapacitated by a serious incurable illness.

My mom carried her DNR with her (in a big bright 9x11 envelope with DNR written in it in big black magic marker lettering) whenever she left the nursing home to spend time with us on holidays, and she clear a space in the coffee table for it. She was really scared something would happen, we’d call an ambulance and they’d resuscitate her because they didn’t know better. She REALLY didn’t want to be resuscitated.

36

I’ve been told that the ambulance crew/EMTs will attempt resuscitation because the DNR is only able to be carried out by doctors. Does anyone know if that is true? My SIL swears that her mom was given CPR even tho they had the DNR.

37

Anecdotal data only, but my dad had a DNR displayed on the fridge for the last few years of his life. It applied to the EMTs, also.

This could be a state by state thing, but you probably need a local lawyer to answer the question properly.

38

It does vary by state. In NYS there is a hospital/facility DNR and a pre-hospital DNR. Here is a link to the NYS regulation. You may want to check your own state.
Frequently Asked Questions re: DNR’s - New York State Department of Health (ny.gov)

39

I’ve thought I understood exactly the opposite. (California here.) DNR’s are instructions to first responders. Once admitted to a hospital, DNR’s are not applicable, but Advance Directives (or similar documents) are.

I’ve also understood (rightly? wrongly?) that once a first responder begins to do CPR or similar, that treatment must continue. That is, the first responder must see the DNR before he begins CPR. If he begins CPR and another person comes running up waving the person’s DNR, well sorry, too late, can’t stop now.

A big question is how to make sure a first responder will be sure to see the DNR in time. Do we all need to wear it around our necks at all times? It seems that hanging it on your refrigerator is popular. Do all first responders know to look there? (Heaven help you if you have a medical event while you’re not in your own house.) It seems, like @Broomstick’s mother, that you had best carry it on your person at all times; but even having it hidden in your purse seems risky.

I have a DNR, but it exists only in a file on a computer at my HMO. Fat lot of good that’s going to do. I need to do something better than that. There is nobody in my life who will be watching out for me when I can’t watch out for myself, so it’s a total crapshoot what will happen to me, no matter what documents I have in some file somewhere.

ETA: I know a guy who had “DNR” tattooed right on his chest in big red letters. (That only works if they rip his shirt off before they start.)

40

Depends on the jurisdiction. My mom lived in Michigan and DNR’s applied to ambulance crews/EMT’s/paramedics after a certain point. This is NOT a universal rule in the US. In some places they do not apply to the folks who show up for a 911 call.

Again, all of this will vary by jurisdiction.

The last 20 years of her life mom almost never went anywhere by herself. So if she had collapsed at, say, a shopping mall dad would have been there to whip the DNR out of her purse.

If you’re alone most of the time yes, it’s more of a crap shoot.