Above All, Do No Harm

I talked forever ago (seriously years ago) about how people should have living wills and consider being DNR. And in light of my hard week, I feel like this post is timely. Just like medical professionals wouldn't recommend chemo to every patient–or even every cancer patient, resuscitation should not necessarily be an expected course of action. It is not beneficial to every patient for every disease process and often times can cause more harm than good.

First, let's go ahead and dispel a common misconception. DNR does not equal hospice. Hospice denotes comfort care at the end-of-life (which, by the way, I am also a total advocate of hospice.) It's kind of a joke among my nursing friends but if I ever have to go to the hospital I will immediately declare that I want hospice. "Ma'am, you just have a broken arm…" "I don't care! I demand hospice!"

But for real, hospice is designed for end of life care. DNR means that if I die–my heart stops beating and I stop breathing on my own–do not bring me back to life. Do not pound on my chest and stick crazy tubes down my throat! The only exception I would make to this is if they needed to keep my heart beating long enough to harvest my organs, because I am also 100% in favor of organ donation.

A while back, I listen to a Planet Money podcast called The Town That Loves Death about the small-town of La Crosse, Wisconsin. In this town, 96% of the population has a living well or advanced directive. They had established a culture of talking about death and individuals wishes about dying. My only criticism of the podcast is that they made it seem as if everyone was a DNR. That is not necessarily the case. All it means is that the majority of the population has a plan in place for what they want their final days to look like. It means that they aren't leaving it up to their family members in a time of crisis while they're lying in a hospital bed. It means that no one has to wonder or guess about the desires of their family. It means that there are no arguments between family members that may not agree on a plan of care for their loved one.

The other day a patient came into the emergency department unresponsive. His family cannot tell us what happened and he could obviously provide no history. So what now? Which interventions would he want? Would he want everything done? Or would he want to die in peace? Would he want to be resuscitated or not? It was too late to ask all these questions now. It was up to family members to decide and trying agree on what he would want.

And it's hard. It's hard to walk into a patient's room and ask those questions. The family is already under a lot of stress and worry about being in the hospital and then we come in and ask them to make potentially life-changing decisions under pressure.

So let's learn a lesson from the residents of La Crosse, Wisconsin. Think about your life and how you want it to end. Think about your family. Make decisions early so that they don't have to. The organization Aging With Dignity developed a booklet called Five Wishes that is recognized and 42 states as a legally binding advance directive. It allows you to name a healthcare agent, determine which, if any, medical treatment you want, discuss how comfortable you want to be, discuss how you want people to treat you, and even lets you list any funeral preferences.

Seriously, everyone should do this. My family may or may not have talked about this over lunch at Houston's one Sunday afternoon. You don't have to do all that. I know that my family is not normal and that we talk about death more than the average people, but this is important and it needs to be discussed before it's too late...