Often I’m called to a home for a very sick patient. The first thing I do in these cases is find and read the do not resuscitate order or advance directives created by the patient. I need to know right away how far we need to go and what we can and can’t do if we need to resuscitate this patient. Sometimes there’s no paperwork but the family states their wishes to us. Other times there is paperwork and the family doesn’t want us to follow it. There’s also times when the family is present and arguing about what we should do. If there’s paperwork for us to follow then it’s easy. What’s difficult for me is when the patient is in an obvious end of life state, there’s no paper work to follow and the family wants us to “full code” their family member…and that’s what we’ll do if there’s no DNR or advanced directives. This happens a lot to emergency workers and hospital staff. If you’re a first responder I’m sure it’s happened to you too.
It’s easy for me to disconnect myself from the situation because I usually don’t know these people. I’ve never seen these really sick patients before, I’ve never met the families so it’s easy for me to think, “It’s their time, just let them go”. After being in this situation so many times I think most of us will think the same way.
We were called to very old man who was dying of a terminal illness. He didn’t have a DNR so if we had to we were going to resuscitating this patient, or at least try to. I began having the “it’s their time, just let them go” thoughts until I saw his wife. This is just another old guy dying for us but for her it’s her husband of 78 years. I noticed all the pictures on the walls of their lives together. Their kids, grand kids and great grandkids, their travels and struggles together. I saw a photo of them together when they were very young, a picture taken 30 years before I was born. This couple had a long life together and it was coming to an end. I could see the love and sadness in her eyes as she held her husband’s hand wishing he wouldn’t leave her. It was super sad and I, at that moment, understood why she didn’t have a DNR created. Remove the emotion and it’s clear to me that this patient should have had a DNR but add 94 years of a loving life together and that decision isn’t so easy. I can’t get too empathetic with my patients otherwise I wouldn’t be able to do my job but I think the next time I’m in this situation I’m going to turn my empathy up a couple notches.