DNR ≠ Do Not Care

When Idaho extended “crisis standards of care” to all of our hospitals in this state, there quickly arose the social media meme that all patients in hospitals were being declared “Do Not Resuscitate” =DNR. I guess that got some folks attention. It sure didn’t push for a big wave of folks asking for Covid vaccinations. But we have outrage to spare nowadays.

While some of that meme is a bit true, most of it isn’t. The “Crisis Standards” mean that the institution can use its resources how it believes would best serve the community. So, if a patient with metastatic cancer had not signed a DNR suddenly stopped breathing, the hospital was not obligated to intubate and ventilate this terminal patient, whereas, without the standards in place it had such an obligation.

Why do we do such wasteful, violent, and destructive things in healthcare? Chest compressions break ribs. But they can save a life; I have done so. When a fifty-year-old man walks into my ER from his bowling night, sweaty and clutching his chest, then collapses as we are hooking him up to oxygen and putting the monitor leads on his chubby chest, we start chest compressions. And when he gripes to me a week later about how his chest still hurts from the broken ribs, I apologize and smile.

Why would a patient with a terminal illness want such treatment? I have come to understand it is because we medical professionals are so lousy at communicating. We often just talk amongst ourselves and don’t fully listen to our patients.

When the question of resuscitation is presented, it can be a brief, almost perfunctory conversation. It can be left to the admitting clerk who talks to the elderly patient or a family member when she is brought from the nursing home to the ER at midnight. “Do you want us to do everything?” Who wouldn’t want that for their loved one?

But an 89-year-old with pneumonia, Covid or bacterial, will most likely die with that tube down their throat and the machine pushing air into their drowned lungs, should it come to that. The question that should have been asked, one that takes time and sensitivity and care could or should have been, “How do you want us to care for you?”

Because that is what we should be asking from our medical industrial complex: care. It seems like we go to the hospital or the doctor in this adversarial culture with the chip on our shoulder, I gotta get what’s owed me. Instead, we should be expecting care.

Maybe we just aren’t caring about ourselves or each other much these days.

For to care about a person in their final, special days is to honor the values they have built their lives around. Many have led dignified, independent lives and to be connected to machines, unable to hold their daughter’s hand or whisper their love to their family is the ultimate indignity. We, my fellow healthcare colleagues need to see this and honor this. Signing a paper form about DNR is not a way to honor a life, or to honor their death. We need to be present and open to the values of those we care for.

But patients, citizens need to see this too. If the choice one makes in life is to be uncaring, unthoughtful, inconsiderate to one’s neighbors, what kind of death should we be expecting? It could be brutal and lonely, not unlike the life we have lived.

This “crisis standards” that Idaho hospitals now have should be an opportunity for us to look in the mirror. Those of us on the “caring” side need to resolve to do better as we listen to the values and lives of those in our care. The folks who come to us for care need to understand that their values are not always clear. Work to make them so.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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