When Too Much Is Not Enough

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Three simple questions – 1) Can you please complete this form?...(for the billionth time). 2) Any changes in your health?... (since last week). 3) Do you have your insurance card? (yep... same as last week...and the week before...and the week before that...).

The exam room feels like “home”...familiar wall charts are like old friends, and Mom and I take our seats. Doctor H. enters, greets Mom (like a lifelong pal), and scans her electronic medical chart. She comes to an abrupt halt....

Dr: Hmmm... ,Nancy, I don’t see any advance directives in your file. Do you have a Health Care Proxy?  (Mom looks at me inquisitively)

Me: Yes. I’ll drop it off at the front desk later today.

Dr: Do you know if your proxy has a DNR (Do Not Resuscitate) directive? (Mom looks at me again)

Me: Yeah, it does.

Dr: Well, we’re asking all our patients to complete this additional form for a better understanding of exactly what level of resuscitation they do, or do not, want. There’re a lot of questions here, so just take it and return it later, with the HCP.

Me: K.

After our (always lengthy) appointment, Mom and I head to IHOP for our usual post-doctor repast... (a welcome free meal for me).

With our food order (“the usual”) in the hands of our able waitress, I retrieve the detailed DNR form from my purse. WHOAA...this has a billion seemingly very similar questions. The once simple DNR has clearly become a means for the doctors and their medical team to CYA.

In theory, the DNR sounds pretty simple... if mom’s heart stops, does she want CPR, or, if she stops breathing, does she want a tube down her throat? Yes, and Yes... Let’s give ‘em both a whirl.

But the questions on the new and improved DNR have highlighted our ignorance with regard to life sustaining options for Mom. Apparently, there are degrees, or levels, of resuscitation.... just how much do we want to keep Mom alive? Or, just how much alive, does Mom want to stay?

With the expanded form, Mom has endless possibilities for continued life (... or not):  Intubation/Ventilation; Non-Invasive Ventilation; Dialysis; Artificial Nutrition; and Artificial Hydration.

For each of these lifesaving options, Mom has to “choose one” of the following: None; Short Term Only; Undecided; or (my personal fave), Did Not Discuss.

Waiting for our food, we delve into (what should probably be), a serious discussion:

Me: So.... Mom... what d’you think “short term” means?

Mom: Hmmm... I don’t know... When you’re 91, there’s really no “long term” to even consider...

Me: (guffaw) Good point... and is there really time to be “undecided” if you’re in need of a lifesaving measure? (more laughter...)

Mom: (snickering) Maybe I could give you a signal?... Move my feet left for “yes” and right for “no”? Give you a thumbs up, or thumbs down?

Me: (ha, ha, ha,) and if you pick “short term only,” do we let you go for another minute, or another month?

Mom: (LOL- ing)... I don’t know, but we better figure that one out... I’d hate to think you’d come up short by one minute, when I could have gained another five years!

Me: And, Mom, if you only get to pick one, which is your favorite life saving measure?...Should we make you eat or drink....“artificially”?

We think we’re hysterical.

Clearly, the subject of extending or prolonging an individual’s life is no laughing matter, and I’m sure these additional DNR questions have arisen from multiple law suits filed against a boat load of medical providers. But, with all the possible combinations of death and resuscitation to consider, SNL could have a field day with a DNR. And, Mom is definitely in on the joke.

We buckle down, take a more serious approach to the form, and eat our pancakes.

Turns out, Mom’s in no rush to leave this world. She actually wants a semi-DNR. Yes – she’d like artificial food and water to stay alive; Yes – she’d like some air forced in to her lungs if she can’t breathe (at least for a little while); Yes – she’d prefer it be done non-invasively, if possible.  

The only lifesaving measure Mom stalls on, is dialysis... it’s something she’s never needed, or even considered before. A surprise to each of us, Mom checks “Undecided” for this one. Just minutes before, we thought the idea of being “undecided” with regard to a lifesaving measure was laugh-worthy. This time? Not so much.



emily gaffneyComment