A man and his wife have been married for 65 years. Yes, if you’re doing the math, that is a really long time and they are in their nineties. As a tradition, every night after dinner, they mix up their favorite cocktails — his a manhattan, hers a martini — then sit on their couch together, and watch the evening news.
One night, they are doing this favorite activity when the wife suddenly slumps over and is not responsive. The husband calls 911 and the paramedics arrive within minutes. She does not have a signed Do Not Resuscitate (DNR) order and since it was a witnessed cardiac arrest, the paramedics are required to start Cardiopulmonary Resuscitation (CPR).
Thus, they lay her on the living room floor and start chest compressions. Two burly EMTs take turns giving pulses of pressure to her frail chest. This is an attempt to apply adequate force to cause her heart to beat beneath her ribs and pump blood to her body.
The husband watches, powerless, as the resuscitation is attempted.
However, the paramedics are unable to regain a pulse. After a few minutes of CPR, a few likely broken ribs later, and a husband who just had to watch the most horrific scene unfold in the middle of his living room, the paramedics officially pronounce her dead. Now, recall, she had actually died peacefully on the couch, with the love of her life, doing one of the activities she most enjoyed. Unfortunately, she had to go through this futile medical procedure and her husband is likely to be traumatized from this scene.
***
A few days later, I receive the EMT report of this CPR attempt on my computer. You see, the wife was my patient, and as her primary care physician, I get a copy of all her medical documents.
From my couch where I am doing my work, I briefly tell my husband the story (glossing over the details to protect patient privacy). He looks up from where he is sitting and, puzzled, says “why would you give that gift away?” The gift of a peaceful, arguably perfect, death is hard to come by. Precautions must be taken to allow it to occur.
At some point in their lives, a DNR order is often appropriate for most people. The time for a DNR order is a personal choice, but is generally when their health has declined enough to affect their daily quality of life. That DNR order is their protection in this type of scenario against “heroic measures” to “save” them from a peaceful death.
Define your “perfect death”
I encourage you to take a moment to define your “perfect death.” Is it at home, in your bed, with your family surrounding you? Is it in a hospital, likely an ICU, knowing that every medical intervention has been attempted? No matter which end of the spectrum you are on, are measures in place to allow this to happen?
If you are the minimalist who wants to die at home, do you have a signed DNR order? If you are a maximalist who wants to die only after all medicine has been exhausted, is your family aware? In all cases, does your medical power of attorney (POA) know your wishes and are they in writing? If not, you need to have these conversations and create an advance directive. (Learn more about creating your advance directive here)
If you wish to be DNR, that document can be part of your advance directive. Note that a DNR order needs to be signed by your physician so you need to plan in advance. Of course, if you have a DNR order, it needs to be immediately available in the emergent setting so that it is available in the moment. Learn more about creating a DNR order here.