July 13, 2011

Final Wishes

It's been quiet on the blog only because I've been incredibly busy with work, losing power with a massive storm, and life.  But I wanted to pop in for a minute to reflect on something that happened at work. 

Most of our business is nursing homes.  Patients that are too sick to stay at the nursing home but not emergent enough to require a 911 response.  We had been busy all day, very little down time to be had.  We took the break in action as a clue to get dinner because chances are we wouldn't be eating that day if we delayed it any longer.  After eating dinner we just sat in the mall parking lot to relax and take a breather, something we hadn't been able to do all day.  Just as we got comfortable enough to relax a little more our pagers went off.  It was about 930pm, end of shift was midnite. 

We take a look at the information our dispatch gave us, only a chief complaint, abbreviated at that.  SOB, shortness of breath.  No vitals.  That can mean one of two things, the patient is REALLY bad, or the nursing home is lazy and didn't take any for us.  Even worse was the dispatch info was abbreviated, normally that only happens when our dispatch runs out of characters to send the page because of other information. 

It was a lights & sirens response, we get there my partner goes to the room and I stop at the nurses station to get the paperwork.  Nurse hands me a DNR, Do Not Resuscitate order in all of our paperwork.  From listening to the nurse I'm thinking nebulizer en route, then my partner, king of cool, shouts down the hallway.  "We gotta go!"  Crap.  I know it's bad when he's telling me to hurry up.  I get my signatures and sprint down the hallway to our patients room, he looks bad.  He sounds bad.  I catch a glimpse of our patients roommate.  He looks absolutely frightened.  We load up our patient and head for the ambulance.  Shortly after we get there, he stops breathing. 

After respiratory arrest occurs, cardiac arrest isn't far behind.  That held true for our patient.  I flip through my paperwork to find the DNR.  Quick glance at it, it's not valid.  I knew what this patients wishes were, but because the DNR wasn't valid I couldn't honor those wishes.  I was able to get a pulse back rather quickly, but not for long.

Our patients final wishes went out the window all because the DNR wasn't valid.  All it takes is one missing signature or one box not checked to make the DNR invalid.  EMS is authorized to honor a DNR, and trust me, with what we see on the private side, we're more than willing to oblige, not because we don't want to work, but because we know what they will face if in fact they are successfully resuscitated, and it's not a good life.

If someone you love is in a nursing home or is dealing with a terminal illness and wishes to have a DNR status, please please please, make sure their DNR order is valid.  Their final wishes will be honored and they won't face the indignity resuscitation efforts bring. 

(events have been changed so as not to identify anyone in this post)


  1. I need to make sure my mom's is up to date. Thanks for the reminder!

  2. I feel for you. My husband and I are both medics for a private company so we both have been there.

  3. I second that suggestion, but I would add to it. No matter your choice, make sure your own wishes are documented, signed, notarized, valid, etc. AND make those wishes known to your family and loved ones. Keep a copy with your primary care provider, or if you don't have one, give a copy to someone close to you. Don't wait until you "get older." Tragedy can strike at anytime, and I, for one, have seen the dark side of "successful" resuscitations and know that I don't want to be there.


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