Often we are 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 (DNR) order or advance directives created by the patient. I need to know right away how far we are going 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 obviously in an end-of-life state, when there’s no paper work to follow, and the family wants us to “full code” their family member (which is 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 this has 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 patients before and 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 think the same way . . . until . . .
We were called to an elderly man who was dying of a terminal illness. He didn’t have a DNR, so if we had to we were going to try resuscitating this patient. I began having the “It’s their time, just let them go,” thoughts until I saw his wife. This man was just another elderly dying patient for us, but for her, the man lying there was her husband of 78 years. I glanced up to the walls of their family home and noticed all of their photographs—pictures of their life together. Their kids, grandkids, and great grandkids. Their travels and struggles. 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. In that moment, I understood why she didn’t have a DNR created. Remove the emotion and it’s clear to me that this patient should have a DNR, but add 78 years of a loving life together and that decision isn’t so easy. I can’t get too empathetic with my patients—I wouldn’t be able to do my job. But the next time I’m in this situation, I’m going to turn my empathy up a couple of notches.