4 different letters when arranged in a certain fashion that have quite a significant meaning.
Do Not Resuscitate / Do Not Intubate
They are part of our medical jargon, our lexicon, to identify patients who have chosen not to receive CPR or be placed on a ventilator if for some reason their heart stops beating and/or they stop breathing.
It is our duty as physicians to explain as clearly as possible what these acronyms mean. What someone's Code Status is, should their heart stop. Here is a sample explanation:
"Do you want us to do whatever we can to bring you back if your heart should stop? Such as pound on your chest, shock you, and possibly stick a plastic breathing tube into your throat so a machine can breathe for you?"
Most people reflexively say yes to being Full Code (where we do everything as above and then some, so called Heroic Measures) others pause, contemplate what we just lobbed their way, while others outright say, No.
While in the ICU I have been apart of these conversations where ultimately the patient or their loved ones decide on DNR/DNI. Ultimately on the path towards CMO: Comfort Measures Only
This last stage is where we withdraw care, make the patient comfortable, pain free is our goal. Morphine and Ativan typically. A Morphine pump on continuous infusion to ensure a constant state of painless serenity.
Some patients are placed on Hospice care when the DNR/DNI order is made and when the prognosis or outcomes are grim. When further medical treatment might cause more pain, suffering, and harm than good.
Professionally I've helped others come to this decision and made people comfortable as they made their final journey into the ethereal plain. Never did it dawn on me that I would be making this decision on a personal level, let alone for a loved one so close and so dear to me as my Grandmother, so soon.
Saying the phrase DNR/DNI over the phone to my Grandmother's attending physician almost made me throw up. I was on the verge of tears. I felt like I was in some sick and twisted dream. In reality, it was the most logical, most loving decision I could make for the woman who raised me. My Grandparents raised me, sacrificed for me. And now it is my turn to take care of them, to look out for their best interests, and to sacrifice for them.
I am still in a slight fugue it seems. The hardest part was looking into my Grams eyes and seeing a tired, suffering soul in place of a bright happy soul. I knew then that my decision was best for her.
The next step was to get her out of the hospital and back home with my Gramps. No way in Hades would we send her back to the Nursing Home! I wanted her back home in her house with my Gramps. They deserve to be together as she transitions thru the twilight of her life. She deserves to pass with dignity, pain free, in her home, the house she raised me in, surrounded by loving family, and on her own terms.
She is home now. Let's pray it is not too short of a visit.
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