The DNR Conversation

How do you ask an awkward question?
And I’m not talking about “Do you think I’m cute”,
or “Do you like me?”
Or, “I’m pregnant… what do you want to do?”

My grandpa is 82 and has end-stage COPD.  Currently his (our) house is in foreclosure.  As the months pass, he gets worse and loses interest in caring about many things.  For example, the house foreclosure.  He isn’t fighting it, or at the very least… doing anything about it.  At the same time, I can see in his eyes and his heath that it is wearing on him.  I just think that at his age, with his health, and the loss of his wife almost 5 years ago… he just doesn’t care.  I think he is ready to go.  Or maybe its denial.  I guess I can’t actually be sure.

Lately he has looked worse than usual.  He quit going to his weekly Alcoholics Anonymous meetings a few months ago, even before winter and breath-taking cold hit.  He is paler than usual for his Irish complexion, and he spends more time in bed than he ever used too.  I’m also pretty sure that this morning, the loud band I heard that finally got me out of bed after smacking the snooze button a good 5+ times, was him falling out of his bed… even though he denied it tonight.

Not only does my Grandpa have end stage COPD, he also has had 6 heart attacks, as well as having 4 stents placed in his heart.  On top of his physical health, I know that mentally he is suffering as well.  The depression in my bloodline stems from him, so I know that with the whole house-foreclosure, he is stressing… even though he plays it off as denial and ignores the fact that the county police can kick us out when the day comes.

The awkward part I mentioned?  With his physically apparent decline in health recently, on top of the house foreclosure… my EMS instinct starting kicking in.  Bad health + Added Stress + Old Age = Bad Outcome.  With my and/or my mom having a 9 out of 10 chance of being the unfortunate ones to find him and/or witness him not breathing or go into cardiac arrest, I wanted needed to know what he wants to happen.

A few hours ago I walked into the living room and saw Gramps watching MSNBC or some shit and went and sat next to him…. I sighed a few times and sat fidgeting until he noticed.  When he said something, I picked up the remote for the TV and hit mute.

“Grandpa… I’m not trying to upset you, or make you mad.  But I need to know.  With your condition and age…. what do you want me or mom to do if we find you, or see you not breathing?  I mean… do you have a DNR?”

He looked at me with a calm look.    I interjected before he spoke.  “I mean… with my EMS job… I’ve seen a lot, and I know it sucks and it’s hard.  And I know its seems weird coming from your granddaughter.  But I love you, and I want to know what you want.  Your competent right now, and I want to know what to do if it happens.  I love you, and want to respect your wishes.”

Grandpa informed me that he doesn’t want to be resuscitated.  He told me he has a full DNR, but that my Aunt K* has it.  I told him, that by law… The family must be in possession of the DNR and be able to present it to the medical crew on scene, otherwise the crew are, BY LAW, required to work the arrest.  I again reiterated the fact that I wasn’t trying to upset him, but the knowing his wishes were nothing but important to me.

Grandpa actually understood   As I sat next to him, I felt my underarms getting sweaty, my heart beat gradually pick up with each question I asked him.  I thought he would get defensive like he does with anything else that had to do with his personal business.  But this time, to my surprise… He didn’t.

So now I know.  My grandpa is 82, understands his sickness, lost his wife almost 5 years ago… but also knows what he wants when it is his time.  I will respect that.  I will get the legal DNR from my aunt, and when the times comes I will know what to do.  I had the conversation with my mom, and even through her tears, she knows what he wants, and what will be done.

I feel guilty being able to have those conversations with my mom and the rest of my family without being sad.  I guess its just another effect of my EMS job.  I’m not lying when I say I have held elderly women in my arms as their husbands lay on their backs on the floors of their homes as my crew tried their best to revive their heart and lungs (ironically, the only times I’ve had the elderly stop breathing, the patient has been male).

It sounds ignorant to the unfamiliar of EMS or terminally, unprepared person…..  But I wanted to know.  I needed to know.  I wanted and needed to know not only for me, but my mom and anyone else in my family that has the chance of coming upon my grandpa in the chance that they/we/I find him not breathing or witness him go into cardiac arrest.

I’m glad I asked.  At his age and illness the physical trauma of CPR, chest compression (resulting in:), broken ribs… he wouldn’t survive.  I’d rather myself and everyone else know what he wants, and have the documents in hand to prove so… versus have it called in and the crew be legally forced to attempt reviving my Grandpa…. not to mention, what if the crew pulled off a miracle?  And they managed to get a heartbeat back?  Only to have my Grandpa die from the physical trauma of the resuscitation ?  That is not what he wants… that is not what I would want for him… and I don’t think it is what anyone in my family would want if they understood him and his illness in the medical aspect that I do.

It wasn’t an easy conversation to bring up.  But I am glad I did.  With everything going on in his life, as well as my mom and mine, that the two of us know his wishes.  I am off of work today (seeing it is already almost 3 am as I write this) and already have an appointment with someone who I hope can help me and my family in the foreclosure aspect…  I’m not a genius by no means, but maybe if I can help solve his issues with the house, I can buy him some more time…  One more birthday for his eldest daughters… one more birthday for a grandchild… one more birthday for a great-grandchild… one more chance to see and feel warm weather… one more chance to sit on the front porch and watch the neighborhood traffic…

14 Responses to The DNR Conversation

  1. Miriam says:

    This post gave me goosebumps. Cause you echoed my head…..
    As an ED nurse, I see so many criticially unwell, elderly people with thousands of co morbidities without advanced care directives, and its soooo hard. Personally, professionally, practically…..
    As a result, I am enduring power of attorney to my parents, and subsequently know what they would want in the event that they cannot make thier own decisions.
    Kudos to you for having the courage and compassion to have this difficult discussion. Respecting someone’s final decisions reallt is the final gift.
    xo

    • Thank you so much. As an EMT, my only experience has been 911, so I see much of what you do. I’ve seen death and understood it as a young adult… but it is still so different when it finally hits home. My father is MIA in life, and my mom is only 52 and I hope to have many more years with her, and am in the process of getting her cardiac issues checked with the doctor I work for.

      I have lived with my grandpa for almost 10 yrs (I spent a few years out of the house after I graduated HS and went to college) and have seen and understood his illness more so than most family.

      Even with my 3+ years of 911 ambulance experience… I needed input from people who know healthcare that DO NOT work with me, know my full story, or all that comes with it.

      So I thank you for taking the time to read my entry, and even more so for taking the time to comment with kind and beautiful words.

  2. Dodge says:

    Leah I was directed to this post from the not in my ambulance Facebook page so I thought I would repost here what posted on that page.

    I left my job and became a full time carer for my mother for a little over 2 years before her passing and I know from experience how painful it is when it comes to making those decisions and it is never easy.

    But knowing what they want and having everything in place is the right thing to do, and I found in some small way it actually made things easier and let us in small way get on with living the best way possible I wish you all the best in the time you have left with your pop and may these the be best days possible filled with warmth and love 🙂

    I know what you are going through Leah I have been running emergency calls with an ambulance service for the better part of 25 years and knowing the end is near for a loved one is never easy but as for me I gained some comfort in knowing what my mother’s wishes were so when that tragic time came in July last year it did make easier still painful but non the less easier that my mother had some dignity at the end and not being needlessly aggressively treated knowing that it was something she did not want. So again I wish you all the best and may these days with your pop be filled with love, warmth and so much happiness

    • Wow! You’ve definitely got more experience dealing with it than I do then! It was weird bringing it up with someone that is family. I’ve had the conversation many-a-times with countless elderly patients and their families.

      I am okay with his upcoming death. I have been well versed in death and funerals years before the thought of EMS ever entered my mind.

      Its funny how a conversation can play out and feel when you have it with someone close to you versus a stranger in the back of your ambulance or while sitting in their home.

      Thank You, Leah

  3. Hardest conversation to have ever. My mum sat me and my sister down one afternoon and made us have it, so we all knew what everyone wanted. My parents are starting to get to that age, so in hindsight I’m glad we’ve had the conversation. My sister and I know who’ll be the one to actually sign the “pull the plug” sheet… it was horrible, but now I know that the decisions I’ll make will be what my parents wanted when they were healthy and sound of mind.

    • Agreed. I stressed and worried about his reaction for days as I built up my courage to finally ask my Grandpa about it. I was so shocked when the old cowboy answered me calmly. I was surprised to see how easily my questions flowed after I finally just asked!

  4. Kat says:

    As a Paramedic I know it’s hard to talk to family about their wishes. I have done this before with my family members. I have talked to my Grandma before about this and she was undecided so looks like I’ll be having another conversation with her again soon.

    As medically trained personnel we understand the legal side & possible outcomes of ill patients. It’s good we can explain it to family members. You are doing the right thing and I’m sure he was glad it was you asking and not some stranger, a doctor or nurse at a hospital.

    Hope you get everything worked out with the house and get that stress taken away from him.

    • After finding out how easy it actually was to have the conversation (after days of fear!) I was almost laughing at myself. I’m glad I finally just laid it out and asked. I knew, but I didn’t know… you know? lol

      Thank you. I sat with my former rescue squad chief the other day (he has done realty for 30+ years) and got some good inside info, numbers, tips, and what and what not to says. I hope they pan out enough to just buy some time. 🙂

  5. Lynsie says:

    I understand why this is difficult for you. I’m a Nursing Assistant, but somehow have had quite a few experiences resuscitating individuals. I was 22 when my Dad was diagnosed with lung cancer that quickly metz’ed in his brain. Stroke led to heart attack one night, Mom was home alone with him. EMS didn’t work on him, just transport to hospital. I made all the decisions b/c my Mom, bless her heart, didn’t know what was happening and possibly going to happen. No DNR, no expected plan of care….. needless to say, we try to separate home from job…..You love your Grandpa, (and your Mom) and you want him to be happy and have a quality of life. I know you may not always feel it, but your family is lucky to have you, and your Grandpa is lucky to have a granddaughter who loves him so much.

    • Thank you. I’m sorry about your father, that could not have been easy. It is good that people like yourself and I can have these hard and awkward conversations. More people and families need to be made aware of the importance of an individuals wishes, no matter the age or circumstance.

      I have written out plans for a funeral for myself in case my mom ever had to deal with losing me at a young age, and the more I think about it, the more I realize how important it is for myself to have a plan even at 26 years old. There are so many situations that I wouldn’t want myself or family to have to deal with or be in if something happened to me.

      Thank you for taking the time to read and comment 🙂

      Leah

  6. Beth Martin says:

    I admire the fact that you faced this issue with your grandpa. This is probably one of the greatest, most loving things you can ever do for anyone. He’s very aware that he’s near the end of his life, and he’s very aware of what his future might hold. God Bless you and him both.

    • Thank you. I plan on making my mother get a living will or something set up for herself. I can gauratnee she is going to have cardiac and respiratory issues and when the time comes I am going to want to know what she will want as well. Thank you for your words of kindness and caring.

      Leah

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