Blank Spaces

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We arrived to find a man who wasn't well. He suddenly went unresponsive at home and he was now barely responsive, had a fixed right gaze, his blood pressure at best was 203/110, and he was in a-fib and had ST elevation pretty much everywhere. It was the first time that I had a real issue with a DNR, or lack thereof. The patients wife was yelling about how he didn't want anything done. That he wanted to die, he had seen Jesus, he had a DNR. All this made me feel horrible and yet want to inquire that if he wanted to die at home why the hell did you call 911? (I'm pretty passionate about people getting what they want at the end of their lives, and it usually doesn't include EMS.) But, people panic for very good reason, and therefore, put us in a tight spot.

And it wasn't even that she couldn't find his DNR paperwork, oh no, it was there. All filled out with the date, witness signatures, and addresses, but was missing one thing. The most important thing. His signature. Two opportunities to sign; circled, underlined, and blank.





I wanted to say to her "I'm going to turn around, and when I turn back, that line will magically have a signature on it." I was so frustrated. So we took him, and initially his heartrate went down into the 50s and made me nervous so I put the pacer pads on him. He was maintaining his airway and breathing adequately, for now. I just prayed that he would survive until we got to the hospital. He did, and thankfully it became someone else's moral problem.

By the time we got to the hospital his wife was calmer and apologized for yelling, even though I begged her not to. She had every right to. I explained again that I trusted she wouldn't sue us, but we have to err on the side of life. She was a sweet, understanding lady in a horribly difficult situation. She thanked us for our help even though I begged her not to. She owed us nothing.

Comments

Unknown said…
This reminds me of every time I go into a nursing home, ostensibly for something relatively tame, to find an extremely sick patient with an altered mental status, or chest pain, or a CHF/COPD exacerbation - you can pretty much pick the situation you walk into because they're all bad. And you're told by the charge nurse that the patient has a DNR/DNI and they can't produce it. My response to that has historically been that if they can't give me the DNR (NH has the portable ones now, a bright pink document that is supposed to go everywhere with the patient. Were you up here when that went in force?) all bets are off. Somehow they manage to find it. The one time they didn't and threatened me with legal action (yes, that happened), my response was to inform them that it "would blow back on them like piss in a high head wind" because then I'd be breaking the law for not doing my job. I bet you can guess how far that went....
24 April, 2008
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