DNR

"CODE STATUS: the patient is a full code (clarified on 1/20/2012). she would like CPR and intubation but does not want to be on a ventilator."

this is a direct quote written in a legal medical document by the resident i fought with yesterday at work. for those non-medical folks out there, perhaps this sounds fine. there's some medical jargon, something about life-sustaining treatment, sounds like maybe the doctor wants to respect a patient's wishes. but for the medical people, this comment should sound assinine! who gets intubated (tube down throat to support one's airway and lungs) without requiring ventilation (the machine used to breathe for a person).

more frustrating than this stupid comment is that this was NOT what my patient wanted. being the kind, inquisitive nurse that i am, prior to sedating this patient for a procedure, i wanted to understand my patient's wishes should an emergency take place under my watch. after a very thorough conversation, it was made clear to me that the patient NEVER wanted to be kept alive by machines. she acknowledged that she's 62, that she's already had 3 kinds of cancer, that she would likely not survive the stem cell transplant her team of physicians is recommending, and that everyone must die somehow. while the patient wasn't ready to die during the conscious sedation i was about to provide (where i run the risk of oversedating her and needing to code her), she does not want medically futile treatment.

SO, i called the resident. i told him there was a discrepancy in what he thought the patient wanted and what i KNEW the patient wanted. he was stupid. he asked me what time i talked to the patient. all fucking day idiot - that's the difference between nurses and physicians. i didn't say that. instead i said "noon." he said, like an 8 year old, "well i talked to her at one." i doubted that in those 60 minutes the patient changed her mind. when we discussed her wishes as stated in his medical note, i explained that CPR and intubation without ventilation made zero sense. he couldn't seem to support his comment or his thinking, so i demanded to speak with his attending. i had nurses around me at the nurses station listening in awe; i am typically kind and respectful, but not regarding life and death issues. i was being defiant. an advocate for my patient. i was NOT about to do CPR on a patient that clearly did not want CPR, simply because the physician i was working with was an idiot.

instead of getting his attending involved and because the palliative care team who does the death talk better than ALL doctors was busy, the resident agreed to meet with me and the patient. he actually called me and asked me to be present - thank god. so we had the talk with the patient, each of us for the second time in the same day. and within minutes, it was very clear that the patient DID NOT want CPR. she did not want to have her ribs broken, her lungs perforated. when she heard the survival rates from a code situation she said, "why are we talking about this? i do not want that." i wanted to stick my tongue out at the doctor. what kind of conversation must he have had with the patient only hours previously that made him think she wanted extreme heroic measures? how come doctors suck at communicating with patients about dying? and why as a nurse do i feel relatively comfortable broaching the subject and extremely passionate about people who are brave enough to die naturally, when nature takes its course?

at the end of the day, i felt good. i had placed a DNR bracelet on my patient (to alert staff that she does not want to be resuscitated). and i had put a doctor in his place - shown him that my communication skills are superior to his, that he should listen to nurses, and include them in conversations with their patients. but mostly i felt good because i understood and respected my patient's wishes. when i said goodnight to my patient last night she said, "thank you for being excellent."