Ain’t the Way to Die by ZDoggMD
Posted on by Douglas Farrago MD
Great Job, Z!
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Talented as ever, Zdogg, but concrete enough for me not to even smile – it’s depressing, and we keep doing it. Just wrote my will and specified no feeding tube (though I may add an exception for a Jack Daniels, only). Brrr….
Major problem with this difficult topic is no matter how much time one takes to explain the situation to “certain” families, they expect “us” not to allow their
loved one to die no matter what.
I saw this as a real big problem 30 years ago in the big university hospitals. Who knows, maybe it’s still an issue today. I’ve had no exposure since I’m in a more rural area and many of the elderly I deal with are much more realistic and make their wishes known. This would have really hit home with me if I’d
seen something like it in 1984. Beating a dead horse was really bad in those
days at big institutions.
I did see a new appellation on a university medical record that I really like.
(I hate academic policy makers vehemently as a rule too) The term “DNI”
or Do Not Initiate, seems more palatable to “DNR”. DNI means yeah, we’re were going to give comfort measures, use an antibiotic to attempt to treat the UTI or pneumonia in spite of the 10% ejection fraction but if the person dies we let them go. DNR after all these years stills sounds like “shove ’em in the corner to die”. Although for some situations that can be the merciful way.
Sure, DNR/DNI is semantics but I finally found something politically correct that I like. Kurt
I thought “DNI” was “Do Not Intubate.”
Creeeeeeap, Lance! Me thinks you struck a mighty blow and are right on that. Me wrongo.
I stand corrected but………..If one hasta to go through the motions, the poor resuscitated
soul will need a vent so going “halfway” turns out to be a waste anyways.
I like “Do Not Initiate” and it should be made part of the Lexicon. Kurt
Yeah, Do Not Intubate came out, I believe, as a sneaky way around the “But you just can’t let Grandma die!” factor.
Instead of going into all of the details of resuscitation, CPR, defibrillation, meds, intubation, vents, etc., which confuse the crap out of rational, competent people, and are like speaking Aramaic to debilitated patients and freaked out family members, you just say, “Remember last month when they had to put that tube down your throat, and it stayed in for a day? You don’t want that to be done again, DO YOU?
Didn’t think so, could you sign here?”
That way, in the event of the Inevitable, you have a very specific thing to say to the wild-eyed family members and long-lost relatives in the phone from across the country:
Rather than going onto the ins and outs of what it means to “resuscitate” or “not to resuscitate,” you just say, “S/he said s/he didn’t want This One Thing, so we’re not doing it” (and, incidentally, not doing a few other things, either…).
In the best of all possible words, I prefer “AND” or “Allow a Natural Death,” but that one can be a hard sell on some people, especially family members, and lacks the concreteness and specificity of DNI.