Have you ever heard a mother say to a child, “I brought you into this world and I can certainly take you out?” Even though this a cute phrase used by mother’s everywhere when trying to tame an unruly child, it rarely holds an ounce of truth. No mother would “take their child out” unless she is mentally ill. Mother’s nurture, love unconditionally and will lay their lives down in the blink of an eye to preserve their child from harm.
However, as the child grows older and the parent ages, it becomes the adult child who then holds the power to take the parent “out”. Every day in nursing homes, and hospitals adult children make life changing or life ending decisions for their parent. I know these life decisions are difficult to make, but sometimes, I sit in awe of the decision maker, and the decisions made.
Mrs. Lucas is a wonderful lady that lives in my facility. She has a quick sense of humor, a kind spirit and loves to chat with anyone willing to listen. She has really good days, and really bad days due to the progression of dementia. Last week, she just wasn’t herself. We sent her off to the ER with the standard “altered mental status” label. The ER docs called us back upon seeing her, and asked, “What’s she here for? We see she has a diagnosis of dementia, so what is altered exactly?”
The nurse explained in detail of how Mrs. Lucas normally acts, how chatty she normally was and “how she just wasn’t herself”. The ER doc was not impressed with our explanation. Obviously, we were wasting his valuable time. He sent her right back to the facility after ordering blood work. That was the extent of the care she received. The note attached to her paperwork that came back with her stated, “89 year old white female, and no apparent distress, seen in ER today. Spoke to responsible party, daughter, who stated that her mother would not want any invasive testing done. Ordered CBC. Returned to nursing home.”
Two days later, Mrs. Lucas’s condition had worsened. We contacted the daughter and explained that we were sending her out to the ER again due to her lethargy and shallow breathing. The nurses explained why we felt she needed to be sent back to the hospital, explaining her vital signs, O2 levels and overall appearance. The daughter replied, “She is a DNR.” That was it. That’s all she had to say. “She is a DNR.”
DNR stands for “Do Not Resuscitate”, strictly meaning t in the event a person’s heart stops, those trained in CPR, will NOT begin CPR. In my facility, every resident chart is labeled as a “Full Code”, meaning CPR is to be started and carried out until an MD gives the order to stop CPR, or a DNR, meaning no CPR is to be initiated.
DNR status has nothing to do with anything but the heart’s activity. Mrs. Lucas on the other hand, did not appear to be having cardiac issues, based on our assessments. Her heart was still beating. We explained this to the daughter, who stood her ground and would not give consent to send her mother back out to the hospital. “Do you know that it’s $700 every time you people decide to ship her out to the hospital? You people need to know that my mother is almost 90. She is going to have good days and bad days. When it’s her time to go, the Good Lord will take her.” Bam. There it was bright as day. 700 dollars. Hmmm, now what?
As the Administrator, my job is often one of mediation and sometimes strangulation. Ok, not so much strangulation, but you know what I mean.
I call Mrs. Lucas’s daughter, using my psych training to convey the message to her pertaining to her mother’s decline. See, to me “almost 90” is not a reason to not seek medical treatment. Neither is the 700 dollar bill. However, Mrs. Lucas is not my mother, and no one appointed me to make life choices for her. Regardless, I make it my business to insure every person in my care has the right to life. I guess you could define me as “pro-lifer.”
I did not make any headway with the family. So, Mrs. Lucas will sit, decline and eventually die from whatever is ailing her. She is almost 90, right? She has dementia anyway, right? So, why are we so bothered by her failing health? Here’s a clue. She is a human being, deserving of a fighting chance to survive.
We, as long-term health care workers spend more time with our patients than we do with our own families. We know almost everything about them, from what time they got up this morning, to when their last bowel movement was. We know how they “normally” behave, or when they are having a bad day, based on our long-standing relationship with them. We have assumed the role in their life as caregivers, and extended family. They matter to us. We are all bound by our oath to “do no harm”. Sometimes, I wish every adult son and daughter of a dementia patient would have to take the same oath.
After a few days of hostage negotiations, I am finally allowed to send Mrs. Lucas out to the hospital. Turns out she has a blood clot in her leg. There are a host of treatment options for Mrs. Lucas, but the daughter declines all treatment plans. “Mother is almost 90. She has dementia. She would not want any invasive procedures. Let nature run its course. She’s almost 90 anyway.”
Mrs. Lucas returns to our facility. The note attached reads, “89 years old seen at ER. Daughter request patient to be placed on hospice care. Returned to nursing home.”
There you have it. Story over. Mrs. Lucas will die here. She is almost 90, you know. And she has dementia.