web analytics
April 24, 2014 / 24 Nisan, 5774
At a Glance

Posts Tagged ‘DNR’

Dealing With The System

Wednesday, December 17th, 2008

Last week I wrote about the inability for two well spouses in different circumstances to handle an illness crisis in the same way. We each bring to any life situation all that we are dealing with at the time. Family circumstances, state of mind, finances, support network, whether a well spouse is working or not, and even being computer literate – all contribute to how we can handle a crisis. No one should assume there is a right way and a wrong way for every care giver. To do so is not only naive, but it is an inappropriate expectation to put on a well spouse and a perilous demand to place on yourself.


One suggestion often made to care givers is to educate yourself about your loved one’s illness when they are in the hospital. Use the Internet where it is “easy” to get mounds of information and then make sure your doctor discusses each of these alternatives with you, explaining why or why not they are appropriate in this case. This may sound like a good idea, but is it realistic for everyone?


We all work – whether it is in or out of the home and whether we get paid for it or not. We all spend as much time as we can in the hospital, being there for those we love. We all try our best to understand what is happening and try to make the right decisions for those who are ill. But we are not doctors and our expertise is non-existent. Stressed and depressed, many of us are not capable – after coming home late – of opening our computer to sift through hours of information that is difficult to understand and may or may not apply. Even if we choose to do that, how many of our doctors have the time or the inclination to then sift through these ideas with us, even if we are lucky enough to get an appointment for a “consultation”?


Sometimes our loved ones don’t agree with our discussions about their care. Who should decide what to do in that case? This is especially true if we decide that what is needed, is a change of doctor, often after our loved one has, for decades, been a patient of that doctor. Do we force our decision upon our loved one and add psychological discomfort to the physical problems?


Do we refuse to sign the DNR when they tell us that resuscitation will break ribs causing the patient more pain and will, in the doctor’s opinion, just prolong the agony of what is inevitable by a few hours? After consulting a rabbinic authority, there is still so much to crisis decision-making that is just up to us and for which there is no right or wrong choice.


If you do decide to research the illness and question the treatment, here are some thoughts regarding how to get the best result:


Do not expect your doctor to spend hours sorting through your material with you. Make a written list of clear, concise questions. Writing your questions down will help you remember them, keep you from rambling and give the questions clarity.


You need to know the practicality of all treatment ideas, not just to the patient, but to anyone who lives in the home, and what the side effects of any new medication or treatment may be. Do not demand that your doctor stop what he is doing to discuss the case with you at your convenience but make an appointment for a specified time period at his office or at the hospital bed, if your loved one wants to be involved. This will hopefully guarantee you the doctor’s full attention and take away the awkwardness of discussing private issues where people, who are not connected to you in any way, are milling around.


 If you can, take a bit of time to think about what you have discussed with the doctor, before you make a decision. Discuss the alternative treatment choices with the person who is ill and anyone who will be impacted by your decision for their input. Become a part of the medical team if you can. Make sure to get back to the doctor with your decision in an agreed upon time and manner.


Whatever the outcome of the treatment, it is important to know you did all you were capable of at the time based on your own life history and circumstances, and not what another well spouse was capable of. Most important, you must take comfort in knowing that whatever happened was what was meant to happen and it is Hashem who decides the outcome, no matter which approach you choose to take.


You can contact me at annnovick@hotmail.com.

The Hidden Agenda (Part Two)

Wednesday, December 21st, 2005

Last week I wrote about how some well-meaning professionals can manipulate the situation in order to get you to do what they feel is in your best interest. I retold Brocha’s experience when she was agonizing over whether or not to place her chronically ill husband in care. Brocha was haunted by what she thought she had been (deliberately?) told. Not able to check it out, she allowed the (mis)information to determine her decision. I also told Joe’s story, according to him, of how he was pushed out of a rehab facility before he felt he was ready to leave. This week I want to relate more stories told to me by the chronically ill and their families. Stories in which these people feel that they too, were manipulated by the system to do what was not – in their opinion – in the best interest of their loved one.


Ada had been chronically ill for years. As she aged and her disease worsened her hospital stays were longer and she was admitted to the hospital more frequently. Lately, she often referred to the hospital as her second home. The nursing staff, doctors and orderlies on every floor knew Ada. She was no stranger to the Intensive Care Unit, either. Ada had always told her family and her doctors that she did want every heroic measure taken to keep her alive, no matter what.


The last time she entered the hospital she had difficulty breathing. The doctor asked Ada’s husband how he felt about a DNR order. The doctor’s prognosis was that Ada’s breathing would just get worse and worse, and the chronic illness would not allow for recovery. The disease was just taking over the body.


Ada’s husband again relayed Ada’s wishes to the doctors, that she be kept alive, no matter what. He told the doctor that he wanted her wishes honored. At that point, the doctor reminded him that as long as Ada was lucid a DNR order was her decision. The doctor thought that perhaps with no chance of recovery, Ada might have changed her mind about choosing to prolong her life, no matter what. The doctor was determined to discuss the options with Ada herself.



Ada’s husband requested to be present at the discussion. He was concerned how the doctor, with his own point of view, might word the discussion. After all, the hospital had a shortage of beds, and


perhaps the doctor didn’t like dealing with patients who could only get worse and never be cured. And, to boot, their insurance was almost used up for the year. Ada’s husband liked to think that these things didn’t enter into patient care, but he felt they had to play a part.




The doctor told him he certainly was welcome to be present, but his schedule didn’t allow him to name a specific time for the meeting. That would depend on Ada’s state of mind.


Widowed, Gav had given his young son his medical power of attorney. Gav’s situation was similar to Ada’s. The difference was that Gav was unresponsive and could not make decisions for himself. Just recently, Gav had become very frail, as well. The doctors had given him just weeks to live, even before this new infection had set in. Gav’s young son talked to the doctor about his father’s desire to have everything done to keep him alive. The doctor explained that in his extremely frail condition, should his heart stop, CPR would break ribs and cause more harm than good. He convinced the young man a DNR order was in his father’s best interest.


Gav passed away a few days later. His son is still wondering if his father would have lived a little longer if he had made a different decision. He knows the doctor gave him the best advice from a medical perspective. He just wonders what a doctor’s outlook entails.


Would the doctor have suggested the same thing if it was his father that was lying there? Meanwhile, he mourns his father and knows he would feel guilty, no matter what his decision would have been.


We all have tunnel vision. We see things and decide things based on our knowledge and experience. When dealing with the chronically ill, doctors often see things differently than family. This may be especially true at the last stages of chronic illness. This does not mean that we are necessarily being manipulated by the system or by the doctors. But it does mean that two people rarely see things in the same light.


That’s why, whenever possible, a trusted second opinion especially from someone with experience with chronic illness might be wise. Consulting a rav who specializes in these types of decisions is a necessity. Their input may not change the course of action you choose, but it may go a long way to giving you peace of mind later.


Printed from: http://www.jewishpress.com/sections/magazine/the-hidden-agenda-part-two/2005/12/21/

Scan this QR code to visit this page online: