I overheard a chaplain chatting with a social worker about a patient.
“She asked me,” the chaplain said, “if a DNR order would interfere with her getting to heaven.”
The two hospice staff kept slowly moving away from me. I don’t know if the social worker responded, or what the chaplain had explained to the patient after she asked her heavenly question. Maybe my colleagues continued discussing this patient or shifted to other subjects.
I’m not sure anyone could tell the patient about heaven’s entry requirements. Different faith traditions have different views of the “better place” after death. Humans have pondered Valhalla and Nirvana and Paradise and Heaven for millennia. I’ve read and heard some Christians describe heaven as more difficult to enter than an Ivy League school. I’ve read and heard other believers claim the “pearly gates” are wide and welcoming for every soul.
Heaven’s rules may be mysterious or debatable, but what about DNR? That was the part of the patient’s question that kept nudging me. It stands for Do Not Resuscitate, and according to webmd.com, it is,
A DNR order is a physician’s written order instructing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest. A person with a valid DNR order will not be given CPR under these circumstances. Although the DNR order is written at the request of a person or his or her family, it must be signed by a physician to be valid.
With a DNR in place, health care professionals won’t attempt to revive patients experiencing “cardiac or respiratory arrest.” Which likely means, without that intervention, the patient will die. Many have seen CPR done by actors to actors in movies and television shows. It’s often portrayed as successful, dramatically bringing the person—the fictional character in the film!—back to life. Reality, of course, is different. In a 2009 study published in the New England Journal of Medicine, 18% of senior citizens who received CPR in a hospital survived to be discharged. That meant that 82% did not survive . . . and that’s in a hospital setting.
Furthermore, attempting CPR on the elderly and the seriously ill can result in collateral injuries. CPR can be “violent” on the ribs that protect the heart, and certainly harmful to the surrounding organs as physical force is exerted on a vulnerable part of the body. In other words, if I am one of the 18% who “survive” because my DNA order triggered a CPR effort, I may have added the complications of broken bones, serious bruising, and damaged lungs (or other organs) to my list of ailments and anguish.
But who cares about percentages? Shouldn’t all of us do everything possible to stay alive? I suspect that it’s sometimes the terminally ill patient who makes sure she doesn’t have a DNR order. After all, that would be giving up. Or the patient fears death and he wants to keep breathing, no matter the consequences. Perhaps, like the patient the chaplain mentioned, the ill person worries that DNR is against God’s will and could prevent “entry” into heaven. I’m equally confident that it’s sometimes a family member who convinces the patient that CPR must be attempted. A spouse or parent isn’t “ready” to lose a loved one. Family members might also dread death, or feel guilty about cultural or religious consequences if someone appears to “surrender.”
Hospice will honor a patient’s wishes. If a patient desires every effort made to keep them alive, those efforts will be attempted. If a patient requests a DNR order, it will be followed.
Do you want a DNR order as one of your health care decisions? Now? Later? How will you decide?
As with many decisions, I hope you openly talk about what you want with your loved ones. Deciding to have, or not have, DNR orders is a serious choice. And what you want when you are healthy and vibrant at 50 will likely be different than what you want at 80 after a cancer diagnosis and years of chemo and radiation. Of course you may change your mind. And then change it again. Just don’t do it privately.
In a break during a meeting, I overheard a snippet of conversation between a chaplain and a social worker. Who knows what they said before or after they walked by me?
Please don’t eavesdrop, guess, or assume with the people you love in your life. Take the time to share what you want, or to listen for what your loved one wants.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)by