The DNR decision?

Did you and Dad not ever have that "I don't want to ever live like that" discussion? You know, when we learn someone had to make these kind of decisions. Was it not ever part of your conversation over the years. When my Mom was in the hospital I fortunately knew exactly what she wanted. She and I, along with my Dad, had had discussions about DNR's, living on life support, etc. just over the course of years in conversations. I didn't want to sign the DNR but I knew that was exactly what she wanted. I wanted to let them intubate her to help her breathe, but she had been very clear about that as well. Here I was, no husband or children, no siblings. Once my Mom passed my family was almost completely gone and, left to me--selfish me---I would have done anything to keep Mom with me. But I didn't feel I had the right so I did for her what I had heard her talk about over the years and let her go. As for what others think.....DON'T TELL THEM about the DNR. If you think anyone will give you crap about it just don't tell them. It's none of their business anyway. You're in a tough place but you will find your way through. Sit and be still. You'll know what to do.

Tinyblu, your father's MD is the one who makes out the MOLST with the patient and your help. MOLST=medical orders for life sustaining treatment. It will ask if you want a respirator, a pacemaker, IV fluids, antibiotics, CPR, surgery or if you want to go to the ER or not. I don't know any elder who wants to be artificially kept alive, hooked up to machines and stuck in a bed. Not one of them. It is not about playing God at all, no, it is about letting God decide instead of the doctors.

Tinyblu, so sorry you're having to going through this and face these rotten decisions. I hope you'll soon get past any feelings of guilt or feeling like you've not done your best for your father. This is simply how the end of life should work, and it's often unfortunate that we humans step in where we shouldn't and prolong what's meant to happen, making our loved ones endure more than any of us would wish. The DNR is really a very backwards document when you think about it, it should be the opposite, some kind of "do you want to unnaturally prolong life by artificial means past the point when it should reasonably end?" document. Anyway, I wish you peace in the days ahead, and comfort in knowing that you've provided all you can for your dad.

All these are such good answers. Its a hard decision to make, and a message to us, to make that decision in a living will and health care proxy now so our children will not have to. It isn't fair parents leave it to us, but most of them do.
We made our decision of DNR and no life extending measures for Mom when she went into the NH. She's 101, and the staff suggested we do so as anything like that would prolong her suffering and CPR would break her bones she is so fragile. As the cancer and dementia progress you will know what will be best for your Dad. God has a way of giving us a message if you leave it in his hands. (((((hugs)))))))

We went through this decision 2 months ago for my mom. Like others have said, paper or no paper it's an awful position to be in and no matter what the circumstances, you still question the decision, even if in your heart you know you made the right one. So expect that if you do make the decision. Yes it comes down to quality vs quantity of life and real living vs just surviving. We will be here for you throughout your process and after. Hugs!!

When we were bouncing in and out of the hospital with our mom, we felt barraged at every point from the ER to the daily visits by "hospitalists", "social workers", "case workers" etc. all wanting to know if we had a DNR, and if not would we like to schedule a meeting with "Palliative Care". Without malice toward any specific person, we were mostly cynical of everyone except the nurses who provided mom's day to day care. We called it the "doctor du jour", where a different MD would visit each day.. none had bothered to read her medical history, but all of them were certain that her death was imminent and that a DNR was of crucial importance. Twice she fell asleep for 2 or 3 days in a row and was non-responsive. All vitals strong. One doc told me that she had suffered a brain "event" and she'd been deprived of oxygen, and that 99.9% of such patients do not regain consciousness. 15 minutes later she was awake and eating. The same thing happened again. All of which is to say ... YOU know your dad better than anyone. Don't allow Medicare-funded doctors and 'case workers' to force you into agreeing to a DNR. Tell them to back off and you'll let them know when you need them. They do not have a choice but to do so.

Having said that, a DNR can be defined as narrow or broad as you wish, at least in NJ. In my mother's case, we decided that we wanted intervention with a bipap if she was struggling to breathe, but if her heart failed and she had no pulse we did not want them intubating, shocking, or even doing compressions. We finally did agree to a meeting with Palliative care, only to learn that medicare and the insuracne companies are very involved in what qualifies as palliative and hospice. No wonder we were being pushed into one of those categories! We said no thanks to those people as well. When she was released from hospital into rehab, we (finally) realized that we could demand the same level of monitoring and preventative care for her that she was getting in the hospital. That was a revelation, as prior to that we were told that rehab and long term care are just "reactive" - i.e., they'll only treat something if it becomes a problem. My advice is to ask a lot of questions. Trust no one whose livelihood depends on the insurance industry. For now at least, they can't legally force you to do anything you don't want to do. So take your time if you have that luxury. When it's time for DNR you'll know, believe me.

I am SOOO happy to have this "family" in light of my DNA-sharers.

Daddy never liked to talk about anything death related. He always thought he was invincible - hence his decision to continue smoking despite the doctor's MANY warnings.

I've been a ball of emotions today. Seeing Dad struggle with the oxygen tank really confirmed his frailty to HIM and me. He looks frustrated about the entire thing and I feel so guilty every time I leave him. Then I feel resentful for being placed in a position of having to feel guilty for needing (and wanting) to go to work.

I have decided to simply wait a while. A decision doesn't need to be made TOMORROW, and things are too stressful to even deal with a decision that major right now.

I found comfort in a book "Can We Talk About Something More Pleasant" by Roz Chast. It is a HILARIOUS depiction of the author's experiences while taking care of her aging parents. It literally got me through the day. I needed to laugh. It's an easy read!!!

Tinyblu: I agree that it is hard. I had to make the palliative care decision for my mother. Do the best you can and don't beat yourself up over it.

I am facing this same sort of decision. My mom has no AD, no DNR, will is not up to date...but I am her executor and oldest daughter...and I live out of state. My mom is 91 and still in OK health so nothing is imminent...but then anything could happen and she could be gone tomorrow. In the past she has asked that "if anything happens to me...do everything possible to keep me alive." At our last conversation she still feels that way. She also talks about updating her will but hasn't done it, won't tell us who her lawyer is...don't know the doctor either. I appreciate how much of a huge decision this is for you - I think if it were my mom, after talking to the doctors and getting their perspectives, I'd put the DNR in place. It seems to me to be the right thing to do. Put it in God's hands as to what happens after that. Many ((((HUGS)))) - I know it's not easy.

Tinyblu, my mom passed away this morning. I was the first to post on this some days back. Now, even in my pain and at the same time relief, I can see in my case the DNR was the right call. She was quite ill and the last weeks have been the hardest on me watching her labor and suffer so with her breathing. Couldn't see them trying to bring her back in sick and aged (86) condition. No more of that....absent from the body, present with the Lord. She's probably having a great time and now sees she never need worry about death. Now off to deal with crazy family funeral politics, but wanted to share that with you.

JB - my condolences on the passing of your mother.There comes a time when they wind down too far to come back up again. Good luck with the crazy family funeral politics. I expect to have to deal with this in the next few months as mother has been put on hospice. I am sure you are relieved, but you also have shock and pain from your loss. (((((((hugs)))))

JB-so sorry to hear about your loss. I'm glad you find strength in knowing your mom is no longer suffering. I hope this helps Tiny as well when/if your dad is in the same boat.

Jb: So sorry for your loss.

Thanks guys really appreciate the support.

JB how kind of you to share and how strong you are to be able to share at this difficult time. xxxx Far far stronger than I could ever be. You are one brave person xxxxx

JB condolances. Your mother raised a strong and loving daughter. May you find peace after the chaos.

Big hugs, JB. And a "well done" to you for doing the right things right though nothing was easy...!

Thanks for your thoughts JB. My condolences to you.

So sorry, JB. Sending hugs and comfort.

God bless, JB.

Mother was recently in the hospital. The Doctor was questioning me regarding Mothers POA of Health Care. It is essentially referring all decisions to POA which is myself. I stated all measures, he asked about resusitation. I said ask me at the time. I wouldn't want to have her ribs broken to resusitate her heart at her age because I hear it is so painful for the patient who is near 100. The Dr. was gruff. He wanted a DNR answer. I stood firm. After he left the Nurse whispered to me. When someone is near 100 they can resuscitate more gently. I would not be quick to say DNR. Also there are elderly patients with older POA health forms who will die from pnemonia if they state no fluids, no antibiotics. I had a tough time handing Mother's POA of Health Care to her facility. It took 6 months until they put the same in their book at the front desk. When Mom got pnemonia (untreated when she was in the Health Care Center when we called 911) Had we not done this Mother would not have survived the ordeal has she had her older Health Care Directive in effect. Pnemonia is very treatable. My cousin, a retired pediatrics Dr. did not support me. His idea that what my Mother decided 15 years ago when she was younger was what she actually wanted as stated when her mind was more alert. My position is times have changed and mother is the figure head of our family and very much loved and cherished. We are blessed, she is not suffering. She is excited by life and wants to live.

Daughterlu, I expect that you will be getting varying answers/suggestions on the issues of the DNR, that your Mother signed 15 years ago, and then put in your hands as her POA to follow.

Im my opinion, the Dr wanted to press you on the issue specifically regarding CPR, as they don't always have the time nor resources to find you and discuss whether or not you would wish them to proceed with CPR, and that goes for Anyone, not just your Mom at age 100, and still wanting to live.

IMO, the time when people fill out their Health Care Wishes, is normally a time when they Are of sound mind, are clear thinking, and would want their wishes abided by, even though at the time, it is a Very difficult decision to go along with them.

Our Mom had a very difficult time making those sorts of decisions too, at the end of my Dad's life too, for religious reasons, so I am most certainly not judging you.

Wow, 100 years old! That in itself is an amazing feat, and one not many achieve too often, you should be happy to have had your sweet Mom this long, and also that you come frome a good line of healthy DNA!

In the end, my recommendations to you are to decide on those most urgent decisions that require immediate attention and stick to them, acting as if you were your Mom making them, and if your Mom is still of sound mind, discuss them once again, and update her Advance Directive or 5 Wishes forms, and let them stand, this way, it is taken out of your hands at the time of high emotions. Then, there should be no guilt attached to those very tough decisions during a crisis. It is always tough though!

Dont put him through a surgery or chemo. So awful for seniors with weakened bodies. My dad said same as yours when he was diagnosed with cancer. My mom forced chemo and dad stopped it after about a month after awful side effects. He just walked into room and announced "im done". He passed away at home "his way" with hospice 4 weeks later.

Dont put him thru this. You have many here's support --thise who have been where you are or know the pain and frustration of dealing with surgery that turns into long drawn out tumultuous recovery that sometimes never comes...just multi hospital visits to treat infections, woulnds that wont heal, dehydration, weakness when they cant get back in their feet.

Save you and your dad the heartache.

My Great Grandfather lived to 106. At 100 he bought a house on a main thoroughfare and had a general store built on to the front that he could run when he was 100 years old. 100 year olds should not be ignored because of their age. Mother has put her faith and trust in me regarding Health Care even though it is in the present tense not when she becomes incompetent. She knows I love and cherish her as head of our family. We have 5 generations. Regarding her eye care, her eye Dr and the specialist didn't want to do anything about her severe glaucoma. We went to a Glaucoma Specialist who does not summarily turn down the elderly. I've seen too many of the elderly not treated for treatable health issues, put to sleep like you would a dog or died and/or mismanagement of their health care I do not want this to happen to Mother. DNR is an easy way out for the facility and family. Each case and family are different and we need acceptance in our society of an elderly person who does not want a blanket DNR.

Daughterlu, I hope that you did not misunderstand my suggestion for the care your Mom should receive during a crisis.

I definitely understand your Loving and Cherishing her, as I did my own Mom, God rest her soul. I too take care of my own 87 year old FIL, in my home, and have for the past 13+ years, and I (along with his Son) also am his Healthcare proxy. He and I have had many a discussion about end of life care and crisis care. He has an Advanced Directive which is very specifically completed, and I will abide by his wishes. At any time, should he wish to make changes, that too!

Having worked in Healthcare for 30+ years, including the Cardiac and Pulmonary department, I have seen on many occasions, patients "go down, and go unconscious" and unable to speak for themselves, and this is where those Directives come into play, as there is not a lot of time, sometimes only seconds, between calling 911 and the paramedics arriving, that CPR needs to begin, and checking to see if an Advanced Directive is in place, let alone call around to see if the Medical POA/HEALTHCARE PROXY is available for consultation, to make the crucial decisions to begin Cardio and Pulmonary Resuscitation, is not a viable option, and there could be the possibility that you aren't there with her at the time. Sadley, in some cases CPR was done, when the patient or family would have preffered that it not have been, and long term health issues then come into play. So honestly, "ask me at the time", is not a very smar decision.

I highly recommend that you research THE 5 WISHES. Which addresses Medical, Legal, Spiritual and Personal desires for end od life care, and is clear, consise, and addresses everything that I can think of for Loved ones discussing what is best for them. It also opens up a good family dialog, so that everyone concerned, or involved can understand the desires of the patient. But mainly, these are decisions the patient must make, and we as their Loved ones can abide by them with the confidence that it is what the Wish!

I love that you Love your Mom so very much, to do right by her, no matter how old she is! Age is just a number!

I don't believe Anyone should have a BLANKET Directive, and also believe that Advanced Directives should be discussed and Updated from time to time, as long as the Patient understands the decisions they are making.

I am sorry that I wasn't clearer. Mother made me her POA of Health Care and replaced her Health Care Directive leaving all decisions up to me, leaving all directives with a note that it is up to the POA. We got help from a facilitator of a Caregiver Support Group and Mother's Attorney. We would be without Mother here on earth if her prior Health Care Directive had not been disavowed and replaced giving me POA over all decisions. We can discuss matters as time goes on. I am an obedient daughter and carry out mother's wishes. I did not have to contemplate DNR as her heart did not fail. The nurse advised that the Doctors can revive an elderly persons heart without breaking her chest bone. She said they are gentle with the elderly. has anyone had this experience?

dauhterlu - this is a very hard time. The main thing is that the senior's wishes should be honored. It is not what the POA wants for their parent. There may be a difference. My mother, aged 104, made her DNR very clear nearly 10 years ago. Frankly, since she has stated her wishes, I have not even thought about what I would want for her. I know her position. We have updates several times but essentially it is the same The POA acts for the person according to the person's wishes when the person cannot state their own wishes. What does your mother want for herself? ((((((hugs)))))

stacey - you make some very good points. Things can happen very quickly and emotions run high. That's why these documents exist.

lu - thanks for the clarification. I question that the nurse can say with certainty that an elderly person's heart can be resuscitated with or without breaking the breast bone. I don't think they can ever be sure that the procedure will be successful. Hope someone here has some experience with this.

Thanks 23. That is a good point. I would like to know more about resuscitation success or failure of the elderly. Can a more gentle push that doesn't break the chest bone be effective?

and what would be her quality of life if she is resuscitated after her heart has stopped for some reason... I think it is harder for you since your mother has given you the responsibility for all medical decisions.