I was just getting my scrubs on to go to work when my cell phone rang with a call from the director. That’s odd, I thought, for him to call me in the evening, just before work.
“Hello, Dr. Plaster,” he said formally. I could tell in his voice that something was wrong. We’ve known each other for years and he never calls me Dr. Plaster. So I went straight to the point.
“Is there something wrong?” My pessimistic nature was conjuring up with all kinds of evil scenarios.
“You know that 80-year-old female that you were so proud of successfully resuscitating the other night?”
“Yeah,” I answered slowly and cautiously. “Did she expire?” This was what I half expected.
“No,” he said slowly with his best professorial voice. “Some might say something worse. She’s vent dependent in the ICU. And she was a DNR.” I had no response beyond a long silent screwing up of my face and a deep sigh of frustration.
“No good deed goes unpunished,” I mumbled under my breath. “The family was there. No one objected,” I said defensively. “Is the family angry at me for attempting to save their mother?”
“Not at all,” he finally said with equal frustration in his voice. “In fact, they were quite appreciative of your heroic efforts. They are quite hopeful that she will recover fully. But you and I know the chances of that.”
“So what’s the problem? This patient had a sudden unexpected cardiac arrest from an unknown cause. DNR was the farthest thing from my mind. No one spoke up in the heat of the moment, or they didn’t know. I did the best I could under the circumstances. And the jury is still out on the outcome. The family isn’t complaining. Like I said, what’s the problem?”
“The risk manager is getting involved because there is likely to be some huge bills and the hospital may be on the hook since there was a valid DNR plus then we have global budgeting and we can’t just keep sending bills that get paid.”
“I remember talking to that lady before she went downhill and collapsed. The clinical picture wasn’t clear. But her mind was clear as a bell. Even if she had previously signed a DNR I doubt that she thought of a scenario like this.”
“Does anyone really know what they’re signing when they fill out those forms?” he said finally sounding like my long time friend again. “You may get a call from administration on this one. So think about it before you start talking. It could come back to you.”
“Thanks for the heads up,” I said before ending the call. You may think you know what you want or don’t want under these circumstances, I thought. But do you really? There are so many factors that you can’t predict.
“Do you want a cup of coffee before you head to work,” my wife asked trying futilely to interrupt my rumination. “Who was that?”
“You know,” I said, ignoring my wife’s question and staring into the distance, “People say they want something sometimes, under a given set of circumstances. But when the time comes, and circumstances are not exactly as they had anticipated…or they aren’t personally in the place that they anticipated being, then their seemingly solid plans just go out the window.”
“What the heck are you talking about?” she said with her open palm waving, shoulder shrugging look of confusion that I was so used to seeing.
“Remember how I used to tell you about my Marines who would tell me that if they ever stepped on a mine or hit an IED and blew off their legs that they didn’t want me to resuscitate them? I’ve seen guys that had horrific injuries. They are glad to be alive.”
“Are you having a flashback?” she said cynically. “Do you have PTSD? I knew there was something wrong with you after you came back from Iraq.”
“What are you talking about?” I said snapping back to reality.
“What are you talking about?” she responded aggressively.
“I’m talking about DNRs” I said looking at her with look of ‘you should know.’
“Oh, yeah, now I understand,” she said rolling her eyes and bobbing her head.
“I’m just saying that people think they know what they want under a given circumstance. But when that circumstance arrives, they feel differently. That’s all.”
“Oh you mean like when I said I thought it would be fun to have five kids,” she said with a little wink.
“Yeah, I guess. But I’m talking about serious questions of life and death.”
“Oh, this is life and death all right. Sometimes I’ve wanted to kill you for knocking me up so many times.”
“You know you would have had 10 if I hadn’t ‘cut it off’, so to speak. You complain, but you have always been in your element as a mom. And by the way, tomorrow is Mother’s Day. It’s your last chance to put in your order for something special.”
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She just gave me that smile that I loved and said “Nah…you don’t have to do anything special. Being a mom to all our great kids is enough of a present for me. You work hard. Just don’t go to sleep on the road coming home. That’ll be enough for me.” That worked for me, because I had forgotten to do anything anyway.
One last hug and kiss, like so many other nights, and I was out the door. But I was troubled by the directors’ call all night. No one from administration called. He was probably overstating their concern. There was probably just some talk around the executive suite that got back to him. But I was still perplexed. Did I do the right thing? Should I have stopped the progress to the code room to ask the husband if he wanted me to resuscitate his wife?
Just the thought of that seemed like such a crass thing to do. Of course, he would want me to do everything I could. He loved his wife as much as I love mine. Would he have produced some form that she signed in the calm light of day when all she was doing was thinking about not wanting to be a burden to her family?
The shift was long and harder than most. I seemed to be double thinking everything I did. By the time morning light started to peer through the ambulance bay doors I was pretty much exhausted and ready to go home and hit the rack. But as I drove home my path took me by the grocery store. It was open at 7 a.m. Who was the poor schmuck, I thought, that got to work at 7 on Mother’s Day.
Then I thought of all the moms who were on the shift that I just finished. Suddenly I made a wild, dangerous left turn through traffic into the parking lot. Jumping out of my truck I saw men coming out of the grocery store with flowers. I had a sudden surge of adrenaline and inspiration. No one seemed to notice as I strolled through the aisles in my scrubs and lab coat, complete with light, stethoscope and tongue blades. I gathered up an armful of flowers, a basket of fresh fruit, some eggs, bacon and fresh scones from the bakery section.
As I cooked in the kitchen I kept remembering that she didn’t want me to ‘do anything special.’ Finally, I gathered up the flowers, eggs, bacon, fruit and scones on a tray and headed upstairs to surprise my wife. But upon entering the room, instead of sleeping, I found her sitting up in bed as if she was waiting for me.
“I’m glad you didn’t forget about today,” she said. I just smiled with a look that said “I’ve been planning this for a year.”
For once, I think I guessed right.
I have worked nights all my career, 30 years, always ICU. I now work LTAC hospital. It is the end of the medical treatment plan. The next step is death. Still families call asking, “any change?” I just do not think the world outside the medical world will ever get the acceptance of “we have done all that is possible” meaning the prognosis is poor, outcome is death, but we, the medical practioners are constantly assaulted in our efforts to bridge the gap between life as they have always been and the ultimate acceptance of the end is death.