Hello and welcome to the Lightkeepers podcast. I'm Clayton Vandiver, your
lightkeeper, with a show dedicated to everyone who wants to get the most out
of life that they can. We don't talk about the end of life, we focus on the
quality of life. My co-host on this episode, Charlene, a licensed clinical
social worker who is certified in the state of Florida, she'll be helping us
answer this week's question, to be or not to be? The question of DNR and what that
means to you and the medical community and so much more on this edition of
the Lightkeepers podcast.
Before we start, I'd like to invite you to please leave your questions or
comments below. We love to hear from you. Questions this week will be answered
during our next show that appears online each Wednesday evening at 7 p.m. Eastern.
The Lightkeepers podcast is an exclusive production of A Guiding Light
Incorporated. We'll tell you more about A Guiding Light at the end of the podcast,
but we don't have much time, so let's get right into this week's topic, DNR, an
acronym that stands for Do Not Resuscitate. Once again with us is
Charlene, a licensed clinical social worker who has a lot of great
information about DNR for us. Hi Charlene. Hi. Thank you for joining us this evening.
My pleasure. And the first thing I guess we need to establish for our guests, for
our listeners and viewers, is exactly what is DNR? Ah, that's a good question.
So a Do Not Resuscitate order is exactly what it sounds like. It's a medical order
that has to be signed by an individual and that individual's physician stating
that that person does not want to be resuscitated if their heart stops. Now
what this means is that if someone's heart stops, they will not receive CPR,
defibrillation, anything like that to try to get their heart restarted. Now not
everyone can be a DNR, even if you want to be. Oh, okay. Not everyone can be. DNRs
are usually reserved for individuals who are maybe elderly and frail, someone
with a terminal illness. Not just anyone can get a Do Not Resuscitate order just
because they don't want their heart to be restarted if their heart stops. There
has to be a good medical reason behind it. Well, that begs a very good question
then. Why would someone not want to be resuscitated if they were injured or
if they have a negative health event? Why is it so important to tell the
medical community that you have a Do Not Resuscitate? So there's a lot of
important reasons. First of all, if you are someone who maybe has a terminal
illness and you have that Do Not Resuscitate order, you don't want to be
resuscitated only to have to die again later. The reason it's so important for
your medical team to know that you have that order is because without that order,
the medical team, the medical community, they are required to do everything they
can to keep you alive. Really? Yes. Okay. And so what that means is that unless
you have a piece of paper in your medical chart that your doctor is aware
of, don't assume doctors read charts first of all. Okay, that's a good point.
But you have to have a piece of paper in your chart that your medical team is
aware of. Otherwise, if your heart stops, they're going to do chest compressions.
They're going to do defibrillation, which is the electric shock, and there's a
very good chance that you're going to be intubated and put on a ventilator. And
that's the sticking point. That's what a lot of people don't want. Well, because
those procedures would actually potentially do more harm than good if
you indeed were close to the end of life anyway. Potentially. They can actually hurt
you. How much of an impact do they typically have when you have chest
compressions and those sorts of procedures done? So chest compressions
can be a very violent procedure. The heart is protected behind the
ribs for a reason. It's a very delicate organ that keeps us alive. But what that
means is if it stops, you have to move those ribs to get the heart restarted, to
manipulate it back, which means there's a very good chance in the CPR process
that ribs are going to be broken. Wow. Ribs can be broken, sternum can be
cracked, lungs can be punctured. There's a lot of injuries that can happen in the
resuscitation process. Now for some people, that risk of injury is worth it
to have that opportunity to come back. Sure. But if you're in a frail condition,
if you're maybe very elderly, very frail, or very sickly, those injuries are just
going to add on to the very reason you wanted that do not resuscitate order in
the first place. That makes a very good point that there is a time when having
that in place could actually preserve a little bit of quality of life a little
bit longer or allow you to go when your time is... Without interventions that you
didn't want. Right. And the way that we often refer to it in the industry is
allowing a natural death. And what that means is you're allowed to die naturally
with only the medication necessary for comfort. Got you. Got you. So being
resuscitated can sometimes do more harm than good. That's important to know.
Most people don't know how violent... I had no idea that it was a really...
That traumatic a procedure. It can be. Well, once you decide that it's right for
you, how do you let the medical community know that you don't want
resuscitation? So there's a couple of different important things that need to
take place here. First and foremost, a person needs to have that discussion
with their family because guess what? Once someone is unconscious, your family
or your medical decision maker, they're going to be the ones calling the shots
for you anyway. Sure. So you're going to want to make sure that they're on board
with your wishes. So first place to start is having that discussion with your
family. Of course. The next place to start is going to be to have that
discussion with your doctor because they're going to be the ones signing off
on it anyway. It is a medical order. It does require physician signature. And so
you're going to need to have that conversation. But the important thing is
if you go into the hospital for any procedures, if you're hospitalized,
anything like that, the first thing that you want to make sure is that one, your
do not resuscitate order is in your chart and two, your medical team knows
that it's there. Ah. So what about in an accident situation where the emergency
responders or paramedics are not going to know you have a DNR? So that one can
be a little trickier because in an accident a lot can happen. You know, you
may have a do not resuscitate card in your wallet. Oh, okay. But in an
emergency, say for example in a car accident, most of the time you're already
on the stretcher in the ambulance on the way to the hospital before the state
trooper writing up the accident actually bothers to look in your wallet. I see. If
you have a do not resuscitate bracelet, there are medical or bracelets that you
can wear that indicate that you have a do not resuscitate order. If you're in a
bad enough car accident, that bracelet might not have stayed on. So they might
not take the time to look at it because eminently it's more important to try to
save your life. That's what they're out there. When in the field in an emergency,
their first response is always first and foremost going to be to preserve life.
There is no guarantee. Oh, I understand. That you're not going to have
resuscitation attempted if you are in an accident outside of your residence. Now
if you are in your residence, I always coach people to have their resuscitate
order, their do not resuscitate order prominently posted. Paramedics are
trained to look like on the door of the refrigerator or on the bedroom door or
in some cases even taped to the foot of the bed. I see. Well how often, this all
begs the really important question, how often are DNRs inadvertently perhaps or
because it's their policy to just do what they can right away, how often do
they they get violated by medical personnel who I'm sure aren't trying to
do that, but I know it happens. So there are no clear statistics on that. I can
tell you that a wrongful resuscitation as it's referred to does happen often
enough that it makes the news. There are several news reports in the last decade
of families that filed lawsuits because their loved one suffered after being
resuscitated, wrongfully so. It is listed as a medical error and there was a very
interesting study that was published in 2017 that stated in the United States
medical error was the third leading cause of death. So it's entirely possible
that among those medical errors there could be some wrongful resuscitations
that then later did pass. I understand. Well it's a complicated issue and what
do you think would help the situation ideally for the people that you counsel
and for our listeners and our viewers? Education. Education, communication, and
making sure that your medical team is aware of your wishes and what you want.
Sure. Well and that is the the whole point then. Communication is what makes
all of our medical concerns work a little bit better in the medical system.
And we know a little bit more now about do not resuscitate your rights, your
medical personnel, what they need to be reminded of about your wishes. Of
course this is all a highly personal choice and no conversation we have on
the Light Keepers podcast should ever take the place of your own medical care
team or other personal advisor who should always be consulted by you on
your specific situational needs. And it's always good to talk about quality of
life and events because every single one of us faces some of these situations in
our lives. Well we hope you found some information that was helpful to you on
this edition of the Light Keepers podcast. Please leave your questions or
comments below. We love to hear from you. The Light Keepers podcast is an
exclusive production of Animation Studios and is brought to you by a
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hope that you will join us in coming weeks. We still have topics like organ
donors and hospitals, funeral homes and your plans, the gap between medical
jargon and medical care and legal jargon, metabolized grief, ingesting grief,
normalizing loss, hospice. It's not just for the last few days or hours. Medical
plans and paperwork and of course your questions and comments we love to hear
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We'll see you next time.