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Hello and welcome to the Lightkeepers podcast. I'm Clayton Vandiver, your

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lightkeeper, with a show dedicated to everyone who wants to get the most out

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of life that they can. We don't talk about the end of life, we focus on the

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quality of life. My co-host on this episode, Charlene, a licensed clinical

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social worker who is certified in the state of Florida, she'll be helping us

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answer this week's question, to be or not to be? The question of DNR and what that

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means to you and the medical community and so much more on this edition of

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the Lightkeepers podcast.

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Before we start, I'd like to invite you to please leave your questions or

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comments below. We love to hear from you. Questions this week will be answered

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during our next show that appears online each Wednesday evening at 7 p.m. Eastern.

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The Lightkeepers podcast is an exclusive production of A Guiding Light

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Incorporated. We'll tell you more about A Guiding Light at the end of the podcast,

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but we don't have much time, so let's get right into this week's topic, DNR, an

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acronym that stands for Do Not Resuscitate. Once again with us is

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Charlene, a licensed clinical social worker who has a lot of great

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information about DNR for us. Hi Charlene. Hi. Thank you for joining us this evening.

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My pleasure. And the first thing I guess we need to establish for our guests, for

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our listeners and viewers, is exactly what is DNR? Ah, that's a good question.

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So a Do Not Resuscitate order is exactly what it sounds like. It's a medical order

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that has to be signed by an individual and that individual's physician stating

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that that person does not want to be resuscitated if their heart stops. Now

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what this means is that if someone's heart stops, they will not receive CPR,

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defibrillation, anything like that to try to get their heart restarted. Now not

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everyone can be a DNR, even if you want to be. Oh, okay. Not everyone can be. DNRs

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are usually reserved for individuals who are maybe elderly and frail, someone

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with a terminal illness. Not just anyone can get a Do Not Resuscitate order just

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because they don't want their heart to be restarted if their heart stops. There

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has to be a good medical reason behind it. Well, that begs a very good question

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then. Why would someone not want to be resuscitated if they were injured or

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if they have a negative health event? Why is it so important to tell the

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medical community that you have a Do Not Resuscitate? So there's a lot of

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important reasons. First of all, if you are someone who maybe has a terminal

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illness and you have that Do Not Resuscitate order, you don't want to be

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resuscitated only to have to die again later. The reason it's so important for

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your medical team to know that you have that order is because without that order,

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the medical team, the medical community, they are required to do everything they

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can to keep you alive. Really? Yes. Okay. And so what that means is that unless

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you have a piece of paper in your medical chart that your doctor is aware

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of, don't assume doctors read charts first of all. Okay, that's a good point.

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But you have to have a piece of paper in your chart that your medical team is

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aware of. Otherwise, if your heart stops, they're going to do chest compressions.

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They're going to do defibrillation, which is the electric shock, and there's a

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very good chance that you're going to be intubated and put on a ventilator. And

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that's the sticking point. That's what a lot of people don't want. Well, because

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those procedures would actually potentially do more harm than good if

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you indeed were close to the end of life anyway. Potentially. They can actually hurt

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you. How much of an impact do they typically have when you have chest

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compressions and those sorts of procedures done? So chest compressions

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can be a very violent procedure. The heart is protected behind the

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ribs for a reason. It's a very delicate organ that keeps us alive. But what that

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means is if it stops, you have to move those ribs to get the heart restarted, to

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manipulate it back, which means there's a very good chance in the CPR process

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that ribs are going to be broken. Wow. Ribs can be broken, sternum can be

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cracked, lungs can be punctured. There's a lot of injuries that can happen in the

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resuscitation process. Now for some people, that risk of injury is worth it

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to have that opportunity to come back. Sure. But if you're in a frail condition,

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if you're maybe very elderly, very frail, or very sickly, those injuries are just

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going to add on to the very reason you wanted that do not resuscitate order in

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the first place. That makes a very good point that there is a time when having

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that in place could actually preserve a little bit of quality of life a little

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bit longer or allow you to go when your time is... Without interventions that you

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didn't want. Right. And the way that we often refer to it in the industry is

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allowing a natural death. And what that means is you're allowed to die naturally

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with only the medication necessary for comfort. Got you. Got you. So being

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resuscitated can sometimes do more harm than good. That's important to know.

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Most people don't know how violent... I had no idea that it was a really...

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That traumatic a procedure. It can be. Well, once you decide that it's right for

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you, how do you let the medical community know that you don't want

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resuscitation? So there's a couple of different important things that need to

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take place here. First and foremost, a person needs to have that discussion

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with their family because guess what? Once someone is unconscious, your family

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or your medical decision maker, they're going to be the ones calling the shots

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for you anyway. Sure. So you're going to want to make sure that they're on board

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with your wishes. So first place to start is having that discussion with your

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family. Of course. The next place to start is going to be to have that

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discussion with your doctor because they're going to be the ones signing off

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on it anyway. It is a medical order. It does require physician signature. And so

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you're going to need to have that conversation. But the important thing is

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if you go into the hospital for any procedures, if you're hospitalized,

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anything like that, the first thing that you want to make sure is that one, your

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do not resuscitate order is in your chart and two, your medical team knows

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that it's there. Ah. So what about in an accident situation where the emergency

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responders or paramedics are not going to know you have a DNR? So that one can

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be a little trickier because in an accident a lot can happen. You know, you

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may have a do not resuscitate card in your wallet. Oh, okay. But in an

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emergency, say for example in a car accident, most of the time you're already

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on the stretcher in the ambulance on the way to the hospital before the state

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trooper writing up the accident actually bothers to look in your wallet. I see. If

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you have a do not resuscitate bracelet, there are medical or bracelets that you

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can wear that indicate that you have a do not resuscitate order. If you're in a

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bad enough car accident, that bracelet might not have stayed on. So they might

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not take the time to look at it because eminently it's more important to try to

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save your life. That's what they're out there. When in the field in an emergency,

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their first response is always first and foremost going to be to preserve life.

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There is no guarantee. Oh, I understand. That you're not going to have

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resuscitation attempted if you are in an accident outside of your residence. Now

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if you are in your residence, I always coach people to have their resuscitate

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order, their do not resuscitate order prominently posted. Paramedics are

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trained to look like on the door of the refrigerator or on the bedroom door or

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in some cases even taped to the foot of the bed. I see. Well how often, this all

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begs the really important question, how often are DNRs inadvertently perhaps or

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because it's their policy to just do what they can right away, how often do

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they they get violated by medical personnel who I'm sure aren't trying to

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do that, but I know it happens. So there are no clear statistics on that. I can

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tell you that a wrongful resuscitation as it's referred to does happen often

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enough that it makes the news. There are several news reports in the last decade

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of families that filed lawsuits because their loved one suffered after being

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resuscitated, wrongfully so. It is listed as a medical error and there was a very

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interesting study that was published in 2017 that stated in the United States

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medical error was the third leading cause of death. So it's entirely possible

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that among those medical errors there could be some wrongful resuscitations

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that then later did pass. I understand. Well it's a complicated issue and what

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do you think would help the situation ideally for the people that you counsel

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and for our listeners and our viewers? Education. Education, communication, and

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making sure that your medical team is aware of your wishes and what you want.

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Sure. Well and that is the the whole point then. Communication is what makes

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all of our medical concerns work a little bit better in the medical system.

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And we know a little bit more now about do not resuscitate your rights, your

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medical personnel, what they need to be reminded of about your wishes. Of

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course this is all a highly personal choice and no conversation we have on

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the Light Keepers podcast should ever take the place of your own medical care

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team or other personal advisor who should always be consulted by you on

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your specific situational needs. And it's always good to talk about quality of

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life and events because every single one of us faces some of these situations in

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our lives. Well we hope you found some information that was helpful to you on

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this edition of the Light Keepers podcast. Please leave your questions or

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comments below. We love to hear from you. The Light Keepers podcast is an

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exclusive production of Animation Studios and is brought to you by a

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Guiding Light, a 501c3 nonprofit organization dedicated to education and

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information that allows informed preparation for living the very best

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life possible. The mission of a Guiding Light is to provide education about life

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planning, guidance and counseling that eases an individual's transition and

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guides them and their family regardless of their ability to pay through options

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that improve the quality of their remaining days. The organization is

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committed to training professionals who will help you find the best information

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and options to meet your planning needs that are available in your area so you

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can be aware of your choices, confident in your decisions and at peace that

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you have made the best decisions to live life your way. For more information on a

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Guiding Light please visit the website at aguidinglight.org or to make a

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tax-deductible contribution and help those less fortunate find the information

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and resources they need. Please visit the donation page on the website where you

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will find tax information and the address to send a check or it's also on

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the screen right below me. We're so grateful for your support and sincerely

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hope that you will join us in coming weeks. We still have topics like organ

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donors and hospitals, funeral homes and your plans, the gap between medical

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jargon and medical care and legal jargon, metabolized grief, ingesting grief,

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normalizing loss, hospice. It's not just for the last few days or hours. Medical

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plans and paperwork and of course your questions and comments we love to hear

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from you. Speaking of that hit the like and subscribe buttons and turn on that

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notify bell so you catch every episode. I'm Clayton Vandiver, the light keeper.

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We'll see you next time.