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  • #16
    Originally posted by Patton57 View Post
    My point is that the DNR decision was mine not my ex-wife's decision. I don't care if she was Elisabeth Kubler-Ross it wasn't her place to specify my DNR criteria (which excluded any form of recuscitation). She was sa wifying I wasn't worth bringing back folks. Good grief!
    Okay the wife is gone, been out of the picture for some time. Let that go. You need to specify your own needs, forget what you think the motivations of your wife were. Now what do you need to do for yourself is to specify your own desires? You need to stop thinking of what you think were your x-wife's motivations and start to think for yourself and what will work for you. Do you have trusted people in your life that will carry out your wishes and that you can depend upon. Full stop...look at what is best for you and clear your mind of the baggage from your X wife.

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    • #17
      Originally posted by SCI-Nurse View Post
      Again, a DNR request is only one part of an advance directive. You can have an advance directive that says you want everything possible done just as well as what you don't want done. Everyone should have one.

      (KLD)
      Are you saying that without an advance directive, medical staff have no guidance or obligation to provide certain care?
      Edit to add: Not challenging you, I'd seriously like to know.
      Last edited by quadvet; 12-04-2017, 08:59 AM.
      get busy living or get busy dying

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      • #18
        Originally posted by quadvet View Post
        Are you saying that without an advance directive, medical staff have no guidance or obligation to provide certain care?
        Edit to add: Not challenging you, I'd seriously like to know.
        In the emergency room (ED), patients are triaged to determine priority of care. This is usually done by an ED RN or physician. Like it or not, personal values and beliefs can cloud these decisions. A study done of ED personnel in the 1990s showed that 80% believed that if they themselves experienced a SCI, that nothing should be done and they would want to be let die. I believe that this can flavor the decisions to go all out (or not) for efforts to provide emergency care to those with SCI. This can also occur with other disabilities, or being elderly.

        Health care personnel often are known to respond to a case of cardiopulmonary arrest for those who they don't think should be revived with a "slow code" (where they don't respond quickly or with all possible interventions). See the story I posted above (post #6), as an example for how health care provider personal beliefs can interfere with all efforts being made.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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        • #19
          My advance directive and DNR were done with my GP, part of it states that I am not to be taken to ER or hospital under any circumstances. We spent a lot of time discussing the wording and implication knowing that if I was conscious I could override eg broken leg/arm however in a life threatening situation I can stick with it only requesting pain relief. GP was very helpful and my medical notes show the discussion. I always have both with me in the emergency trache bag my support workers carry, the care agency go through them both with new starters.

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          • #20
            The last time I went to emerge, I requested DNR and the clerk disagreed with me. Pffft!

            What's a good example of specifics KLD?
            Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

            T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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            • #21
              Originally posted by lynnifer View Post
              The last time I went to emerge, I requested DNR and the clerk disagreed with me. Pffft!

              What's a good example of specifics KLD?
              Did you make a verbal request? Do you have a written Do Not Resuscitate documentment?

              Here is the form from the the British Columbia Ministry of Health that should be executed by you and your doctor or nurse practitioner to assure your wishes whether you are at home and paramedics are called in an emergency or in a hospital setting.
              https://www2.gov.bc.ca/assets/gov/he...rms/302fil.pdf

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              • #22
                Thanks KLD.
                get busy living or get busy dying

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                • #23
                  Originally posted by lynnifer View Post
                  The last time I went to emerge, I requested DNR and the clerk disagreed with me. Pffft!

                  What's a good example of specifics KLD?
                  At least in the USA, when you are in the hospital, a DNR order must be entered by the provider. It cannot be entered by a clerk or even a nurse, so you would need to do this in the ED once you were seen by a physician or other licensed provider.

                  "Specifics" (examples)
                  • If I have an immediately terminal condition, or am diagnosed to be in a persistent coma, I want medication for pain control only, and no IV or tube feeding nor other methods of providing nutrition or fluids to prolong my life.
                  • If I am unconscious or delirious but appear to have a non-terminal condition or temporary coma, I want IV medications for resuscitation, but no ventilator.
                  • In the event of a cardiopulmonary arrest, I want all resuscitation measures taken including CPR, medications, and defibrillation as indicated, including the use of a ventilator.
                  • In the event of a cardiopulmonary arrest, I request that no resuscitation measures be taken, including CPR or artificial respiration of any type, "rescue" medications, or defibrillation.


                  This should be detailed in your advance directive, and you may want to consult with your provider for the specific wording or conditions that should be addressed. In the USA, any of your health care team are not allowed to be named as agents, nor can they witness your advance directive.

                  (KLD)
                  Last edited by SCI-Nurse; 12-04-2017, 05:32 PM.
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                  Comment


                  • #24
                    Originally posted by gjnl View Post
                    Did you make a verbal request? Do you have a written Do Not Resuscitate documentment?

                    Here is the form from the the British Columbia Ministry of Health that should be executed by you and your doctor or nurse practitioner to assure your wishes whether you are at home and paramedics are called in an emergency or in a hospital setting.
                    https://www2.gov.bc.ca/assets/gov/he...rms/302fil.pdf
                    Actually in Ontario. Yes it was verbal only as I was in an emergent situation.

                    Just downloaded some forms today for my province. Here for other Canadians:

                    http://www.dyingwithdignity.ca/downl...e_planning_kit

                    Thanks KLD... those are specific! Vent in this case, not in that .. requires some serious thinking.
                    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

                    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

                    Comment


                    • #25
                      Originally posted by SCI-Nurse View Post
                      Health care personnel often are known to respond to a case of cardiopulmonary arrest for those who they don't think should be revived with a "slow code" (where they don't respond quickly or with all possible interventions). See the story I posted above (post #6), as an example for how health care provider personal beliefs can interfere with all efforts being made.

                      (KLD)
                      While a slow code is fraught with intrinsic ethical problems (if you're not really going to try, why try?), sometimes it's the only alternative.

                      For example, you get admitted to the hospital, you're frail, 80 years old with terminal cancer on top of chronic medical conditions. You make it clear that you don't want to be resuscitated in explicit terms, but you don't fill out advanced directives, but DO designate your son/neice/uncle/baby momma your medical power of attorney with all the proper paperwork and whatnot. Soon you get delirious and no longer are able to make decisions for yourself, your power of attorney immediately makes you full code.

                      IMO the above situation (which probably is happening to one degree or another every day in every major hospital) leads to 3 possible outcomes:
                      1. the providers code you, following the law and respecting the wishes of your medical decision maker, but directly violating the wishes you made clear prior to losing your faculties. Legal, but not ethical (IMO).
                      2. the providers respect the final wishes of the patient, who explicitly stated while of sound mind that they did not want to be intubated/CPR, etc. this violates the wishes of the medical decision maker (and the patient ain't there to argue in your favor) and opens you to lawsuits and whatnot.
                      3. you slow code. The patient is probably going to die, and you are respecting their wishes while being able to say that technically you pursued all available medical treatment.

                      As paternalistic as it is, option #3 almost always satisfies everyone. The patient's wishes are respected. The family member feels that they did everything they could and nothing else could be done and thus feels absolved of any guilt they might have had for "pulling the plug" on grandma. It's often the least bad alternative... and maybe a med student gets to try an emergent intubation for the first time.

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                      • #26
                        Originally posted by SCI-Nurse View Post
                        "Specifics" (examples)
                        • If I have an immediately terminal condition, or am diagnosed to be in a persistent coma, I want medication for pain control only, and no IV or tube feeding nor other methods of providing nutrition or fluids to prolong my life.


                        I think this is a brilliant little phrase to use in your DNR, especially if you have any pulmonary problems.

                        If you make it explicit that you don't want any life sustaining measures and say that you do want "pain control" that's a wink, wink, nod, nod to your doctor to slam you with pain meds until you don't appear to be in any pain, which with opioid pain meds tends to be right around the point that they suppress your breathing, thereby preventing a prolonged course of events. But if you put that in, you should be aware that most docs are going to read it that way. "Pain meds only" is a hospice-type way of saying "don't let me linger".

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                        • #27
                          I have a friend who is a paramedic. He has told me, don't have your relatives call for a paramedic team if you are in an "end of life" threatening situation and have a Do Not Resuscitate order because paramedics will ignore that order every time.

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                          • #28
                            Signing a DNR.

                            Originally posted by funklab View Post
                            snip ...

                            For example, you get admitted to the hospital, you're frail, 80 years old with terminal cancer on top of chronic medical conditions. You make it clear that you don't want to be resuscitated in explicit terms, but you don't fill out advanced directives, but DO designate your son/neice/uncle/baby momma your medical power of attorney with all the proper paperwork and whatnot. Soon you get delirious and no longer are able to make decisions for yourself, your power of attorney immediately makes you full code.

                            ... snip.
                            I was my mother's medical power of attorney and she had a living will which I had to follow if she became terminally ill which she did. Signing the DNR was the most difficult paper to I had to sign my name on in my life.

                            When my parents got their living will made out I don't understand why the attorney didn't have them sign their own DNR while they were sound of mind. They signed the living wills but no DNRs.

                            Ti
                            "We must overcome difficulties rather than being overcome by difficulties."

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                            • #29
                              Originally posted by gjnl View Post
                              Okay the wife is gone, been out of the picture for some time. Let that go. You need to specify your own needs, forget what you think the motivations of your wife were. Now what do you need to do for yourself is to specify your own desires? You need to stop thinking of what you think were your x-wife's motivations and start to think for yourself and what will work for you. Do you have trusted people in your life that will carry out your wishes and that you can depend upon. Full stop...look at what is best for you and clear your mind of the baggage from your X wife.
                              The ex was a hospice social worker and was always pushing DNRs on her patients and everyone else. Thanks for the tips.

                              Comment


                              • #30
                                It's important to let those around you know your wishes as well. I did my advance directives several years ago and did put in DNR. As a result, I wear a DNR bracelet to let medical personal know my wishes just in case (see left arm). As said earlier, I feel more at ease when it's on if something would happen. I went to the ER in November and ended up in the hospital for a week. Having my bracelet on made for easy conversations to quickly cover what I did and didn't want.

                                Unfortunately, my parents (who I live with) don't agree with my choice so I can't wear it when they're helping me. That's why you also need to be sure your contact person(s) are aware of and will follow your wishes.
                                Attached Files
                                C2/3 quad since February 20, 1985.

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