Remember what I said about my surgeon yesterday? Plain talker, not pretentious, good guy? When you think of the hospitalist think the opposite of those qualities. This doc gave me the distinct impression that rather than listening to what I was saying he was always thinking of what to say next.
When the hospitalist came in the room he sat in a chair for our initial conversation. It seemed rehearsed. He asked if I wanted extraordinary measures taken should I have a medical emergency. I said I had all that written down in an advanced directive which I had given the hospital.
“You’re saying the hospital has that on file?”
“Yeah. My wife gave it to one of the nurses during admission. She made a copy.”
“Well it’s not part of my file.”
“Yeah, well I gave it to them.”
“I’ll make a point to find it. So tell me, in a general sense what are your wishes should we encounter the need to resuscitate you?”
“I don’t want anything heroic to happen if there’s no point.”
We talked some more, sort of. Before he left he asked
“Mr. McClure, how can we help you better?”
“When this leg block wears off and I have to take other meds for pain you could give me morphine instead of hydrocodone. I’ve had morphine in the past and it worked the best. I have good memories of that family of drugs.”
He laughed. I had made the same request of my surgeon, each nurse I encountered, and while not laughing at me like this guy, all of them dismissed it.
“We don’t give out much morphine these days,” the hospitalist said. “Morphine is old. There are more effective drugs now.”
That seemed to be the general consensus. Morphine was the only bright spot in my operations long ago, and now that was gone. Also gone however, was much of the pain. Hydrocodone is now king.
In less than a half hour the nurse, either my own or the nurse in charge, an older woman who looked like she knew her stuff, blew into the room and made straight for my bedside.
“Do you know you have a DNR? Is that what you want?”
“DNR as in Do Not Resuscitate?”
“Yeah. The hospitalist ordered it.”
“Generally yeah. I guess. I mean if it’s only going to prolong my life…”
“No you don’t get it. Your chart has a DNR. If you have an arrhythmia out of the blue, or some freak thing happens that you stop breathing, I can’t help you get over it because you are DNR. Is that what you want?”
“Well no. I mean if I’m in god awful shape and dying, you know, and shocking my heart back to life or putting in a feeding tube only lets me live a while longer I don’t want that. But if as we’re talking here I can’t breathe then, yeah, I’d like you to help me out.”
“That’s what I thought. I’m going to talk to the doctor. I’m not sure he knows how you feel.”
My wife came back from the cafeteria about that time.
“Honey, let me see that Five Wishes thing.”
She dug it out of her purse and I started rereading it.
“I talked to that hospital doc and he’s got me down as not wanting to live if I have some kind of an emergency.”
“He marked my chart Do Not Resuscitate.”
“What in the world did you tell him?”
“I told him I didn’t want them knocking themselves out if I was dying. But apparently a DNR has everyone standing around watching me die today and tomorrow.”
“Well you’d better change that.”
It wasn’t twenty minutes before the nurse, with the hospitalist five steps behind her, burst into my room. She went to one side of my bed, the hospitalist took the other side. I had the distinct impression they were about to settle an argument. My wife’s eyes were wide. The nurse started.
“OK Mr. McClure tell (the young pretentious hospital doc) what you told me earlier.”
“Well I may have misunderstood your question, but I’ve read my directive here (held up the Five Wishes paper) and what it begins with, is this statement. Let me read it to you.
I believe that life is precious and I deserve to be treated with dignity. When the time comes that I am very sick and am not able to speak for myself, I want the following wishes to be respected and followed.
I think that’s where the confusion came in. I was talking about dying. Do I look like I’m dying? Hell, I’m 65 and just had my ankle fixed. Other than that I’m OK.”
“Mr. McClure, with all due respect, that’s not what you told me. You told me clearly that in the event that you were dying you did not want hospital staff to take extraordinary measure to save your life.”
“He’s not saying that,” the nurse said. The hospitalist gave her a dirty look. She was challenging his judgment.
“Can I see that paper?”
He took the document from me and began to scan it.
“I think what you have checked here for options in these scenarios backs up my decision. There are three choices.
o I want to have life support treatment
o I do not want life support treatment. If it has been started I want it stopped.
o I want to have life support treatment if my doctor believes it could help. But I want my doctor to stop giving me life support treatment if it is not helping my health condition or symptoms.
In each of these four cases, you’ve checked “I do not want life-support treatment. If it has been started I want it stopped.” That’s what a DNR is. No life support treatment. That’s what I ordered.”
I had the distinct impression he was trying to save face with the nurse for the decision he made. Thank God for that nurse.
“You’re missing the point. This whole thing is built upon me being very sick and close to death. Do I look very sick and close to death to either of you? And what about the four cases? Did you bother to read them? Give that thing to me. Here’s the four scenarios it applies to.
§ Close to Death
§ In a coma and not expected to wake up or recover
§ Permanent and severe brain damage and not expected to recover
§ Another condition under which I do not want to be kept alive
Do any of those apply to me now?”
Neither of them answered.
“Well do they?”
“Mr. McClure, we can’t predict the future,” the hospitalist said.
“You don’t have to. Look at me right now. Do you know why I’m getting this ankle fixed? So I can take trips and walk around new places. So I can golf eighteen holes, with a cart, and not have to ice my leg for six hours and hobble around the house. So I can walk my daughter down the aisle. It’s maintenance and repair for Christ’s sake. I’m not dying.”
They didn’t respond. I had a cup of melon chunks left over from lunch in a plastic cup with a spoon on my table.
“Are you telling me, that because I’m listed as a DNR, if I took a bite of this fruit and got a chunk of honeydew stuck in my throat and turned purple, neither of you would do the Heimlich on me?”
“Yes,” the nurse said. “As long as you’re marked DNR.”
The hospitalist chimed in.
“There are people you know, who believe they have lived a good life and do not wish to continue under any circumstances. But look Mr. McClure, if you want to change your mind it’s fine with me. I can change this order and I will. Just tell me what you want.”
“How about this. If I look like I’m dying in the next two days, and you can bring me back, do that. Then we’ll discuss what happens again. And if you can’t talk to me, talk to my wife or my kids. But I am pretty interested in continuing to live. Life if pretty good. I’d like to stay at it. Hell, with any luck I might even break 80 on the golf course before I actually turn 80. And I wouldn’t mind turning 80, as long as thing are going well. So yeah. Forget whatever I said, bring me back to life, and either me or my family will take it from there. But I don’t want you making that decision. Do you understand? I want my family to decide. They know me, you don’t, and there you go.”
I wished I had brought my flask. I needed strong brown alcohol of some kind. Any kind really .
The rest of my stay was uneventful. The hospitalist visited me the next day, but his visit was short. I was released the following day.
As they were taking me out to the Buick to head home, I asked Colleen to find my pocket knife in the backpack.
“What do you want that for?”
“I want to cut these damn plastic bracelets off my arm.”
It’s good to be back in the shack. Stay out of hospitals if you can.
For information about The Five Wishes, click https://www.agingwithdignity.org/contact