Trending Topics

DNR order: Should we do what is best for our patients or for ourselves?

This is the choice I made when a man was dying and the family couldn’t find the do-not-resuscitate paperwork

The hour is late, and the life of the man whose dying breaths fill the room is going to end soon. His agonal respirations and the fear they produced prompted a family member to call 911, hoping for a miracle.

They thought they were ready and had prepared for this moment for months. But when the end closes in, few of us are actually ready, and able to let go.

Most of those closest to him are there now. The phone calls were made a few hours ago — that chain of communication families who are dealing with terminal illness know all too well; the voice on the other end of the line saying the words that everybody has been waiting for, praying for and dreading.

“It’s soon.”

The gathering of loved ones parts as we arrive, making way for our bag full of meds, the defibrillator, and the stair chair. We came prepared to do what we must.

We join the family, strangers in their house, but oddly the people in charge. I go to the side of the bed, and touch the dying man gently, first his forehead, brushing a wisp of hair back, then his wrist. The pulse is slow and barely palpable.

“Does he have any final wishes?” I ask, hoping somebody understands and comes up with the do-not-resuscitate order. My partner puts an oxygen mask over the man’s face, a few people protest, most just watch.

“The hospice people have the paperwork,” says a younger person’s voice behind us.

The patient’s respirations are slowing now, his eighty-pound frame shaking, thankfully unconscious as the morphine pump grinds along.

I hear the sirens of the engine company in the distance. More strangers are about to invade this intimate gathering, this final farewell. It’s a moment that will stay with the survivors forever, and give them comfort in the difficult days ahead. Knowing their loved one died with dignity, in the home he built, surrounded by family will help make the memory of his passing painful, but profound.

Or not.

“I need a do-not-resuscitate order signed by him or a doctor,” I say to the person who appears to be in charge; maybe the man’s son. He nods, hopefully understanding my request and the position we are in.

Two respirations a minute now.

The dying man’s son is fumbling for the paperwork as his dad is about to leave this earth forever. The engine company arrives on scene: four firefighters, more equipment and radios clacking. Chaos is about to enter and ruin the hoped for serenity of a man’s final moments with his family.

“It’s okay,” I tell the son, and my partner and I step outside for a moment, closing the door behind us.

I have often asked myself why I took such risks. It was not my fault the paperwork wasn’t where it needed to be. I knew then, just as I know now, that all it takes is one of the family members who had assembled to file a complaint, and all of my explaining, rationalizing and pleading would do about as much good as the CPR we did not begin on the dying man.

My license to practice as an EMT could have been rescinded and very likely would have been. So why did I walk out?

Had I become so jaded that I simply did not want to initiate something that I knew would fail?

Did I think I knew more about life and death than whatever entity created it?

Had I become a monster, or a fool?

Truth is, by the end of my 23-year career I had simply seen enough. I knew without a doubt that the man would not survive the trip to the hospital. I felt the emotion in the room, the fear, the sorrow, the anticipation, and especially the absence of hope.

As my time in the streets grew, and my experiences added up it became clear to me that my job as an EMT went far deeper than providing emergency medical care to those who needed it. I had a choice: Do what was best for me, or what was best for the patient. If I had it to do over, I wouldn’t change a thing.

Captain Michael Morse (ret.),, is the bestselling author of Rescuing Providence, Rescue 1 Responding, City Life and Mr. Wilson Makes it Home. Michael has been active in EMS since 1991 and offers his views on a variety of EMS and firefighting topics, focusing mainly on the interaction between patient and provider as a well respected columnist and speaker. Captain Morse is a Johnson/Macoll fellow in literature from the Rhode Island Foundation.