Character Medical Advice: Do Not Resuscitate

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You have a character who is dying or has a disease/condition that puts their life at risk. Maybe cancer, ALS, or even just getting on in years. Whatever the reason, they may have decided they don’t want life-saving measures performed if they get worse. This could include CPR, defibrillation, intubation, feeding tubes, IVs, certain medications, etc. Or maybe, your character is the nurse/doctor caring for this patient. How does the healthcare team treat patients who are DNR (do not resuscitate)?

alt text A few misconceptions to clear up:

  1. DNR does not mean palliative. Literally anyone can choose to have a DNR status (as long as you’re old enough to make that decision for yourself, so like, a 7-year-old can’t make themselves DNR). It’s meant for anyone who doesn’t want to be intubated, have CPR, etc in the event of an accident. So, when you see a DNR status on a patient, it doesn’t mean they are necessarily (in the words of my Nana) one foot on a banana peel.
  2. Palliative care means end of life care, with a focus on comfort and rest.
  3. DNR is not a one-size-fits-all kinda thing. It’s important, as a health care provider, to review what the patient does, or doesn’t want. Some patients don’t want to be defibrillated but are okay with a round of CPR and drugs. Some are fine with oxygen and artificial airways but don’t want to be intubated. You get the idea. Patients get to choose what they are most comfortable with.

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Your character is the nurse/doctor:

  • If the PT is DNR but otherwise well: the care doesn’t change. You will assess them, and treat their condition accordingly.
    • If the patient is palliative, you usually don’t do vials or assessments (except pain assessments, those are key!) You will provide comfort care, baths, and companionship.
  • If the patient is dying: for DNR and palliative, the goal is comfort care. A lot of patients will still receive oxygen therapy, as feeling like you can’t breathe is uncomfortable. They will get pain medications if they are in any pain. We often turn off the monitors and give family time to be with the patient (we give them a private room if we can, often bring the family tea/coffee, have Kleenex available, etc). We never rush the family out after the patient dies. They can have as much time as they need to say their goodbyes. (Unless we are dealing with organ donation… But that’s a whole other topic.)
    • If there is no family, the nurse will sometimes sit with the patient (if staffing allows) and be available to talk, hold their hand, wipe their face with a warm cloth, whatever small comfort we can provide. Often we let them rest, checking quietly to see if they appear comfortable.
  • At some point, the doctor will come by with the nurse to declare “time of death,” but it’s not a rush on these situations. The family and patient comfort take priority.
  • When the healthcare team realizes a patient is likely going to die, Doctors and nurses will often have long patient and family meetings to discuss and of life care, and explain that the patient’s condition is likely in the end stages. We leave lots of space for questions.

alt text Your character is the one dying:

There is no right way to write about death. your character could be scared, relieved, impatient, even! If they are on pain meds, they might be in and out of vivid dreams and have a difficult time pinning down reality. They could be thinking on their good memories, contemplating their mistakes, wishing for more time to slay their mortal enemy…the options are endless.

alt text Writing about grieving, death, and dying:

This is such a fascinating topic, as it can take so many forms. Cultures and religions all deal with death differently, and of course, if you’re writing fantasy, you can come up with your own customs. Grieving peoples’ feelings can range from despair, relief, detachment, celebration (and not only if they hated the person; some cultures celebrate death!). It’s normal for people to experience a wide array of feelings (see the 5 stages of grieving, for example).

Healthcare professionals, even those used to dealing with death, can still struggle with feelings of loss, wishing they could do more, exhaustion, etc. A lot of nurses/doctors will hold it together while on duty, but on the way home, cry in the car. Healthcare providers have really high rates of burn out, even suicide, from not having proper support in dealing with the care of dying patients.

Today’s topic was suggested by Mandy Webster on twitter. Thanks for the great idea :) Have more questions about caring for dying characters? let me know in the comments, or Facebook/Twitter

DISCLAIMER this post is based on my experiences, and the experiences of those I have talked to about this subject. Every hospital/country has their own care models.

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