The 93 year old cardiac arrest rolled in without advanced airway or IV access. No drugs. Asystole. CPR was halfheartedly in progress. The young man who had found her on the floor was living in the house, a friend of the patient's great grandson. The patient was supposed to be DNR. Why, then, was she in our ER? The young man called 911 in a panic, and could not produce the DNR or any documentation. Since none of the actual family members were at home, CPR was initiated by EMS. She was pronounced dead moments after her arrival in the ER since she had an advanced directive on file and the family member called us. Good; we didn't have go all out on the Poor Dear, and the end of life wishes not to be kept alive by artificial means were (sort of) followed.
Note to self and others: discuss end of life plans. Have one in place. Keep the DNR handy. If there is a terminal illness, understand what to do if the family member dies at home. This was a case of good intentions, just a tad short on follow through.
It fascinates me that although death is inevitable, so few families are prepared for it. We don't often discuss it. Terminal illness aside, it seems as if by ignoring the Reaper, he will ignore us.
I can't stress this enough. Everyone deserves to be treated with dignity, yet there is little dignity when an elder loved one dies in an ER, worse still when it isn't their wish to be kept alive with heroic measures. I would hate to have my last image of a loved one lying lifeless in an ER.
