Bad news

Yay, she is eating more today!

(We have some bad news)

She managed to walk from the room to the nurses’ station!

(We have some bad news)

Her labs look a whole lot better today. I think the bleeding has stopped.

(We have some bad news)

I think we may be able to move her out of the ICU today.

(We have some bad news)

She looks like she might be able to be discharged today!

(We have some bad news)

The cervical cancer is back. It’s stage four and its’ metastasized to the liver. There is nothing we can do. We can give her palliative chemo which may give her another 3-6 months or she can go palliative.

She chose to go palliative. She came home and passed away months later in her bed. I was 16. She was 41. She was my mother. October 18th will make 18 years since she passed away. It still hurts just as bad now as it did then. Fuck cancer. Fuck how it destroys people. Fuck how it destroys families. Fuck the pain it causes people. Fuck how it attacks old and young. Fuck cancer.

 

DNR vs Comfort Care

I have heard DNR and comfort care used interchangeably, especially by doctors. One is not the other!

DNR: Do not resuscitate. It is exactly what it says, you do not try life-saving measures in the event of a code situation. This does not imply that you stop caring for a patient. DNR does not mean “do not treat”! You will continue to provide patient care. You will hang medications for their blood pressure if it is dangerously low. You will more than likely continue to draw labs as well. You will still treat this patient pretty much like any other unless the patient, or their medical POA (power of attorney), tells you otherwise. One thing you must be aware of is whether or not the patient has exceptions to their DNR. Some may say that in the event of a code they want code medications but no chest compressions or intubation. Some people may say meds and intubation are fine but no chest compressions. I have even seen meds and compressions but no intubation (which leaves you wondering but hey, it’s what they want.)

Comfort Care: This is what most people think a DNR is. Just keep them comfortable until they pass on their own. At this point, you are no longer going to escalate care. In fact, you will more than likely begin to scale back dramatically the amount of care you provide. Typically the only medications you will give will be pain medications like morphine and maybe a few breathing treatments to help ease their work of breathing. For the most part, you are there as support for the family if needed, and to assure that your patient dies with dignity.

Please, for the sake of your patient, understand the difference. If you need to clarify with the patient or POA then do so. You don’t want to wait until the patient is near death to try and figure out what the patient actually wants.