Adventures in EMS: Slowly Dying

The Worst Kind of Calls

There are many tragedies to encounter in EMS.  This weekend alone two terrible events took place in the districts I work in; my friends and family were EMT’s for them.  In one, a young man crashed his motorcycle, going near 100 mph.  He died nearly instantly.    The EMT crew worked on the young man until life flight arrived and declared him dead.  Another one was the body retrieval of a seven-year-old little girl from a river after she had been missing for a day.  A friend of mine staged at the retrieval, which meant he was in service at the scene before he was officially needed.  But he never was needed, since the girl was declared dead immediately.  Dealing with traumatic deaths and especially the death of children is the worst part of the job, and every EMT has their own private horror.  What gets us through is the knowledge that we tried.  We did what we could to fight biology, to deter death, to conquer inevitability.  That is what the entire healthcare system faces, and how health care providers can justify themselves to why we endure traumatic event after traumatic event.  There is an instance, though, where our repeated and valiant attempts to thwart the grim reaper is, perhaps, cruelty itself.

I don’t have a strong or specific view on euthanasia, and I’m not the type of person who consoles by saying someone has gone to a better place, or that their death was a mercy.  Even so, I have a deep and abiding respect for what is called the DNR/DNI.  It is a Do Not Resuscitate/ Do Not Intubate standing order.  What this means is that a person with a DNR/DNI is requesting that in the event that they need CPR, Rescue Breathing, or a medical airway, they would rather not receive it.  It is not available to everybody.  It is a prescription by a doctor with certain conditions and even an expiration date that is usually provided for the terminally ill and elderly people with multiple illnesses and hospitalizations.  Conditions may exclude DNR/DNI from traumatic events, such as a car accident.  They may say, please perform CPR but do not intubate (intubation is a procedure of providing a medical airway by placing a tube down the trachea when a patient can not maintain their own airway).  There are many ways one can specify the DNR/DNI.  As an EMT, it can be frustrating to handle a DNR/DNI patient, because we are continuously trained to save, and in these instances, the best we can do is possibly make a patient more comfortable.  It can also be problematic if family members disagree with the DNR/DNI.  Family fights have been known to break out during treatment where one side wants to respect the DNR/DNI and the other won’t produce it.  (A DNR/DNI is only effective when it is present).  It can be downright heart wrenching to not provide a patient treatment with family members pleading, beseeching, and begging you to intervene.  Even these moments are acceptable though, knowing it is the patient’s desire to allow nature to take their course, and that the healthcare system has provided a means for them to do so.  I know that I would not want to live the last of my days on a respirator in a coma or in terrible pain to die months after I was rescued.

But there is a different call altogether that rips at my sensibilities and claws at my heart.  That is the elderly patient, the ill patient, whose wish is to die peacefully (well, as peacefully as they can manage) and not be intervened upon, but do not have a DNR/DNI.  Perhaps they are no longer considered competent and a family member will not allow it.  Perhaps they are simply old with no illnesses, except a body that has finished.  Perhaps they don’t know that it is an option.  Treating those patients gives me chills.  Knowing that while they plead for you to just let them die, as soon as they become unconscious, it is our obligation to pull them back, to give them the chance to linger in pain and misery just a bit longer.  Hearing their plaintive cries, filled with fear of death but a greater fear of living a part-life, of being shuffled off into hospice to die slowly surrounded, not by loved ones, but of other people dieing slowly.  These are the patients that I pity, because these are the patients the system seems to be working against, the system that I am part of, and can not, and even would not change.  The opposite of friendly fire, the accidental rescue.

DNR Orders

These are one example of DNR orders, from Pennsylvania.  Image by Google Images
These are one example of DNR orders, from Pennsylvania. Image by Google Images
Despite this woman's apparent wishes, this is not a sufficient DNR.  A written order signed by a physician must be present.  Image by Google Images
Despite this woman's apparent wishes, this is not a sufficient DNR. A written order signed by a physician must be present. Image by Google Images

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