Sunday, 7 February 2016

The DNR discussion

It was difficult to know how to begin this post, so I might as well jump in with both feet by stating the blindingly obvious. Like it or not, we're all going to die one day.  With few exceptions, we have no way of knowing or controlling when that will happen.  However, we can express a preference about where we die and how we are cared for towards the end of our lives.

Like the majority of people in the UK, Steve would like to die at home in familiar surroundings, with people around him that he knows and loves. Having made that choice, issues around resuscitation as and when the body starts shutting down of its own accord are somewhat academic.  

If an ambulance was to be called in an emergency, the chances are that Steve would be dead before it arrived. If he was still alive and the crew thought he had some chance of survival (notwithstanding his terminal cancer) he would be taken to hospital, shocked, thumped on the heart, intubated and, if resuscitated, taken to intensive care where the chances of him surviving any length of time are remote in the extreme. In all likelihood, he would die in hospital - the last place he wants his life to end.  

When death is imminent at the end of a terminal illness, such intervention would be more likely to prolong the process of dying than extend life in any meaningful way.  Considered in that context, having a note on his file saying "Do Not Resuscitate" (DNR) is a no-brainer.  So that's what he's decided to do.

Sarah the palliative care nurse was at pains to point out that DNR does not mean that treatment would be withheld.  Steve would still have whatever medication or other action thought necessary to make him as calm, comfortable and pain-free as possible as the end of life approaches.  He would also have the comfort of knowing that no one will insist he is taken to hospital and subjected to intrusive and ineffective intervention, when what he really wants to do is finish his days in comfort at home. 

Before having the discussion with the palliative care nurse, my instinct would have been to urge him to opt for whatever gave him the chance to stay alive a bit longer, including resuscitation.  Having a DNR note on his file would have felt like giving up.  After such a long Meso journey on which Steve has already survived what is now approaching seven years against all the odds, and having enjoyed life for much of that time, it would have seemed strangely counter intuitive. However, having thought it through, and in the light of his wish to die at home, it now feels like the right choice.

It would be different of course, if his cancer was curable or capable of being managed long term without compromising the quality of life. Should research deliver drugs capable of doing that - drugs which he could take - then it would be a different matter entirely. That time seems tantalizingly close with the development of immunotherapy and treatment targeted to meet the individual's specific needs. But it's not happened yet. Until then, the DNR note will stay in place and we will get on and enjoy life as best we can.

Indeed, we have been connecting with people and events in spite of Steve's declining health.  More of that in my next post.  Until then, big hugs to the Meso Warriors and love to you all xx

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