Just the mention of code status to patients and their families often turns a (sometimes feined) upbeat demeanor into a solemn one. While the mere mention of even a remote possibility of dying understandably makes patients uncomfortable and introspective, the lack of truly understanding the significance of the code status is potentially catastrophic. So teaching our patients the true significance of a DNR order is vital.
It seems as if just about everyone knows or has heard of someone who was inhumanely kept alive far too long, all the while suffering needlessly as a "vegetable." So, naturally, when asked if they would want to be resuscitated should their heart or lungs show signs of giving out, many people quickly answer with a resounding "No!", while others point out that they have an advance directive, not realizing that this legal document is not the appropriate option in all situations. But as physicians, we know that a 3 a.m. run of ventricular tachycardia in a generally healthy woman admitted with severe diarrhea and dehydration may simply be the result of an easy-to-correct electrolyte abnormality, and not an indicator that her heart is giving out.
I have had countless conversations with patients and their family members about code status, and I find it very unfortunate that the general public is so poorly informed on this issue.
I remember a gentleman in his 50s who declared himself a DNR in the ER, not realizing the implications. When I subsequently saw him and explained to him that in many situations, a person’s condition can be completely turned around with appropriate treatment, he changed his mind and revoked his DNR status. Within a few hours, his oxygen saturation plummeted as a result of his pneumonia, and he required intubation. He had no other significant medical problems, and he did very well. Had he not revoked his DNR status, he likely would have succumbed to pneumonia in the hospital. Instead, he was eventually discharged home to go back to his normal life.
Though our workflow is often hectic, taking a few minutes to confirm that patients really understand what a DNR order means, as well as understand the difference between an advance directive and a DNR order, can literally save lives.
Dr. A. Maria Hester is a hospitalist with Baltimore Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care.