End of Life Care

8 Oct


This is just simply – what’s been on my mind lately. 

What do we do with ‘End of Life’ care?  What do you do when it’s your family?  Now – theoretically at least – I don’t have to have that conversation with my Dad about what he wants or doesn’t want.  We just have to deal with decisions like whether we continue the HRT or instead go over to radiation-only therapy.  We compare side-effects and treatment options and talk about what surgeons want and what radiation requires. 

My brother made the decision to move back to my Dad’s apartment – under the guise of getting a job up there – just so he can take care of my dad.  My dad who can’t really put on his own shoes in the afternoons because his feet have swollen up so much throughout the day.  My strong, impressive and always-active Dad…he can’t get his shoes on.  So my brother helps him. 

As an EMT, I am regularly called to the various nursing homes / assisted living facilities in my area.  Sometimes the calls are completely bogus in nature where the staff just wants the patient moved to the hospital (we see this most regularly on Friday’s, starting about mid-day) because the staff at that particular facility doesn’t want to deal with a potentially difficult patient through the weekend. 

But sometime’s we’re called for legitimate, end-of-life calls.  Respiratory distress, cardiac arrest, pre-code – whatever it is.  Among the many things that happens when all of the firefighters and EMS personnel arrive,  in addition to finding out where the patient is, how old they are and how long have they been ‘down’, is to find out whether or not the patient has a DNR.  DNR = Do Not Recessuitate Order.  So no CPR, no invasive procedures, just ‘comfort’ – assuming the patient hasn’t already passed. 

As an EMT, I believe that a DNR is a wonderful thing.  As the daughter of someone with Stage IV prostate cancer, I think it’s essential.  Please do not misunderstand, I don’t want my dad to die.  Actually – putting those words ‘dad’ and ‘die’ in the same sentence, has me crying at my computer.  I love my Dad and as such, I want him to be comfortable throughout his life.  Comfortable physically, spiritually and emotionally.  To accomplish this, medical professionals – nurses, doctors, technicians – everyone involved in the care cycle must be honest with the patient about the disease, treatment options and expected outcome. 

I’m just an EMT.  I only have 3 years experience on the streets.  I’m not a nurse or a doctor and I certainly don’t have the education to stand up against an RN or a MD.  However, I see people struggling to breathe, exhausted, in pain and their families do not want to let them go.  So we do CPR, we break the bones in the chest with compressions (one of the most nauseating feelings I have ever had was the sound and feel of the sternum and ribs crumbling against my hands as I started CPR), we push the body full of drugs, we place tubes, start lines and jolt the body with electricity.  This is far from the peaceful “hope I go in my sleep” ideal that people talk about their death – if they talk about it at all. 

I believe in palliative care.  I believe that hospice is a beautiful thing.  I believe that life is sacred from the minute of conception to the moment of death.  I will always perform life-saving procedures until provided proof that the patient does not want that.  But I believe that one of the measures of how sacred life is, is shown in chosing to do nothing.  To show respect for  the life that you have led.

When I have walked into a room where a DNR is present, family members are around – they know what is happening or just happened.  They are sad, they are crying but they have reached a sense of peace with it.  They have had a chance to say goodbyes, to let that person go knowing that they expressed their love.  The emotional destruction is not there the way it is when someone has chosen to want all intense and invasive procedures to prolong life. 

For me – if I can’t be ‘me’ – I do not want any ‘heroic measures’.  Just let me go – make me comfortable because I don’t believe death should be painful – but just let me go.  I hope that if the time ever comes to it for my family – especially my dad – that I will have the courage to look past my want, my desire to keep him longer and how much I will miss him, but instead focus on what he wants and what is best for him.  I want him to know he is loved and to show love, it means placing his needs above my own.


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