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Saturday, September 8, 2007

Pretty profound, huh?: DNR in the treatment decision at the end of life

In Margaret Edson's play, W;t the character Vivian is an independent, crotchety, cerebral English professor with Stage 4 ovarian cancer, and the character Susie is her nurse on the cancer ward in an academic medical center. Near the end, Susie brings Vivian an orange double popsicle to relieve her throat. Vivian breaks it in half and hands half to Susie.

Susie: Sure?

Vivian: Yes.

Susie: Thanks. [She sits.] When I was a kid, we used to get these from a truck. The man would come around and ring his bell and we'd all run over. Then we'd sit on the curb and eat our popsicles. Pretty profound, huh?

Vivian: It sounds nice.


Susie: Vivian, there's something we need to talk about, you need to think about. There just isn't a good treatment for what you have yet. I'm sorry. They should have explained this-

Vivian: I knew. I read between the lines.

Susie: What you have to think about is your "code status." What you want them to do if your heart stops.

You can be "full code," which means that if your heart stops, they'll call a Code Blue and the code team will come and resuscitate you and take you to Intensive Care until you stabilize again. Or you can be "Do Not Resuscitate," so if your heart stops we'll…well, we'll just let it be. You'll be "DNR." You can think about it, but I wanted to present both choices before [Dr.] Kelekian and Jason [the research Fellow] talk to you.

Vivian: You don't agree about this?

Susie: Well, they like to save lives. So anything's okay, as long as life continues. It doesn't matter if you're hooked up to a million machines. Kelekian is a great researcher and everything. And the fellows, like Jason, they're really smart. It's an honor for them to work with him. But they always…want to know more things.

It's up to you.

Vivian: Let it stop.

Susie: Really?

Vivian: Yes.

Susie: So if your heart stops beating…

Vivian: Just let it stop.

Susie: Sure?

Vivian: Yes.

Susie: OK. I'll get Kelekian to give the order.

Advice to patient advocates for patients at the end of life: If you need to have this tough conversation, Susie's kind words may provide an example.

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