February 12, 2006

Home Life > D.N.R.

A few hours ago I authorized a Do Not Rescucitate order for my older sister, Tana.

Three Saturdays ago I took her to the Blount Memorial ER. Our mom and our cousin (whom my sister had been living with) had been trying for days to get her to go to the doctor. She finally agreed to go to the ER. I drove Tana to the ER and gave her the money she needed for the ER, and a check for the pharmacy. My sister is on Social Security Disability. I'm her payee, because she's been addicted to drugs for so long that she can't be trusted to handle money.

That Saturday Tana had trouble breathing. That wasn't new. She had surgery a few years ago for a benign lung tumor. She had also had breathing problems and low blood oxygen problems prior to that, related to smoking cigarettes and crack cocaine. I was horrified a half dozen years ago when I found out my sister smoked crack cocaine. Tana was a horrible drug addict for a decade before that, but smoking crack was a sign that she had hit the rock bottom of absolute gutter drugs. It occurred to me just the other day that not only had Tana never quit smoking cigarettes, but that she had never even tried to quit. In her mind smoking cigarettes was probably the least of her problems.

Last Monday Tana was worse. She was taken by ambulance to the Blount Memorial ER. A nurse called to tell me her condition. They wanted permission to extract fluid from Tana's lungs. I consented.

Curiously, the nurse asked me if I wanted to transport her to Baptist Hospital, where Tana had had surgery for lung cancer, for exploratory procedures which might lead to open chest surgery. The pneumonia had set up, and pus had formed in the interpleural spaces around her lungs. I thought it was odd that someone from Blount Memorial would ask me that, but I recalled that Tana had bad things to say about Blount and wanted to go anywhere but there, and concurred that Tana should be transported to Baptist if there was a chance for surgery. (I'm concealing some details here to protect the career of that nurse.) At Baptist she told us that the procedure at Blount had removed about 500 CCs of fluid from Tana's lungs.

When I asked mom she recalled that Tana had bad things to say about the staff at Baptist, but I still ranked them above Blount in Tana's estimation, and figured I had done the right thing by sending her to Baptist.

Melissa has visited Tana every day. I visited Wednesday, Friday, and today, Sunday. After a week in the Critical Care Unit Tana was worse. She went from an oyxgen mask to a fulll face mask to intubation and a ventilator. Even with up to 100% oxygen she was struggling to maintain 85% blood oxygen.

At my Wednesday visit the nurse was mystified why Tana hadn't responded to the antibiotics prescribed for the lung infection. Our cousin answered that question. While packing Tana's things she discovered Tana's medicine from her Saturday ER visit. Tana had thrown the powerful antibiotics to treat her lung infection in the trash. My wife and I have speculated that Tana didn't take the medicine either as a means of suicide (which she had attempted before with Xanax), as a means of sympathy (our cousin had decided she couldn't live with Tana and her drug problems and had told her to go back to her own apartment), or as drug-induced negligence.

There were several lines of evidence for drug-induced negligence. Tana had taken her 120-pill, one month's supply of the prescription anxiety medicine Xanax in one week. Melissa and I both made sure that the medical staff was aware of Tana's propensity to abuse Xanax. Many, many times in the past Tana would inhale her monthly Xanax prescription. Then she'd suffer seizures a week or so later as she went into Xanax withdrawl. (We have a pending complaint with the Tennessee Bureau of Health Licensure and Regulation over a Blount County physician who continued to prescribe Xanax to Tana even after her suicide attempt.) The Baptist staff made sure to continue to give her Xanax. Without them she'd go into withdrawal and seizures, just as she had in the past.

The ER staff had noticed three fresh burn marks on Tana. When she was still cognizant she told the ER staff that they were from a heating pad. Then she said they were from a dog scratch. Then she said they were from barbecuing with me (which is a lie - I haven't eaten a meal with my sister in over a year). Telling multiple stories about an event is a sign that my sister is lying and that drugs are involved. When her cars would disappear she would tell multiple, conflicting stories about what happened to them until facts forced her to tell the truth. (Our cousin also found a crack pipe among Tana's things.)

Ultimately, the nurse decided that the burns were from crack pipes. After she would smoke crack she would drop the hot pipe. Numbed, she wouldn't notice that it was burning her. That she had three fresh, unscabbed burn marks meant that she had smoked crack in the week or so prior to admission to the ER and CCU, even as she had lung infections. As she had many times in the past, Tana decided that getting high was preferable to living.

Today, Sunday, we met with a pulmonologist. Tana's situation was not good. They had done everything they would normally do, and nothing had worked. He had a few tricks to try (such as nitrous oxide) and that was all that was left. Tana had developed what they called Adult (or Acute) Respiratory Distress Syndrome. Her lungs are non-compliant, and are resistant to expanding and contracting on their own.

I talked to mom, because I knew she and Tana had talked about their final wishes. Tana didn't want to be kept alive on a ventilator. I talked to my brother, and he didn't see any point in keeping Tana alive on a ventilator. Both of them, and Melissa and I, too, suspect that Tana may have been attempting suicide by different means due to her physical pain and unhappiness these last few months.

The pulmonologist says that some people would have pulled the plug by now, and that Tana has just a 10-20% chance of survival. If she does survive, she'll be even less healthy than before, and may require a tracheotomy. She'd likely be confined to a nursing home at age 45, and is likely to die early due to Hepatitis C or lung cancer (which they think may have relapsed).

He suggested that we authorize a Do Not Resuscitate order, so that's what I've done. Should she have a heart attack or other organ failure the CCU staff won't resuscitate her.

I'm waiting until Wednesday to check her condition beyond that. If her condition worsens we'll have to decide whether to withdraw life support.

Posted by lesjones | TrackBack



Comments

It takes a lot of guts to share something like this with so many.

I don't even know where to begin to pray for you, so I'll pray for wisdom and discernment for you and your family.

Posted by: Paul Simer at February 13, 2006

:(

Ouch. There's nothing that can make one feel so helpless as wanting to help someone who just won't let themselves be helped.

I'm so sorry, Les.

Posted by: Tam at February 13, 2006

Sorry, bro. Stuff like that's never easy. I wish you the best.

Posted by: SayUncle at February 13, 2006

What they said, and our thoughts and prayers are with all of you.

Posted by: Michael Silence at February 13, 2006

I am so sorry.

Posted by: Cathy at February 13, 2006

My prayers are with you and your family.

I lost my brother indirectly to drug abuse. My son is now taking the first steps down that path. I know the pain, the anger and the utter dispair and frustration of not being able to help someone who is hell bent on self-destruction.

Posted by: LissaKay at February 13, 2006

Add me to the list of people thinking of your family at this time.

I can say that I spent a lot of time at Baptitst about a year ago when my mother had a qunituple bypass and I thought the staff there was top-notch. I'm sure they're doing everything possible, as you are.

Posted by: Frank at February 13, 2006

Les, I am so sorry. Thinking of you and your family during this difficult time.

Posted by: Busy Mom at February 13, 2006

What can I add to what's already been said? I can only offer up prayers for your family.

Posted by: Brian at February 13, 2006

Les, I'm no good at saying the right thing at moments like these. So I won't even try, other than to say that when I say prayers with my kids tonight, we'll make certain to pray for your family as well.

Posted by: Bob K at February 13, 2006

Les -- you're a damn good brother, and a damn good human being in general. I'm truly sorry you have to go through this.

Posted by: Steve K. at February 13, 2006

Les,

First of all know that we will be praying for you, and your family.

Secondly, that is powerful stuff and it had to be extremely hard to write. Thank you for sharing and giving a lot of knowledge, wisdom, and strength to those that read it.

Third, we are going to post a TB about it this afternoon, so hopefully a lot of people will give it a read.

Posted by: Team Swap at February 13, 2006

My heart aches for the decisions you have had to make.
Addiction as an illness runs through my life like an overgrown ivy or somthing, lots of cases in differing amounts, friends, family myself.

You are a damn fine son, father, brother, and human being. Many people would completley abandon someone that does not try to get better family or not.

My hat is off to you, and my head is bowed, you have done all you can, God bless you.

Posted by: Cinomed at February 13, 2006

Les, let me know if you need anything, a sitter for the young 'un or anything else. You and your family will be in my prayers.

Posted by: rich at February 13, 2006

You're a mensch. And an adult. 'nuff said.

Posted by: John of Argghhh! at February 13, 2006

It's a hard choice, and the right one. While the circumstances of my own decision to sign a DNR are very different, the reality is the same. At some point, you know that there is more harm than good in forcing medical care.
Take care - I wish you and your family the blessing of peace.

Posted by: Barb at February 13, 2006

I'm sorry for your loss (in all sorts of senses of the phrase). One of those real ugly facets of life :(

Posted by: Evan Erwin at February 13, 2006

With some decisions, the first in a series is always the hardest. Except for ones like this.

With regards to DNRs, each succeeding one is just as hard. The pain you're feeling means that you did not shirk your responsibility nor did you rationalize it.

The pain will fade, leaving an ache to remind you of the price of making adult decisions. Then God soothes the ache to remind you that, despite your adulthood, you still remain His child...

Posted by: BillT at February 13, 2006

Amen to what the rest of this good company have said, and prayers to you and your family as you traverse this ordeal...

As far as Tana is concerned, the best I can wish, given all you have said, is a swift and painless passing, so that she might find peace.

I believe that the Good Lord's mercy extends to all, including lost sheep...

God Bless you all...

Posted by: Sgt. B. at February 14, 2006

I hate that you are having to go through such a terrible time.
I wish you and your family peace during an unpeaceful time.

Posted by: newscoma at February 14, 2006

Les, let me just second (third? fourth?) the good wishes for you and your family in this difficult time. I cannot imagine how hard this must be for you, and I'll add you to my list of people to include on my chats with the Big Guy...

Posted by: Jay G at February 14, 2006

Our prayers...have strength.

Posted by: -keith in Silicon Valley at February 15, 2006

Allyson and I will help in anyway we can. We can babysit, stay with your mom, or run errands. Take care.

Posted by: Tony at February 15, 2006

i feel your pain, i too have a sister in a similiar situation.

Posted by: chelsea at February 16, 2007

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Posted by: fhagnlgdpx at July 07, 2007

i am terribly sorry about your situation, i will be praying for you all. Have faith in the LORD, and trust in him always.

Posted by: Nathan at December 10, 2007
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