DNR – No Vent – No Intubation

I created this sign and hung it over the head of my bed:

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Relieving the Decision

This COVID-19 Pandemic is crushing our country… really, crushing the world. As more and more folks get sick and some of those sick die, I’ve made some decisions I never thought I would have to make in my life. While I have felt closer to death than not the last few years, now it is looming, shadowing almost every thought I have.

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Since the beginning of the Coronavirus Pandemic, I’ve been hearing that doctors might eventually have to make the excruciating decision about who gets a ventilator, a machine that breathes for the patient, and who does not get one. The number of vents around the world and here in the US, are far below the number of patients that need them. As each day passes, they are in shorter supply and we are not even at the apex of the epidemic yet.

The time is for decision-making has arrived.

Doctor’s & DNR

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This was in Wuhan, China (you can tell because they actually have protective gear) in late February 2020.

Doctors have begun initiating their own DNR’sDo Not Resuscitate orders… because it’s clear that certain COVID-19 patients are going to die no matter what a medical team can offer. Therefore, if a patient “Codes” (goes into cardiac or respiratory arrest), the doctors are being permitted to:

“‘think more critically’ about which patients should receive one of their limited number of ventilators, and that the institution would support doctors who ‘withhold futile intubations.'”

“Futile” being the operative word.

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“Aerosols” During Resuscitation

When resuscitation occurs, that is one of the most dangerous times to be around a COVID-19 patient. During the life-saving procedures:

“…airborne transmission may be possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed; i.e., endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation.”

So what do I do if I do not want to infect the healthcare workers around me?

I die at home.

Hospice Care?

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I have been trying to see if there is Hospice Care for those dying of COVID-19, but have not found anything but warnings to those that go into the homes of COVID-19… until today.

Ex-NFL kicker Tom Dempsey in hospice care with coronavirus

“Former NFL kicker Tom Dempsey is in hospice care after being diagnosed with coronavirus, relatives said.

“Dempsey, who once held the NFL record for booting a field goal 63 yards when he played with the Saints, began receiving hospice care Wednesday after contracting the virus last month during an outbreak at a senior living center….”

But the likelihood of finding someone to help me at home would be slim, so I am thinking of other options.

Dying at Home

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There are other people here at the house and the prospect of their finding me dead isn’t appealing, but I am kind of lost about what to do about the situation. I listened today as they said ambulances are waiting in line for 5 hours at the ER door to bring someone in and then the person is sent to the waiting room for another 10-12 hours, then there are 100 beds in the ER crammed everywhere and people die waiting.

I do not want to die among strangers. I would rather die in my bed.

I want to die in my bed.

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Setting Up the Scenario

I will not go into details at the moment, but I have set it up that I will have someone with me as I die… on the phone… and I will not die alone. This person will set everything in motion to get my body removed in a timely matter, call the kids and my mom and alert my work. The girls will get into my Facebook, come in here and say I am gone, etc. etc. etc.

I have been told I am being morbid, but I find more peace discussing these things, getting all in line.

I do not want ANYONE to feel bad about my dying, from EMS to doctors to nurses to the kids, etc.

I want to die in peace, being a caregiver, even in death.

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Peace in Chaos & Beauty

Holding the Space

“Be kind to the children, for they are close to the other side.” – unknown

When my father was given 3 months to live when he had the intestinal cancer, everyone had an idea of what he should do. Take this herb! Try chiropractic! I was in the “Call Hospice” camp. But my father had a different plan. Instead, he wanted to do chemotherapy. Those of us in the medical arena of his life, holding the labs in our hands, shook our heads at the futility of that… and it might/probably will make him feel much worse. We did what he wanted anyway.

My dad did 2 sessions of chemo and then said, “Call Hospice.”

His death 2.5 months later was peaceful and gentle. And he was so so loved.

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My dad, Saturno Herrera, about 1 month before he died.

When We Need to Listen

In my life right now are a couple of people who have family or friends with terminal diagnoses. Those around them are rushing to help with all sorts of remedies, diets and even insisting on the “power of positive thinking.”

Instead, perhaps this is a time to ask the dying person what they want, not foist on them what we want.

Being near those that are dying is an amazing honor and privilege. For one thing, it isn’t a sudden, unexpected moment where there are always regrets about things not said or done. When you are at the side of a dying person, you have the opportunity for completion and the giving of your heart in a way you might never have before.

It is not a time for airing grievances that will never be resolved. Not a time for your confessions of guilt (find a Priest for that). It isn’t even a time to just sit keening and crying your eyes out, the dying person trying to comfort you in their time of need.

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Nanea Reeves with her husband Vic as he gets closer to dying.

Mindfulness

Holding the Space is a concept I learned in midwifery, but had been doing a long time already with men dying of AIDS decades ago. Holding the Space is sitting quietly, perhaps praying silently, seeing golden light of love surrounding them or just Be-ing with the person heading to the other side (into parenthood/through death/in illness/etc.). Allowing the person to say what they want… rambling speech or exquisite poetry. I like to keep notes, but not at the expense of my complete attention.

One caveat: Take as many pictures as you can… with each person separately, everyone together… take pictures holding the person’s hand… get video of them if they are still talking. I have nothing with my dad’s voice on it and regret that terribly.

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Mindfulness is a buzzword right now, but if there was ever a time to be Mindful, it is when with someone in transition. Not worrying about getting to the store, checking your phone or even talking to others in the room about mundane life crap. BE with the person. Give your full attention to them. Watch them. Witness their transition completely.

If you get tired, you rest. No one can be expected to be Mindful or present 100% of the time. Do go for walks outside. Walk the dog. Eat a good meal. Be mindful of your needs, too.

There But for the Grace of God Go I

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When I am with someone in this holy place (which does include childbirth, of course), I want to share with them how I hope to be treated during my own transition through death. Not that it is my prescribed way of dying, but simply respectful and kind attention.

My family knows how I want to go. At home. People happy, laughing, music blaring, telling fun stories, remembering all the wondrous things I have done in this life. I also want to be read to. Read to me when I am tired and need to close my eyes for a moment.

But that is me. Not everyone wants the levity part that I have requested.

Perhaps the person you are with wants to smoke again, drink until they are drunk every day, wants to go out to a forest and dig their toes in the dirt one more time. Take them! Even if you have to hire an ambulance service and need to push dirt through their toes while they are on a gurney. Be creative to give the dying their wishes. If they want to watch a favorite movie on a 24-hour loop and it makes you crazy…

…so what?!? Let them!

Talk to your loved one. Ask them what they want and need from you.

Then do it.

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An added note: I understand that children dying slowly can be another aspect entirely. I have not lost a child to cancer or another illness or malformation, so cannot speak to it accurately. But, as with everything anyone in the world writes or says:

Take what you want & leave the rest.