COVID-19 • DNR/DNI

Do not resuscitate / Do not intubate.

These are some of the most profound decision you and your loved ones will make.  At this point, most everyone should have end of life care decisions written down or at a very minimum, expressed clearly to your next of kin.

DNR or Do Not Resuscitate basically says if your heart and lungs have failed, the healthcare team will not push on your chest (CPR) or put a breathing tube into your throat (Intubation).  CPR is a borderline violent act – especially for the frail and elderly – and for any extended period has a very low survivability.  It is very aggressive attack on the body, and often the medical community realizes the futility of that work. 

DNI or Do Not Intubate indicates that the you do not want a breathing tube in your throat.  All other care continues and that process can be very aggressive even in airway management.  A significant reason for not intubating folks is certain conditions will mean they will never come off of the tube regardless of survival.

In both cases, those orders limit a very narrow scope of the care.  And no other care is changed because of a DNR or DNI order  With the same conditions, a person with a DNR/DNI order will be treated exactly the same as a person without a DNR/DNI order right up to the time where those tools are needed.

Please have the talk with all the adults in your life that you care for.  Crisis is a very difficult time to have that talk and often leaves folks wondering if they should have/could have.  And know now, given the impending COVID-19 situation, “at the bedside” will likely be by phone or video conference.

Talk to your doctor about what the best path is for you.  Certain medical conditions make surviving COVID-19 a near impossible challenge and could lead to a longer and more challenging death.  This is very difficult stuff only made easier only by talking about it.

There is another reason healthcare should know about your wishes; and this should not enter into your decision as to what to do.  This is only a plea that you make a plan. A plan so healthcare can quickly do what is right for you, protect precious resources for your neighbor, and keeping the staff healthy.

The process of placing a breathing tube, especially in a crisis situation, has shown to put the healthcare team in the greatest risk of getting COVID-19.  Replacing critical care personnel takes weeks if they are exposed, months if they are sick and a decade of training if they cannot return to work.

These critical care personnel are well aware of the risk that saving lives with these tools, puts them in.  That needs to be respected in the decisions that are made; in the decisions that you make. If these personnel have a clear understand of your wishes, that is a huge help that could pay off for years.

(This post has been edited from its original form. I was clearly angry and my words are not in line with my faith. Sorry. Jurgen.)