Isabel Hardman
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May’s response also mirrored that from the health care establishment over previous years. These orders are something doctors should be discussing with patients as a matter of routine anyway – but they must be handled sensitively. The last time I wrote about DNRs was in the Times a few years ago when GP practices started phoning around their patients to try to talk about resuscitation. This was clearly as inappropriate as trying to rush families now but the principle behind both actions was right. Patients need to be aware of what resuscitation really entails.
Contrary to popular opinion, deciding to refrain from cardio-pulmonary resuscitation isn’t a sign a doctor doesn’t want to give you a chance. Instead, it is a sign that the state you might be restored to is a horrible one that makes the absolutes of life and death seem rather blurred. Only 20 per cent of all hospital resuscitations bring a patient back. CPR is a forceful procedure, requiring doctors to push up and down on a patient’s ribcage to force blood around the body. That force often cracks ribs but, worse than that, if someone does return to life after their heart has stopped for a while, they often do so with hypoxic brain damage, leaving them in an undignified stage of dying that lasts for days and weeks before they eventually succumb.
Many of us are not aware of this reality, partly because hospital dramas tend to involve the resuscitation of fit and health young adults with a shockable heart rhythm. But it’s also because our culture shuns proper conversations about death and dying. Of course, in this pandemic, the concept of a ‘good death’ has been torn apart. People are dying without family and friends at their bedside because of strict hospital rules preventing visitors from also being infected and spreading the virus still further.
Others who had planned a ‘good death’ from a terminal illness diagnosed long before the outbreak are now having to think again about what that might entail, given they are isolated at home and unable to say all the goodbyes they had hoped for in person.
Families cannot even say goodbye properly at funerals. Today’s image of the coffin of 13-year-old Ismail Mohamed Abdulwahab being lowered into the ground with none of his family present because they are all at home, self-isolating, is a powerful illustration of that. But there are still ways of ensuring that even in this time, when our rituals around death have been changed beyond recognition, there is as much dignity as is possible at the end. And that means we need to think more about death than we’d like even in good times, let alone now.
Because you read about care homes
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