The hardest question

Even after doing it hundreds of times, it's never easy to ask someone whether they want you to let them die.

By Jeff Drayer

Mar 27, 2000 | "OK, Mrs. Brown, there's just one more thing I want to discuss before I leave you alone for the night."

I opened the chart and pretended to read. I always had trouble looking into my patients' eyes during this part. Just stay cool, I thought to myself. This is your job. Nothing to worry about.

"Are you comfortable? Do you have any questions about the medications we put you on or the plan for the next couple of days?" I was clearly stalling now. I'd already gone over it all three times. I forced myself to put the chart down.

"No," she replied. "I feel much better now, doctor." I smiled glassily. That's what made me hate this so much.

"Mrs. Brown," I began, shuffling jerkily toward her bed. "I need to ask you something." Her smile bade me continue. "Now, we think you're going to do just fine and I don't think anything bad is going to happen. We know what's wrong and we know how to treat this. I think everything's going to be absolutely OK." For just an instant I could see the smile waver. She sensed a "but."

"But if something should happen. Well, I mean, more specifically, if your heart should stop beating, such that we would need to start compressions and maybe even shock you, like on TV." The smile was definitely gone. "Not that I think that's going to happen. Not at all." I found my gaze drifting down to the floor.

"Or if you stopped breathing for some strange reason, which I also don't think will happen, and needed to be put on a breathing machine which we may never be able to take you off of." I forced my eyes back to her face. It was wrapped in confusion and increasing dismay.

"Are these things you would like us to do?" I asked, handing her a blue mimeographed piece of paper. "Because if you don't, I'll need you to sign this." She started to read, then stopped.

"What does this mean?" she asked. "It just says DNR/DNI."

My internship mainly consisted of one uncomfortable episode after another. Informing people of a loved one's death, dealing with difficult patients and staff and being vomited upon were, unfortunately, rather common occurrences.

However, the most disquieting part about internship for me was meeting each new patient, reassuring him that we had state-of-the-art facilities and were going to work very hard to get him better, and then asking him to sign a waiver saying whether or not he would desire treatment in case his heart stopped or he couldn't breathe.

As the member of the medical team who knew the least (except when we had med students on the team, and even then it was a tossup), it always fell to me to perform the delicate task of discussing do not resuscitate/do not intubate orders. It was a job I feared.

After all, patients are admitted to the hospital either for a new and scary disease or an old familiar one that may finally be getting the better of them. It takes a lot of work to calm them down and make them feel safe, which is not just nice for the patient but can actually affect the course of their hospitalization. And once this tenuous bond of trust is forged, about the best way for a doctor to screw it up is by asking a patient if, in the scariest of situations, they'd rather have us help them, or sit by and watch.

That's what I had to do, usually about seven times per night when on call, two times a day otherwise. One would think that I'd get good at it, or at least not have it make my hands sweat and my voice shake.

But one would be wrong.

Next Page: She'd make it through the night, I thought

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