Even with a living will and a DNR order you may not die in peace.

Shortly after my father retired at age 65, he and my mother signed Living Wills to be used in the event they were in a terminal situation. My father died almost 30 years later.

Hospice was called in during the last week of my father’s life, during which he suffered a number of small strokes. The people working with Hospice are devoted, not to prolonging life, but to guarding the quality of life for the terminally ill patient and his family. For this reason a yellow “Do Not Resuscitate” order was pinned to the wall above his bed. Hospice will not care for anyone unless the order is in place.

My mother is now older than my father was when he died. Recently she moved into CountrySide, an Assisted Living Facility. She is currently sharing a two-bedroom apartment with Tess, who just celebrated her 102nd birthday. We are waiting for a one-bedroom unit to become available.

My mother is in a wheelchair; she has never re-gained the confidence to use her walker after the series of falls that forced her removal from her own home. Other than that, she is in very good physical condition, taking only one daily medication in contrast to the handful consumed by most of the other residents. Her mind is clear and her short term memory reasonably good. She is alert and doing very well for her age.

Tess is in even better physical condition but suffers from degenerative dementia. In a less well-staffed facility she would be confined to the Alzheimer wing, a little-talked-about area which exists in every ALF or nursing home. But CountrySide is an upscale place and the staff keep an eye on her during the day, feeding her in the staff Break Room and seating her in the hall near the nursing station for most of the time she is awake.

Tess does not have the aggressive behavior often evident in this disease, but she is prone to the compulsive repetition frequently seen in AD sufferers. Tess travels the hallways with her walker whenever she can slip away from her watchers. Up and down, up and down, up and down the halls, forty times a day. This is probably what keeps her in such good physical health.

Knowing this about Tess, I was surprised to see a DNR order on her bedroom door. The edges were curled as if it had been there for a long time. I inspected it more closely and saw that the date was several years old.

I had been under the impression that a DNR was only issued when the patient became terminal. After all, didn’t a Living Will dictate that life should not be prolonged by artificial measures?

My friend, Michelle, is a nurse in the Urgent Care section of our local hospital. I went to her for information.

”We see them all the time,” she said, “the people who don’t have a Do Not Resuscitate order. They are usually older people who have had a heart attack or a stroke. They are all blue, with lots of tubes attached to them. And the families are upset because this is not what their parents wanted.”

”But doesn’t a Living Will cover that?” I asked. “That’s what my mother has, what my father had.”

”No,” Michelle said. “A Living Will means we may not prolong life with artificial respiration or intravenous feeding. But we have to try to save someone’s life if we can.”

”Explain that to me in more detail, please.”

”Quite frankly,” Michelle told me, “when people your mother’s age come in because of a stroke or something like that, they usually have another episode within a day or so. Then we have to do defibrillation or perform CPR. And that’s horrible. Old people have very fragile bones and it is easy to break their ribs. I’ve done it myself, several times. It’s terrible. I hate it. Most health workers do.”

I was reluctant to talk to my mother about this. She has often mentioned her Living Will and the peace of mind it gives her. When she went into hospital we had my Durable Power of Attorney renewed, and the attorney suggested I also obtain a Health Power of Attorney. My mother willingly signed both of these. This means I can make health decisions for her. Still, I was reluctant to ask her doctor to issue a DNR order. What would he think of me?

”Ninety-nine doctors out of a hundred would approve of you getting a DNR now,” Michelle said. “It’s better than waiting until something happens to her.”

I checked with other health care professionals and they all agreed with Michelle. My own doctor told me that often ambulance teams ignore a DNR order; that there was no guarantee she would not be resuscitated.

In a way, what he said was a relief to me; the ultimate decision probably will not be mine. I picked up a DNR form from CountrySide, filled it out, and took it to my mother's doctor for his signature.

So now it is done. But I still feel like I’ve signed her death warrant.