Resuscitate or Not ?

[GarryP]

Yesterday I was asked this very question. My wife is exceedingly ill in hospital and the doctor asked me whether they should attempt to resuscitate her using CPR if her heart stops beating. It was so on the spot that I told the doctor I needed to time to think about this and also consult with my son. I will need to sign the hospital papers one way or the other in the next few days.

FYI, my wife is only 49 years old, lucid, but severly malnourished and has both heart and lung problems and has trouble eating solid foods as a result of surgery for cancer of the tongue 4 years ago. However, there is a fair chance that with better nutrition she can overcome the heart and lung issues to some extent.

I have now made my decision, but am interested in the views of other posters. Resuscitate or not?

[animatic]

If she was terminally ill with no hope of improvement DNR makes sense.

It lets them go with some dignity in a natural way.

If there is hope of improvement and she would only die before that improvement can come about,

then DNR is not appropriate, unless that is the wish of the patient.

IMHO.

[Crossy]

+1 for animatic, since the lady is lucid one could ask what she wants, how to ask such a question of a loved one is of course another issue.

[villagefarang]

DNR was the choice of my parents and my personal choice but I would not advocate one way or the other. It is a personal choice.

[Gecko123]

GarryP:

That's a terrible decision to have to make, and I can understand wanting to get the perspective of other people.

But good heavens, is this really the place you want to turn to for help with such a sensitive and intimate decision? Seems a little pointless to seek opinions here especially when there's so many unknown specifics and intangibles.

Can't imagine my wife being too happy with me if she ever found out I had taken a poll on TVF whether or not to pull the plug on her, and I'm just cringing when I think about the kind of callous comments you are likely to have to sift through in the process.

If it helps you get through what you're going through, I guess I understand. My prayers are with you.

[pgrahmm]

I had to do this with my daughter (car crash).....as nobody could tell me if she'd ever have mental capacity or be anything more than breathing - it was of course a lot more complicated than that as the blood supply to the brain had been cut off for an hour or more as just one part of the many complications.....this was a healty 26 y/o that had just been given a full scholarship at Northwestern + her workplace just made a corporate position offer so not as to lose her.....hard decision - but had to be made....thankfully 5 people are still alive now through organ donations so in some way she lives on....

In consulting with my family they agreed with what had to be done - - - - - In our case there as there was NO up side or hope.....I had no one else other than the Doctors to consult.....and my daughter was a fighter/winner/overcomer - but there simply wasn't the promise of a fight.....

It sounds as if you have some hope....whether the lack of oxygen has affected her mental capacity is a factor to consider - it can manifest itself in many ways as life continues....is she a willfull person than can fight through this?.....or is she just worn out and tired.....what are her wishes (in my Mothers case she did not wish to be brought back and voiced it to me - which again I had to sign for).....many many many many factors to consider - and then be reconsidered - not many of us have to face life or death decisions & we're not aloowed to take their place/switch positions....

I think I can say with 100% certainty that myself - and everyone else on this board wish you the very best and peace with whichever decision awaits you.....

Edited September 10, 2014 by pgrahmm

[submaniac]

I agree with what has been said here that if there is no hope of recovering DNR is appropriate, but is not if there is a reasonable chance of recovery. However, above all, it is the family's decision.

I had this come up when I thought I had lung cancer and was going into surgery. They asked about the DNR and what I said is if I was going to be a vegetable with no hope of recovering, DNR. If I have a good chance at living a normal life then resucitate.

For the OP: I know that you are facing a very difficult situation and my thoughts are with you. Stay strong through this hard time.

[GarryP]

GarryP:

That's a terrible decision to have to make, and I can understand wanting to get the perspective of other people.

But good heavens, is this really the place you want to turn to for help with such a sensitive and intimate decision? Seems a little pointless to seek opinions here especially when there's so many unknown specifics and intangibles.

Can't imagine my wife being too happy with me if she ever found out I had taken a poll on TVF whether or not to pull the plug on her, and I'm just cringing when I think about the kind of callous comments you are likely to have to sift through in the process.

If it helps you get through what you're going through, I guess I understand. My prayers are with you.

My decision has already been made and I am comfortable with it. I am not polling, just interested in other people's views.

Yes, TVF can be nasty and people do make some terrible comments, but there are also many posters who post thoughtful stuff. You just need to ignore the former and focus on the latter.

In any case, your input is appreciated, as is the input from the others, which all appears very well balanced.

[siampolee]

In my case my wife has been told and knows that if i was to enter a catatonic vegetative state she is to ensure the doctor gives me a powerful shot of whatever so as to send me on my way and relieve her and our children of the problems my existence may have caused.

Certainly I for one would not want to exist as a vegetable and I would also not wish to any of my loved ones in such a state either.

For me D.N.R. Euthanasia is the best way in dire circumstances.

[Mrjlh]

Isn't that a decision "Your Wife" should make? If she is lucid then she should be asked and decide. Then you should follow her wishes. If she is not lucid then, one would try to determine what would she want. Difficult decision when they can't speak for themselves.

[NeverSure]

Garry, I just read your OP again. I'm not sure if you said to what extent her health might possibly improve. If her heart and lungs recovered only enough to sustain life, but not enough for her to ever get out of bed and have anything like a normal life, that would be one thing. That's different from a chance that she might recover even more.

If "recover somewhat" meant that she'd be bedridden and unable to feed herself, I'd have to ask myself what kind of life that would be and how long it would go on like that.

In the end it's up to you. I'm sorry you're going through this and I wish for strength for you and in the end, peace.

[KarenBravo]

Asking complete strangers on an internet forum about such an important decision is totally disrespectful to your wife.

Ask her.........now. She's your wife fer chrissake. The only opinion that counts is hers.

Edited September 10, 2014 by KarenBravo

[konying]

Asking complete strangers on an internet forum about such an important decision is totally disrespectful to your wife.

Ask her.........now.

Totally agree.

Though it's rather strange doctors did not ask her in the first place .

I was in the same situation less than a year ago and doctors first asked my mother while she was "sane"

As she was out of it on pain killers they asked me.

I knew my mothers original answer so was easier to confirm her wishes.

Do not know if I could make a choice and live with it without knowing her wishes

[Basil B]

I would only ever agree to DNR if the person in question would not regain conciousness...

Thank god I hope I will never be asked that question.

Garry I am sorry for you and your family, it is an awful question to be asked.

[Gecko123]

GarryP:

Don't know where your wife is being hospitalized, but if she's in a government hospital, based on what I've seen, the resuscitation equipment is so minimal, the DNR question seems almost moot.

[Aussieroaming]

Jeez what a decision. Hopefully your wife spoke to you during better times and conveyed her wishes in the event something like this were to occur. I wish you and your family strength and faith to get through this time.

[GarryP]

Asking complete strangers on an internet forum about such an important decision is totally disrespectful to your wife.

Ask her.........now. She's your wife fer chrissake. The only opinion that counts is hers.

Perhaps, reading comprehension is not a strong point for you. I am not asking anyone what I should or should not do. As I have pointed out twice, a decision has already been made. I am simply interested in other people's views on the subject. Where is the disrespect in that.

FYI, the doctor asked me not my wife. Why me and not my wife? I do not know. I was simply put on the spot.

[MrWorldwide]

This a decision that I would never want to have to make on someone else's behalf, but I think it's as essential as writing a Will, particularly for couples. Apologies to the OP if he finds this image upsetting, but this is what I would like to have tattooed on my arm, regardless of the legality or otherwise of such a 'Will' in Thailand - the signature and witnesses seem redundant but there may be some legal requirement beyond the standard DNR tattoo. Having sat in the emergency room in severe pain last week this issue has taken on greater urgency for me.

If the mods elect to remove the image I would ask that my post be removed in it's entirety.

[HeijoshinCool]

FYI, my wife is only 49 years old, lucid, but severly malnourished and has both heart and lung problems and has trouble eating solid foods as a result of surgery for cancer of the tongue 4 years ago. However, there is a fair chance that with better nutrition she can overcome the heart and lung issues to some extent.

Forgive my bluntness, but based on that statement, I can not imagine why this question is being asked.

[krisb]

Gee mate, I feel for you.

Way to personal for this forum, you do what you feels right.

[NancyL]

I don't wish to appear callous, but why haven't the problems with nutrition been addressed earlier? She may have been better able to fight her illnesses with proper nutrition. I know 20/20 hindsight is great, but there are ways to ensure proper nutrition even when someone is unable to swallow. If the body isn't getting proper nutrition it starts to "eat" muscle mass and the heart is a major muscle.

How will proper nutrition be addressed in the future if she is resuscitated?

I'm sorry, but I've seen too many elderly expats here who suffer from poor nutrition because their Thai families don't understand their needs and then they fall sick with illness that could have been prevented if they had been properly feed by their families. Rice gruel is not an appropriate diet for the elderly and infirm.

[thaibeachlovers]

GarryP:

That's a terrible decision to have to make, and I can understand wanting to get the perspective of other people.

But good heavens, is this really the place you want to turn to for help with such a sensitive and intimate decision? Seems a little pointless to seek opinions here especially when there's so many unknown specifics and intangibles.

Can't imagine my wife being too happy with me if she ever found out I had taken a poll on TVF whether or not to pull the plug on her, and I'm just cringing when I think about the kind of callous comments you are likely to have to sift through in the process.

If it helps you get through what you're going through, I guess I understand. My prayers are with you.

Seriously, everyone should make their wishes known when they are able to do so and not leave it till such a situation exists.

I have told everyone that I do not want to be resucitated if I am in a coma, regardless of the possible outcome. Looked after too many people with terrible lives that were resucitated.

[thaibeachlovers]

This a decision that I would never want to have to make on someone else's behalf, but I think it's as essential as writing a Will, particularly for couples. Apologies to the OP if he finds this image upsetting, but this is what I would like to have tattooed on my arm, regardless of the legality or otherwise of such a 'Will' in Thailand - the signature and witnesses seem redundant but there may be some legal requirement beyond the standard DNR tattoo. Having sat in the emergency room in severe pain last week this issue has taken on greater urgency for me.

If the mods elect to remove the image I would ask that my post be removed in it's entirety.

I agree with you. I think I will get DNR tattood on my chest in English and Thai.

[kannot]

I arrived back from Thailand to the Uk 5 weeks ago, my Dad has had prostate cancer for 15 years, I hadnt seen him for 9 months.

I came back to a man in a lot of pain, curled up on the floor screaming in pain crying you name it. He had lost a bout 2 stone in weight.

My Mother hadnt a clue what to do, doctors said hes gonna die in 3-4 months or maybe tomorrow, they didnt know.

That was 5 weeks ago.

I changed his diet and a few other things which sorted most of the problems out.

Now he is fine pain has gone almost completely and his life is almost normal, he was begging me to die 5 weeks ago.

Doctor is now saying he could go on for years like this.

Sometimes when people say they want to die it just isnt the case.

Now my Dads very glad he didnt die but at the time he wished he was dead.

Everyones circumstances are different, only you will know.

[Sheryl]

In my experience, doctors do not ask this question unless they have good reason to believe there is no prospect for a decent quality of life. Especially not Thai doctors, assuming she is in a hospital here. (And BTW- from provincial hospital level on up they do indeed have resuscitation equipment).

There is a big difference between stopping treatment and deciding not to resuscitate in the event of cardiac arrest. Whatever chance of recovery or improvement she may have now is NOT what she would have in the aftermath of a cardiac arrest. From what you describe of her condition, she would not ever fully come back from one.

Assuming that she does not now have metastatic cancer or other incurable condition, my vote would be to go ahead with nutritional support etc. but not to resuscitate if she suffers a cardiac or respiratory arrest. ( If she does have metastases then personally I would question even nutritional support.)

CPR was originally developed for situations when someone undergoes a sudden respiratory or cardiac arrest from reversible causes..drowning, electrocution, transient heart arryrhthmias as may accompany an otherwise survivable heart attack, etc. Somehow it has morphed into standard operating procedure for all deaths, which it should not be, and the process of dying has been rendered much more difficult as a result.

[Beetlejuice]

I am shocked and appalled that the doctors would even ask such a question regarding a patient who has a hope of recovery.

Considering what the OP has explained, than there is no question to ask, meaning, every attempt possible must be made to save the OP`s wife until all hope is lost, especially taking into account that the lady is only 49 years old.

May I ask the OP; is his wife receiving medical care under the Thai 30 baht scheme or is she being treated under private care? Perhaps if on the 30 baht scheme than the hospital will only provide limited care under the scheme and if private, maybe the OP has problems financing his wife`s medical treatment that can be ultra expensive if the patient is not covered by any medical insurance.

My advice to the OP; to seek other doctors opinions at a different hospital and have her transferred if not satisfied with the hospital in question Or perhaps the OP has concerns about his wife`s future quality of life if she was resuscitated after a cardiac arrest?

Lots can be involved here as something like this is not cut and dry, and in order to give a sincere opinion, the OP needs to give some details as mentioned above.

Edited September 10, 2014 by Beetlejuice

[Sheryl]

Again,the doctors did not ask about stopping her treatment. They asked about what to do if, despite best treatment, her heart stops. That is an entirely different matter.

People whose hearts stop as the result of a prolonged chronic illness very, very rarely ever return to a reasonable quality of life. In fact, they rarely leave the hospital, period. From the condition described she definitely does not sound like she would recover to a meaningful degree after cardiac arrest. Of course treatment should continue if there is a chance of recovery or prolonged improvement, but performing CPR if despite best efforts she in effect dies (CPR only being done when clinical death has already occurred) , is another matter entirely and would almost certainly have no effect other than to draw out her death.

[Thongkorn]

Asking complete strangers on an internet forum about such an important decision is totally disrespectful to your wife.

Ask her.........now. She's your wife fer chrissake. The only opinion that counts is hers.

Some times a bit of advice from complete strangers, gets an unclouded answer, also maybe the poster just wants to talk, Dont be hard on him.

[geronimo]

If she is lucid and aware of the situation then it's her call.

[GarryP]

Thanks for all of your input. There has never been any question about stopping treatment for my wife.

I believe that Sheryl has hit the nail on the head with her detailed response. Recovering from illness with medicine and appropriate diet is very different to recovering after resuscitation.