The following is a FICTION tale. I ask in advance for the pardon of those who do not share my black sense of humor.
And as the curtain rises...
The star of this show is Prudence, an 90 year old 80 lb. LTC Alzheimers patient, contracted, bedridden and poorly responsive. Prudence has an Advance Directive and an out-of-hospital DNR.
LTC Nurse: "Oh dear! Poor Prudence has a fever, crackles up to her earlobes, and is coughing yellow sputum! I fear she has aspirated! Prudence is a DNR, but because this is a change in status, I must notify Dr. Brilliance!"
Dr. Brilliance (arriving on a white steed wearing armour and a white hat): "This is indeed a change in status! Aspiration pneumonia is a potentially reversible condition. Transport Poor Prudence immediately to the ER!"
ER Nurse: "Great Scott! I have two code 3 ambulances arriving and a waiting room full of puking toddlers! I must transfer Poor Prudence to the Med-surg floor ASAP to make room for viable patients!"
Med-Surg Nurse: "Fie on the ER! They have sent me this patient with a blood pressure of 75/40, a heart rate of 140 and a respiratory rate of 36! Admittedly she is a DNR, but look at these orders! IV fluids, antibiotics, respiratory treatments, suctioning...clearly we are treating Poor Prudence aggressively, and I have five other patients. Can she not go to the ICU?"
ICU Nurse: "No, a thousand times, no! I have only one empty bed, and I am receiving a fresh MI from the ER! I do not have the room for a contracted, bedridden DNR! You must do the best you can."
Dr. Brilliance: "Behold! Poor Prudence is a DNR with a Directive, but she has aspiration pneumonia and she is clearly nutritionally challenged! Both of these are potentially reversible conditions. I must call my two faithful sidekicks! Dr. Gastro will insert a PEG tube and Dr. Pulmo will provide pulmonary support."
Sweet Penelope (Prudence's great-granddaughter): "Alas, poor granny! I would not want her to starve, or to struggle for breath. Yes, Dr. Brilliance, you must do what you can!"
Poor Prudence: "Good grief! I've put up with two days of this dreck, and I'm outta here! See you all on the other side!"
Sweet Penelope: "Oh, woe! Granny Prudence has croacked! What am I to do?"
Malpractice Lawyer (wearing black cloak and twirling his moustache): "Fear not, Sweet Penelope. I will take your case for gratis. If we uncover any substandard care among these devious healthcare professionals, we will avenge Poor Prudence's demise (and did I mention that we can make a boatload of moolah in the process?)"
Sweet Penelope: "My HERO!!!!"
And as the curtain falls, JeannieM comes running from the wings and flings herself, screaming, into the orchestra pit.