Sometimes it’s What’s on the Refrigerator Door That Really Counts

Sleepless in Seattle?  No, this geriatric care manager was slightly sleepless in New Rochelle, New York. The reason? An elderly client’s Out of Hospital Do Not Resuscitate was about to expire and the newly signed document had not been received. The current one is taped to the front door of the refrigerator and each aide who cares for my client knows its exact purpose.

Depending on the circumstances, hospital personnel may ask the health care agent to consider signing a Do Not Resuscitate (DNR) for the duration of a patient’s hospital stay. Should the family wish for the continuation of the DNR upon discharge, an alternate form is used in the home: The Out of Hospital Do Not Resuscitate. The form is specific to New York State.

The Non Hospital or Out of Hospital DNR document informs the EMS providers that in the event of cardiac or respiratory arrest, no chest compressions, ventilation, defibrillation, intubation or medications will be provided to extend the life of the individual. If the person is not in cardiac or respiratory arrest, full treatment by EMS providers will be given.  Put another away, this form becomes effective if the heart and/or the lungs have stopped pumping.  Should these conditions exist without the presentation of this form, CPR will be initiated.

The document itself is quite simple. It states the name of the person, date of birth and expresses the wish not to be resuscitated.  It is signed and dated by the doctor along with his/her license number.  The form can be downloaded at: www.health.ny.gov/forms/doh-3474.pdf . While it should be reviewed every ninety days, as long as it remains posted it is considered in effect. Neither a living will or a health care proxy can take the place of the Out of Hospital Do Not Resuscitate.

Understandably, not all families are interested in having such a form in the home. And often, even with the form present, in a moment of panic a family member will chose to have a spouse or parent resuscitated. Nevertheless, for those families who are intent on limiting further treatment this document is essential.

Thinking Gratitude in Westchester County

Sandy showed her wrath early on here in Westchester County, New York. In New Rochelle, where my practice is based, by five o’clock on Monday, my office was approaching darkness. Only a week left of daylight savings time, the extra hour gave me time to situate my flashlight and put the files I would need into order. Clients and their aides, all spread throughout Westchester had been called. I was ready, at least in practical terms.

But readiness and long practiced habits were hard to change. It was that darn light switch that proved most daunting. For ten days, with a three day interruption for a trip to Chicago, each time I entered the room I attempted to turn on the light. If the cold of my office was not enough of a reminder, the unresponsive switch sealed the deal. Fast forward to November 9 at 4 PM. “And on the tenth day Con Edison said let there be light, and there was light.”

Getting accustomed to now having the light respond to the motion of the switch, made what was once a thoughtless action into a mindful act of gratitude. Not only the light, but the ring of my phone, the movement of the hands on my clock, the sound of my pencil sharpener grinding a new point. All things one takes for granted took on a new dimension. Whether by coincidence or a gentle reminder, once reconnected with my computer, I received the quote below. Ten days, so much lost and so much gained.

Can you see the holiness in those things you take for granted – a paved road or a washing machine? If you concentrate on finding what is good in every situation, you will discover that your life will suddenly be filled with gratitude, a feeling that nurtures the soul.

Rabbi Harold Kushner