The Sandwich Generation: What Does DNR Mean To You?

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Do Not Resuscitate Order Decisions

The last days of winter are upon us and you spent last Saturday morning talking with your son about his potential college choices and Saturday afternoon with mom. During the conversation with mom, she spoke of her friend’s experience and the plans she made in case she needed drastic medical intervention. Being proactive, mom wanted to have this type of tough but compassionate conversation with you. Life today is active, especially for women aged 45 – 56 who care for both their parents and children. These people are caught in the “sandwich generation” and these columns are focused on issues affecting you.

What exactly does “do not resuscitate” (DNR) mean to you? This can be a real problem as it may mean something totally different to your brother and sister. Like most people, mother was saying that she did not want to be kept alive if her mind was gone and there was no hope. So, when does a person reach that specific point? Is there “that specific point” and if so, who will make that decision? Unlike the old movies, people aren’t energetic one moment and just close the eyes and be gone the next. Death can be more of a process where people change ever so slightly day by day. So, what kinds of questions can be asked to help more establish this line?

If someone’s heart would stop during surgery, what is the likelihood that they would come back to 80 – 90% of where they were at previous to surgery? What would be the goal of a feeding tube? How long would the feeding tube be placed and what happens if that person’s condition worsens? When do we stop aggressively treating a person and start treating with the goal of keeping a person comfortable?

Now a little more work needs to be done from this discussion. All immediate family should be included in this discussion, but some may choose to ignore this difficult talk. After attempting to include them, perhaps a loving letter can be written by mom to that person to declare her intent for aggressive treatment or her choice to not be so aggressive.

If one wishes to have a signed DNR, the form, itself should be on red or pink paper. It should be posted in a conspicuous location such as above one’s bed, on their refrigerator or door. It should also be given to all doctors, presented at a medical facility prior to surgery and a copy kept in your purse or wallet. While this subject brings out all sorts of emotions, gaining a clearer understanding of the wishes of a loved one may provide peace and direction in the future.

Helping mom and dad and caring for your children simultaneously is not easy. It is very helpful to discuss and plan for reasonable future events, and a sandwich generationer should guide their parent through these issues and the primary issue of safety, while being careful not to take all control away from a parent. Once again, it is important to start talking, making suggestions and guiding early, do not wait for a crisis. If you would like a list of “questions to ask in different aspects of care” see our website and look under the “Patient Advocacy Division”.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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