DNR

Walking into his office, my doctor looked at me and said, “I almost asked how you are, but after last week, I know.” In a way, he’s struggling more than I am with the murder of Renee Good. Everyone has a point at which they realize, on a visceral level, that it could be them. I’ve known that for a long time, but for Dr. P, who had felt safe in the bubble of his privilege, seeing a white suburban LGBT person killed was the moment. “I saw the stickers on her car,” he said, “and I know that kind of suburban lesbian mom.” I tell him about the march, and he says, “I think I really understand civil war now.” He explains that now he knows what it’s like to have a position on something that is so fundamental to who you are that there is no flexibility, no possibility for compromise. He asks what’s going on at work, and I tell him about my client, the ICU, the intubation, that I am thinking of making him DNR. He’s seen this plenty of times and he agrees with me, that resuscitating someone in this condition is not going to have a good outcome. Talking about the client makes me think of Mark who was also someone with AIDS, kidney failure, and an odds-defying knack for survival, and then I’m crying. Dr P has seen me much more of a mess, so he’s not too worried about it. Almost as an afterthought, 90he asks about my shoulder and I tell him how frustrated I am that now my non-injured shoulder hurts, too, and is making it hard to sleep. He agrees with my thought that if there’s a lot of arthritis in one, there probably is in the other, and adds the other shoulder to my physical therapy prescription. Then he gently pressures me to be better about actually going to PT. I know I should, my schedule has just been packed and then I’m in pain after, which keeps me from being able to get more stuff done. I promise to have Misty add it to my schedule, and he trusts Misty to keep me on track, so he is satisfied. Just as I get back to the office, the ICU calls. The situation is not good – they were hopeful about getting him off the heart medicine, but they couldn’t do it. They haven’t been able to extubate him either. He still has bacteria in his blood, but they can’t find the source, and now his white blood cells which were high, a sign that his body was fighting, are low. His red blood cells and platelets are, too. They want to replace his central line and his dialysis line in case they are the source of the infection. I agree to that, but then I carefully say that I think we’re getting to the end of the line here, and that he should be DNR. I can hear the relief in his nurse’s voice as she tells me they were talking about that among the ICU staff. It has to be a hard conversation for them to initiate no matter how much they do it, and some people fight it. “He would hate this,” I tell her, and she must have had him before when he was awake because she says, “I know he would,” and gets another person to confirm with me that I want to make him DNR. I put down the phone and Misty sees me shaking with silent sobs and comes over. I text his mother and explain as clearly as I can about his heart, the infection, etc. I am surprised by her response “Is this life-threatening?” The idea that she somehow didn’t understand that being sick enough to be in the ICU, never mind intubated, is life threatening is hard for me to understand. But I tell her that, yes, it is. I tell her Jeff, the volunteer, is offering to drive her to see him, but she says that she and - her brother? The client’s brother? – anyway, someone else, will take an Uber to see him tomorrow.