HOW SHOULD A “DO NOT RESUSCITATE” BE HANDLED IN THE ER WITH THE MENTALLY ILL

Our parents always taught us to respect people who were older than we were, anyone who was a professional or businessperson and Doctors. We said Mr. or Ms. and Dr. so and so. I never called my friends parents by their first names even when asked to. My friend W is the exact same. She called my mom Mrs. C until the day she died. Although my mom was funny, she wanted all of our friends to her mom. I didn’t like that. For those of them that came from shitty homes it was a wonderful thing. She cooked for them, made sure they had school supplies, and even clothed some of them. A few never forgot it and took her death as hard as we did. Honestly, I resented a few for it.

I was also taught that Doctors were right and to TRUST THEM. That one has come back to bite me in the ass more times than I can count. I do not trust any Doctor. I do not care if he has worked on the most famous bowels and bones in the World. I still do my research and learn what I can. I also request a copy of any MRI/CT scans with the findings. Doctors have a habit of leaving stuff out. They also will mention something in passing that leaves you sitting there thinking WTF? Am I supposed to worry about that or not? Then you can’t reach them.

The problem is I had all the signs of something bigger going on that no one caught on to. It could’ve prevented me from almost losing my life 6/23/15. When I went to the ER a nice Dr. O’Connell treated me and knew the results firsts. I was surprised when I read them myself recently. “Patient came in with Significant Threat To Life”. As a Bipolar Person that’s hard to read. Your entire life is spent feeling like you want to die and then death is there.

I remember him telling me to call my family and tell them to come to the Hospital as soon as possible. As usual no one answered. The only one with an excuse is my dad. He was in Dialysis.

A nurse came in next and asked in one breath if I “wanted to see their priest and sign a DNR”. Uhhh…..scuse me? I said “I’m an Atheist and I’ll sign the DNR”. Why not? My family couldn’t bother to pick up the phone, I wasn’t getting any better mentally or emotionally, so let the chips fall where they may. I was being wheeled from room to room, having a million tests, I was in and out of it, at some point I signed the DNR paper. It was in my chart that I am Bipolar with Conversion Disorder. I had actually spent a few weeks in their psychiatric ward when I was in my late teens.

At some point the nice Dr. came over to me. He had a chance to look at everything including the signing of the DNR. He had tears in his eyes. He pulled a chair close to the hospital bed. He told me “I’m not going to lie to you. I know you’re too smart for that. It looks bad right now. You are in Kidney Failure and we don’t know why. If we don’t find out soon and do something it will start to affect your other organs. I have to ask you, did you really want to sign this DNR?”. I asked him if it mattered. He replied “To me it does. Your kidneys have probably not been working right for a long time. This could’ve had an impact on your medications. I want to make sure that you are making this decision with a clear head”. When I heard that my kidneys could’ve been interfering with my medications it changed some things for me.

Then in one hurricane like moment my twin sister descended upon me. I literally mean she descended upon me. She didn’t watch out for the tubes, needles, or wires. She had me in a death grip and was sobbing. That was the second thing that changed my mind. When I told her I had signed a DNR she was furious. For once not at me.

Which leaves the question, in emergency situations should people with a history of Mental Health Issues be asked whether or not they want to sign a Do Not Resuscitate Order? Should I have the right to make that decision on my own?

I think the smartest thing to do is unfortunately think ahead. You can’t plan for some things. When you feel you are at your best mentally and emotionally sit down with someone you trust. Talk it out and then write down what it is you want to do in case of an emergency. You can have it notarized if you want but I don’t think it’s necessary and give a copy to your Primary Care Doctor. You can also keep a copy on you.

You never think it will happen until it does. You never know where your emotions or brain will be at when it does.

I told Dr. O’Connell “Most of my life I’ve spent wanting or even trying to die. Now it’s a real possibility and I feel numb about it.” It wasn’t until after I saw my sister that I realized I wasn’t numb I was in shock and scared. He knew that and I thank him for it.

What Your Doctor Might Not Know

At my last Dr.’s appointment I had mentioned Ketamine to my Psychiatrist. He said no one was doing it and FDA approval was probably 5 to 6 years away. I mentioned to him that there is a doctor in our state using the nasal spray version for pain management. He looked at me funny and said that he “didn’t think this was true”. I had the doctor’s name and gave it to him. He is well known not just in my state but also New York and Massachusetts. I had a feeling patients were seeking him out for the use of the ketamine nasal spray for more than pain management it just wasn’t being disclosed. I also told my doctor that his own hospital had done a study on it. He didn’t know.

This drug, once the side effects are taken care of can lift a Bipolar patients Depressive state within 10 to 20 minutes in most cases. Right now there are ketamine clinics across the U.S. but you have to stay and be monitored while it is being done. Most clinics do it through transfusion and are using the version with the hallucinatory side effects. It is my understanding that the nasal spray does not have these side effects but may not be as effective.

Regardless, if this was another medication for erectile dysfunction it would already be on the market. The drug reps would be pushing it like candy. Because the people who take that type of medication are usually middle aged Caucasian men with good health insurance.

The people who usually are portrayed as taking psychiatric meds are poverty stricken, homeless, with no health insurance or are on State Assistance or Medicare.

The estimated cost of 1 ketamine infusion is $500. You need more than one and insurance doesn’t usually cover it. But they will cover ECT. Which does help some people I personally found it barbaric.

The other problem is finding a good doctor that is educated and open minded about your diagnoses. If you have Medicare good luck with that. The entire system is set up to encourage you to give up. I have a fairly decent education, I could barely fill out the forms. The hundreds of pages that are required. Then to go before a judge only to be humiliated by his snide remark “what? Didn’t you take your meds today?”. Then laughing. While my father sat in the back of the room with tears in his eyes and his fist balled up. It’s a good thing I had a lawyer to speak for me, and boy did he. He said ” for your information she has Conversion Disorder also which causes her to stutter I spoke about this disorder on the Senate floor recently”. And that was that. I cried a lot that day. They still make me have reviews every year unlike everyone else who has them every 5 to 7 years. Even though I have gotten worse and have had 2 prominent doctors say I can’t work plus brain scans that show cognitive damage. But I’ll deal with it as it comes. I can try to change the system a little at a time as long as it doesn’t change me.