2 patients who are NAR died during my call few days ago. NAR stands for no active resuscitation, meaning that in the event of collapse or when the patient's condition is deteriorating, no active intervention like CPR or intubation will be done. When a patient is very old and ill with a lot of co-morbids and bad prognosis, the family members will be counselled for NAR. It is a choice that the family members would have to make, a very though one.
My specialist told a patient's family member that in view of a patient's co-morbids and old age, even if he survives this time, he would not live for long, probably a year or two. I couldn't imagine how hard it would be for them to decide. If it was me, i would want the extra year or two to spend with my loved ones. I would want everything to be done when it is still possible to do something. But then again, it would also mean prolonging the suffering of a patient. Standing at the patient's point of view is a totally different situation. During that year or two, there will be multiple hospital admissions, tubes and needles all over, multiple branula insertions and blood taking and painful bed sores all over the body. I have a patient telling me that she would rather die than go through procedures like endoscopy.
To counsel patient's family member for NAR seems cruel and believe me, it's not easy because you have to be gentle and use the right words at the right time. It's a whole new encounter for me because i haven't seen it done back in paeds posting. It feels like you are passing on a death sentence to another person. But i believe as much as it's difficult for me to deliver the message to the patient's family members, it's even harder for the family members to decide because ultimately their decision will literally speaking determine how long the patient will live or be kept alive. It's painful to decide to end the life of your loved ones, but it's also painful to watch them suffer in pain.
So, is it better to hold on or to let go? Seriously I don't know.. Letting go is never easy, but holding on could be just as difficult.