My dad’s mom had surgery the same day as the memorial service for my mom’s mom, and she had a hard time (as a matter of fact is still in the hospital now, 3 weeks later). That’s why I haven’t been around much; it was pretty hairy there for a while, and when it looked like I was going to lose both my grandmothers in about a month and a half, I flew down to LA to see her.
There are a few things I’m going to talk about related to seeing my grandma in the hospital, but I’m going to start with advanced directives because, well, that was the last entry I wrote.
Grandma Barbara has a Do Not Resuscitate order (no CPR, no intubation, no nothing). This makes sense because she lives in an assisted living facility, and it’s quite likely she could have an event and not be found for hours, and she doesn’t want people to try to resuscitate her after hours of brain damage have already occurred. She also has a no antibiotics order on her DNR, which sort of makes sense, because assuming the picture Grandma had in her head of how she is going to die, antibiotics would only be used to prolong her life, not to make her better.
Well, then Grandma needed surgery. It’s common, at least at the UWMC (which is not where my grandmother is, and if it were, she would be getting much better care, I think), for doctors to suspend DNR during surgery.* But that suspension normally ends when the patient is 24 hours(ish) out of surgery. Well, my grandma wasn’t recovering all that well, so she and my aunt, who is her durable power of attorney for health, agreed to continue to suspend the DNR. Also, I’m not sure why, but it took the docs 2 full days to start treating her post-surgical pneumonia and urinary tract infections with antibiotics. I think, though, that the delay might have been because her DNR said no antibiotics, and there was a period of time when although the family thought the DNR was still suspended, the doctors might have thought it was reinstated.
So, there are two problems with this whole scenario. One is writing advanced directives that only account for the most likely way you’re going to die. Don’t assume you’re going to fall over from a massive heart attack. What if you get hit by a car? What if you get pneumonia, or sepsis from a massive infection that’s potentially deadly, but equally potentially treatable? The other problem is not having a living will in place as well.
In my opinion, the place for requests like “no antibiotics” is the living will. The DNR needs to be a black and white document so people immediately know whether to start CPR, intubation, and ventilation or not. The living will is the place for gray areas and if . . . thens. It’s there that you can say under which circumstances you do and do not want antibiotics, or any other care. Also, having a DNR does not negate the need for a living will: there are many circumstances under which you may be unable to make your own decisions, but you don’t need resuscitation. And, if you’re going into surgery, you should review all of your advanced directive and make sure they are relevant to the most likely things to go wrong during the surgery.
Also, remember that your living will and DNR are meant to take care of you. If you are even halfway with it, you can revoke either or both at any time. You can also insist they be followed. You just want to make sure they tell the medical staff to do what you think they tell the medical staff to do.
I don’t mean to blame confusing advanced directives for shoddy care, though. Any medical staff worth their salt would check that the decisions they make based on the advanced directives with the patient and/or family to make sure that’s what the desired outcome was. Advanced directives don’t allow the medical staff to abdicate responsibility.
*This is not doctorly arrogance. There are many ways a person can try really hard to die in surgery, and very few of them have anything to do with how ready their body is to fail outside of surgery.







YAKIMA – Nancy Ann Tobin Putney Faller, 83, died July 17, 2010, at Yakima Valley Memorial Hospital. Nancy was born on September 22, 1926, in Sioux Falls, South Dakota, to Carrie Farmer and Tom Tobin, a Notre Dame graduate and Irish road construction contractor. Her father died when Nancy was seven. Two years later, her mother married Ellsworth Putney, whose daughter Virginia “GeeGee” Putney became the “sister of love” Nancy had longed for.
In 1961, Bill became the football and baseball coach at YVJC and the Fallers moved to the house on Barge Street which remains the family base. While Nancy had always worked to keep the promise she had made in World War II, it was in Yakima that her community activism became a way of life for her.






