Do Not Attempt Resuscitation

The community nurse came to see us yesterday and while here gave us a DNAR form; "as agreed" she said as she handed it to Mum. DNAR stands for 'Do Not Attempt Resuscitation'. It only refers to Cardio Pulmonary Resuscitation (hereafter CPR), not any other continuing treatments which remain in place. Basically it removes the obligation of any visiting healthcare official to perform CPR on Dad if his heart or breathing stop as a result of the progress of the melanoma. It is written and signed by Dad's doctor. Mum and i both believe that when faced with this situation, it would in fact be kinder to let Dad go, rather than to prolong him, probably only briefly, in hospital, having suffered great physical trauma and most likely in great discomfort. So we are not opposed to the form. We were both surprised however, to be presented with this form, without anybody having mentioned it or discussed it with us previously. At the time, since the nurse referred to the form as having been 'agreed' I assumed they had previously discussed it with Mum, but she was as surprised to see it as i was. i thought she was quiet. Advance directives and DNAR forms provide a means for patients to communicate what sort of medical treatment they would prefer to receive if they reach a stage in their illness where they are lacking the mental capacity to make decisions. When Mum and i both hold power of attorney for Dad it surprised me that the doctor didn't even mention this form when he was here a few days ago. He is their GP and as such has had a relationship with them for several years prior to the past few months. We were both quite shocked to find ourselves, without warning, holding a piece of paper instructing people Not to attempt to resuscitate Dad. However, although advance directives are often completed by ill people, DNAR forms can also be completed by a doctor, independent of any input regarding the patient's wishes, on the basis that in the final stages of incurable illness, CPR is unlikely to be clinically successful. Clearly that is the situation we are in and as i said, we do not contest the decision, as on balance we think it kinder to Dad. We are still a bit shocked though; wouldn't you try to warn the patient's family and discuss it, or at least explain the decision, rather than just hand it over?

What's the time Mister Wolf?

Dad's steroids have been increased again and that along with his absence of headaches, on account of the morphine, made him pretty chirpy today. I managed to get him sitting upright, take his medicine and eat a bit of dinner as well as some pudding. Mum made a bit of a breakthrough yesterday. She has been taking Dad meals in bed for the past few days and found he hadn't eaten much or sometimes anything. But yesterday she spoon-fed Dad and found he ate far more. She suspected he was feeling too weak to bother and was desperately worried that the end was very very near. But we now think that the cognitive process of knowing you must lift the food and put it into your mouth was perhaps disrupted. Either way, tonight he fed himself the pudding (yoghurt). Realistically, this could just be down to his increased steroid dose (they increase perkiness and give you a false appetite) but we are very relieved he is eating again (and Mum is glad she didn't manage to starve Dad simply by not helping him to eat the meals!)
Dad is still very muddled. He still refers to the remote control as the 'screwdriver' and is keen to know where it is at all times, even when the television is turned off (and he doesn't want it turned on.) I tease him gently when he says things that make no sense and he laughs at me. When he laughs though he screws his face up as if in pain because his face is less fleshy than it used to be. That has taken some getting used to. The doctor has decided not to proceed with Dad's radiotherapy for the metastasis on his left side. The effects take a while to become apparent and it could bring Dad more discomfort while not guaranteeing any benefit. We have been advised that Dad probably has 'weeks' ahead now rather than 'months' so bringing him extra discomfort at this stage seems unfair.
I chatted with Dad a bit tonight. Knowing his interest in Barbados since we lived there, I told him about hurricane Tomas which has just wreaked havoc in Barbados and which is currently battering St Lucia and on it's way to Haiti. I showed him the coverage of Qantas' A380's engine explosion in today's paper too and he asked if my boyfriend's sister was worried about 'her planes falling out of the sky' She is Australian (like my boyfriend funnily enough) and met Dad when she was here in September (so recently flew to Australia) Maybe that's why he said that? Dad also made an extra effort i noticed, to sound normal when speaking to Grandma on the phone earlier. Dad has these glimpses of himself and of alertness which peep out from behind the fog of confusion from time to time. Which reminds me, he can no longer tell the time. I spotted him looking at his watch earlier and asked him what the time was. His response was to look at his watch again, fold his arms across his chest, announce "I couldn't tell you" and then laugh.