A woman in a nursing home is in severe respiratory distress. History of COPD. Her lungs are decreased with an expiratory wheeze. Her SATs are in the 80's. The nurse's aide who gives me her paperwork says she is a DNR, but the papers haven't been signed by her doctor yet. I give the patient a breathing treatment but it doesn't help much. Her breathing is very labored and irregular. At the hospital, the doctor peers over his glasses at the patient's respirations then looks at the unsigned DNR I have handed him.
"Well, I think we should get this signed," he says.
We clear the hospital and five minutes later get sent back to the same nursing home and the same room. The patient in the other bed is an obese woman having a full seizure. She is bleeding from the mouth where she has bitten her tongue. She has a CVA and IDDM history, but no seizure history. Her blood sugar is fine. I give her two milligrams of Ativan, which stops the seizure. She remains unconcious.
When we get to the hospital, she starts seizing again. It turns out she has a massive bleed in her brain. While she is a full code, her roommate now a few rooms over has gotten her DNR signed.
Both patient's families gather by their sides in vigil.
One a DNR. One a full code. Roommates.
