Mancini’s health care team and having their questions answered, they realized that this was their mother’s choice and that they were fortunate to be with her at the end. Her family was understandably distraught, but after meeting with members of Mrs. Mancini called her family to tell them the news. Mancini concluded that she was ready to have DNR orders instead of waiting to die from lack of dialysis, she would stop taking her heart pressors and she would be given a sedative by her doctor when the time came, so that her death would be as painless as possible. “What’s going to happen to me? Am I going to be in pain? What am I going to do about my family? How long do I have before I have to make this decision?” She was teary-eyed, but after spending several hours with the social worker, nurses and the doctors, Mrs. What we can do is assure you that we will make you comfortable, be honest with you, and make sure whatever questions you have are answered.”Īfter a moment of silence, Mrs. Unfortunately, we don’t have many options to offer. We need to discuss where to go from here. If you stop your heart medication, your blood pressure will not be regulated. You can no longer receive dialysis effectively because of your failing heart. Mancini, it’s time to make some tough decisions. Mancini’s health was failing and that it was time to discuss the next steps with her. This medication was only a short-term intervention and did not resolve the long-term concerns related to her severe hypotension which compromised her ability to safely receive dialysis. Her cardiomyopathy and severe peripheral arterial disease necessitated use of pressors that had to be administered in an inpatient setting. Who knows, these things might keep me alive long enough for them to find a cure for what ails me.” “Ya know, I’ve been thinking, if I ever get really sick, I think that it would be best if I had CPR and a respirator. Mancini was encouraged to share her wishes with her daughters and her brother. But no, no CPR-I don’t want to just be some vegetable.” The team was in agreement with this plan, and Mrs. “I guess I don’t want any life support, except for dialysis-if it would even make a difference. Mancini document her advance directives and assisted her in choosing which medical procedures she would want in the event of a medical emergency. Mancini’s case since her admission three months ago.ĭuring that hospitalization the care team helped Mrs. Hayden, a first-year resident, who had been monitoring Mrs. Mancini was well known to most of the critical care unit staff, who were familiar with her extended hospital stays and many comorbidities.
On a few occasions her blood pressure dropped so low that she had to be given intravenous vasopressors in the intensive care unit. She required dialysis almost daily, but her worsening heart function was complicating the situation. Mancini was in the hospital for her third admission in three months.