Confusion in the Operating Room
One Sunday last summer, Sara Frommer’s back pain was so severe, she called an ambulance, carrying a physical copy of her D.N.R. order aboard. Once at the hospital near her home in Bloomington, Ind., an X-ray showed that she had a spinal fracture and would need surgery to repair and reinforce the bones. Ms. Frommer, who is 86, told her surgeon she understood that typical hospital procedure meant suspending the D.N.R. during surgery. “I said, ‘I hate that, but I get it,’” Ms. Frommer recalled.
Still, she worried that CPR would break her fragile bones, already weak from osteoporosis. “I know what happens when they’re trying to resuscitate you by pounding on your chest, and that would leave me in really, really bad shape,” Ms. Frommer said.
Ms. Frommer’s surgeon did not have time for a longer discussion. She was prepped for surgery the next day, and her D.N.R. was suspended for the time she would be on the operating table, according to standard procedure. Though the surgery went smoothly, Ms. Frommer never knew there were other options.
“A lot of doctors have discomfort with what we call iatrogenic reactions,” complications that arise from medical interventions rather than underlying conditions, said Wendy Kohlhase, a bioethicist who consults at six California hospitals. Many doctors suspend D.N.R.s for surgery so that they have the freedom to correct these easily reversible problems when they arise in the operating room.
For example, an allergic reaction or a severe electrolyte imbalance can stop the heart, issues that can be fixed during surgery with medications and chest compressions that wouldn’t be allowed under a D.N.R. Anesthesia suppresses breathing, which could require the surgical team to intervene and take over respiration, usually by inserting a breathing tube, which is prohibited by a do not intubate order, said Dr. Jeffrey Jackson, an anesthesiologist at Indiana University Health.