- DNR for a Survivor
The forms sat on my kitchen table for months. As the days went by, mail, newspapers, bills and various household items slowly covered them, like an archeological dig. Hidden but not forgotten, the DNR forms gnawed at me, even as my procrastination grew to monstrous size. How—how—could I make my mother DNR? How could I make this woman, a Holocaust survivor, who endured unimaginable horrors, who held on to life with legendary ferocity, how could I officially stop her fight for life? Yet I knew better, as a doctor, as a teacher of medical ethics, I knew what to do. The trouble was doing it.
My mother lived through the Warsaw Ghetto, the Majdanek death camp, starvation and degradation. But could she survive the nursing home down the street from my house in suburban Chicago? She liked to say that one mother can take care of ten children, but ten children can't take care of one mother. This saying resonated with me in the months of her decline, and in the making of the ultimate DNR decision. I struggled to take care of this decision—ironically, I had led so many end–of–life discussions with families as an emergency physician, as a fellow in medical ethics, as chairman of my hospital's ethics committee, and as a college lecturer in medical ethics. I certainly knew much about this decision. Knowledge is one thing. Saying goodbye to a force of nature is another.
My mother was born in 1924 to a middle–class family in Warsaw. She enjoyed the usual girlhood pursuits, ice–skating, French lessons, girlfriends. All of that came to an end when the Nazis invaded Poland in 1939. Her high school closed, and she always spoke sadly of how she couldn't finish her education. Her gentile friends avoided her. Soon, she and her family were forced into the Warsaw Ghetto. Her father and brother were taken one night, never to be seen again. She survived, miraculously, alongside her mother, in various concentration camps, including Majdanek, specifically designed as a death camp. She didn't speak much about the war in later years, often dismissing our childish questions with a wave of her hand. I do remember when we asked how she could get through all the horrors, she once said, "We wanted to live."
Life in America brought safety, comfort, and for her children, an abundance of food. Years of starvation instilled a great respect, a near insanity, about eating. Being hungry was perhaps one of the greatest misfortunes to befall our easy American lives. In later years, we nicknamed her "the food police," as she inspected everyone's plate to ensure no one wasted any of her delicious cooking. Fondly, I do recall that after I was accepted into an elite Eastern college—during my interview there—after excitedly telling my mother I had been accepted, she congratulated me, but quickly added, "Did you have lunch?"
This was a formidable woman, in so many ways. My father came to call her "The General," [End Page E1] and after some fifty years of marriage, he had learned his marching orders well. Life had been inconceivably cruel to her, yet she never whined, rarely did self–pity enter her vocabulary. Her entire family was gone. "Hitler," as she used to say, "killed my family." Her children, and later her grandchildren, were her focus. She cultivated her garden, literally and figuratively. With a green thumb, she could bring plants back from the dead, or so it seemed. She lived, she loved, and she was loved by many.
And so, when I would get phone calls from the palliative care nurse, I hemmed and hawed, and promised to get back to her. My mother's health had declined to the point she needed full time nursing care. Palliative care was consulted to help with various pain issues. What is her code status, they asked. Initially, when she wasn't doing so poorly, I figured I'd make her a full code, knowing we could always withdraw or curtail therapy based on her clinical condition. With time, she was getting weaker...