SPECIAL ARTICLES

When the Purple Do-Not-Resuscitate Bracelet Was Slipped ontoMy Wrist

William R. Hazzard, MD

J Am Geriatr Soc 62:770–771, 2014.

Key words: reflections of aging; meaning of life anddeath; DNR bracelet

It has been only a few months since I declared in thesepages1 that, as a 75-year-old gerontologist crossing the

threshold to old age, I did not wish my life to end sud-denly but rather hoped to progress gradually through thearc of multisystem decline more typical of old age, endingin a “natural death” under the care of a compassionategeriatrician.

But that essay, like so much of what I have pro-claimed about the aging process, was largely a philosophi-cal, intellectual, futuristic treatise, an empathic exercisebased in scholarship and observation of my older patients,friends, and family members.

Little did I know at that juncture that my insights intothat process were about to change, abruptly and forever.For I was about to become a casualty of a “perfectstorm,” largely of my own creation. This had been brew-ing since I had flown across the country in a 16-hour,three-stop, three-time-zone nightmare flight to Lake Tahoe(at 7,000 feet elevation) for a 3-day geriatrics meeting, fol-lowed by another 3 days driving in a rental car meander-ing about the High Sierras, sleeping in the car a couple ofnights (brrr!), returning on a similarly complicated, grue-some itinerary back to Winston-Salem, coming down thenext day with the worst upper respiratory infection I couldremember, and spending a long weekend cooped up in myapartment while it ran its course. I was finally on my way

back to the Wake Forest Baptist Medical Center when sud-denly I could not manage the gentle slope between myparking place and my office in the J. Paul Sticht Center onAging. I struggled mightily with each step, required multi-ple stops en route to catch my breath, and finally collapsedinside in a chair just a few feet from my office. Fortunatelyfor me, a friendly greeter had spotted my struggle andimmediately alerted the staff in the clinic nearby. A smallhorde of professionals led by Jeff Williamson quickly des-cended on me, barely conscious and struggling for breath.I was rapidly assessed and moved upstairs to the AcuteCare for the Elderly (ACE) unit. There my condition wasquickly stabilized, and over the next 6 days, I received theexpert and humane care for which the unit is justlyrenowned. My attending physician, Kate Callahan, one ofour astute geriatric junior faculty, was right on top of thecase and convinced me to undergo evaluation for her lead-ing clinical diagnosis: a life-threatening pulmonary embo-lism (despite the absence of antecedent symptoms of leg orchest pain).

My most sobering, profound, and instructive memoryfrom all this drama took place shortly after emergencyacute pulmonary artery imaging (which demonstrated largebilateral occlusions but, thankfully, not in a saddle config-uration) confirmed her suspicions, and enoxaparin antico-agulation was immediately established. At that point, Katereviewed my diagnosis and its implications for me. Shelooked me squarely in the eye, and asked, “If you shouldsuffer cardiac arrest and be judged to have zero chance ofrecovering your cognitive and executive functions, wouldyou want to be resuscitated or placed on life support?” Towhich I managed to respond, as emphatically as I could,“No!” Whereupon she gently slipped a purple “DNR”bracelet on my wrist, and in that moment my thoughts onmy own life’s end were changed forever.

Suffice it to state without all of the other gory detailsthat I fortunately survived all of that trauma and dramawith a deeper appreciation for the gift of each day of mylife. During those days of close monitoring and clinicalassessment, I greatly appreciated Kate’s remarkable careand respect for my privacy and confidentiality, includingour daily, thoughtful discussions about my status, develop-ing conjoint decisions about each test or procedure to beundertaken (or not). Gratifyingly, I have since recoverednearly 100% of my previous vigor and ambition, and I

From the J. Paul Sticht Center on Aging, Wake Forest School of Medicine,Winston-Salem, North Carolina.

Address correspondence to Professor William R. Hazzard, Section ofGeriatrics and Palliative Care, Department of Internal Medicine, J. PaulSticht Center on Aging, Wake Forest School of Medicine, Medical CenterBlvd., Winston-Salem, NC 27157. E-mail: whazzard@wakehealth.edu

DOI: 10.1111/jgs.12743

JAGS 62:770–771, 2014

© 2014, Copyright the Authors

Journal compilation © 2014, The American Geriatrics Society 0002-8614/14/$15.00

have added only one medication, warfarin (hopefully foronly the next few months), to my handful of inexpensivepreventive drugs that I have taken each morning for years.

So what did I learn from this ordeal? First, look afteryourself! I had experienced a textbook case of venousthromboembolism that should be easily diagnosed by anythird-year medical student or first-year resident, and witha little attention to my own situation, I should have beenable to prevent the whole catastrophe. So do not takehealth and life for granted, and pay attention, dummy!

Just as important, I have converted from having had adispassionate, vicarious empathy for my patients, theirsupporters, and other old folks in their struggles with theproblems of aging and the end of life and now—through agruesome experience—having gained the true insight andsympathy that perhaps only a near-death experience canimprint indelibly on one’s heart and soul. In the process, Ihave become much more attuned to issues of family, faith,forgiveness, hope, humility, and even afterlife that anyonefacing death must confront and process.

By way of reconfirming with emphasis borne of mynewfound wisdom what I proclaimed in these pages just afew months ago—I do not wish to die suddenly or, espe-cially, so soon, for I believe that I still “have miles to gobefore I sleep.” To depart so suddenly would preclude anyopportunity to approach the end of my life as an old manin a more-gradual, indeed more-typical and gratifying fash-ion. Already I am urgently reprogramming my thoughts,

time, and energies, and I am mapping the course of myremaining time on earth in a fashion that I hope will resultin a more-balanced “bottom line” for my life when Idepart. My time to achieve this balance is running evershorter, however, and I must not procrastinate.

In the end, I wish with more-informed and deeper pas-sion that the potentially bumpy and erratic course of myfinal journey will be buffered through care from compas-sionate, expert professionals, allowing me to come to clo-sure on questions of love and family and spiritualism andacceptance, leading at the end to a “good death,” and—asKate so wonderfully demonstrated—I hope with even morefervor that my physician during those last days will be ageriatrician.

ACKNOWLEDGMENTS

Conflict of Interest: The author certifies that there are nofinancial, personal, or other conflicts of interest with thispaper.

Author Contributions: Dr. Hazzard is solely responsi-ble for all aspects of this manuscript, which will appearonly in this journal.

Sponsor’s Role: None.

REFERENCE

1. Hazzard WR. As a gerontologist enters old age. J Am Geriatr Soc 2013;

61:639–640.

JAGS APRIL 2014–VOL. 62, NO. 4 DNR BRACELET ON MY WRIST 771