DNACPR: a personal illustration. I see a lot of terribly worried and anxious people on social media, and so many misconceptions DNR decision making. I want to share a story about someone I loved, to help if I can. @doctor_oxford @drkathrynmannix 1/13

This is my Auntie (great-auntie) Rachel, legend of a hundred and one family stories. Escapades chasing escaped rabbits. The time she took my mum and her teenage friends around Europe. Her suppers, her houseguests. Her unwavering devotion to others, her stubborn independence. 2/13

Auntie Rachel helped raise my mum and my uncle and then helped raise me and all my cousins. She was clever and funny and loved us and we loved her. She had a DNR order in place for years, but that did not stop her having her hip replaced when she broke it. Twice. 3/13

She threw herself into physio and was back riding the Brighton bus in an incredibly short period of time. It didn’t stop her having surgery for an early cancer when that was detected. She was admitted to hospital several times with chest infections and she always bounced back. 4

Her DNR went with her every time and she was very particular that it did, but it was never needed. We joked that she was indestructible. Sadly, over the last year she started to struggle more for breath. One day her oxygen levels dropped very low and she was rushed to hospital. 5

I was on call in my labour ward in London when the nursing home called to tell me. My first thought was that it must be really bad because she would have resisted being taken into hospital in normal circumstances. I dropped everything into the hands of my work family and drove. 6

When the family converged, Auntie Rachel from her bed brightly asked why we had rushed down. She was being given oxygen through a BIPAP machine, a type of non invasive ventilator, and with her oxygen levels better than they had been for months she was sharp and to the point. 7/13

She told me to go back to work and stop fussing and dispatched Mum to source Soduku. Tests showed that she didn’t have a new infection, just that her lungs were scarred and worn out from all her past infections and her brains drive to breathe was failing. 8/13

The BIPAP, an uncomfortable device forcing air into her lungs, was keeping her alive. She didn’t want to wear it forever, and neither BIPAP nor a ventilator could have corrected the underlying problem. The medical registrar on the ward very honestly and compassionately explained9

this to her, to my mum, to me by phone. She knew she didn’t want to stay on it, she wanted to go back to the nursing home and rest there until nature took its course and her oxygen levels drifted down again. We took her home. 10/13

We had two weeks of visits, time to read and talk and pray together. On her last day, she asked me to sing for her. I sat with her and my grandmother, singing her favourite hymns as she peacefully passed away. This is what we would all wish for our relatives, for ourselves. 11/13

This is what I wish for my patients. Love, and family, and birdsong outside. Not pain and fear and assault by arrest team. DNACPR is not eugenics or euthanasia or anything apart from the recognition that CPR for this person would be degrading and futile. 12/13

Auntie Rachel didn’t have Covid-19, but she walked a path that many are now on. My grandma lives in the care home and I haven’t been in weeks. I miss her, but am reassured by her carers and by the knowledge that she too has a DNR to protect her, should the worst come to pass. 13.