He seemed like his usual self, strong willed and irreverent, with his gravelly voice and nicotine stained fingers, and as always tied with clear plastic tubing to the oxygen concentrator on the back of his wheelchair.
He is a DNR, Do Not Resuscitate. But during his last hospitalization he ended up intubated and on a ventilator for several days.
His daughter gave her version of what happened and the discharge summary was less clear cut. So I turned to him and asked:
“So what happened? How did you end up on a respirator as a DNR?”
He answered “I said HELP ME, and that’s what they did”.
“I think the doctors panicked when he said that”, his daughter concluded.
“And would you want that to happen if you say HELP ME again?”
“No.”
“So when somebody can’t breathe, there are sometimes only two options, sticking a tube down their throat and hooking them up to a respirator or giving them morphine to treat the agony and anxiety of the process.”
I glanced over at his daughter and then looked him straight in his eyes.
“So, let me make sure I hear you right. If you can’t breathe and say HELP ME, does it mean machine or morphine?”
“Morphine”, he said, emphatically.
I’m glad we had this talk. This very plain talk.
A Country Doctor Writes: 
Unfortunately, you are unlikely to be there. It’s better to not go to the hospital.