You do understand about DNR? Don't you? Don't you?

Four years ago, my mother underwent a routine hospital procedure to verify the suspected presence of an ulcer. Strong-willed in every inch of her five-foot frame, at seventy-three she had suffered no major health problems. Yet she was failing. For years we had been unable to persuade her to eat properly. Whenever I delivered homemade meals, often her own recipes, she'd take a few bites or say, "I'm not hungry right now. Just leave it in the fridge." The plate usually remained untouched. As her ailing joints began to make cooking a hardship, I applied to Meals on Wheels, which Mom promptly canceled. She didn't like gravy and couldn't trust anyone to remember not to serve it to her. Meanwhile, she kept an open bag of corn curls propped by her chair. In her kitchen I'd find a trail of wrappers from candy and packaged bakery goods. Throughout the day, she drank her coffee and munched her treats; she nibbled on quartered lunch-meat sandwiches, her mainstay. She weighed eighty-six pounds.

The night before the procedure, Dr. Austin (not his real name) visited my mother to describe an endoscopy. The test involved passing a flexible lighted tube through the mouth and esophagus into the stomach. He'd be finished in an hour, he assured her; she'd be home the following afternoon.

But that was not to be. Instead, routine turned into a fight for her life. In the waiting room, I listened as the doctor described how his patient had become nauseated. Vomiting, she had aspirated the contents of what should have been an empty stomach into her left lung. Immediately she had begun to struggle for breath. "This happens sometimes when the digestive system gets sluggish," he said. "The nurse should have checked before sending her down." Dr. Austin had ordered oxygen.

Although disturbed and saddened to hear of my mother's complications, I waited confidently for Dr. Austin to tell me how he proposed to clear her lung. Instead he asked: "Has your mother ever indicated her feelings regarding artificial life support?" My mind stalled; I must have gasped. "Sometimes," he offered quietly, "a person will make a comment to a family member about not wanting to be resuscitated."

Dr. Austin went on to explain that my mother might need the help of a respirator. Already, he said, he had contacted the intensive care unit (ICU) on the assumption that she had pneumonia, a typical result of aspirating foreign matter into the lung. Again he prodded: "I was just wondering whether your mother ever mentioned anything to you. About life support." Without quite knowing why, I lied.

I told him she hadn't discussed the matter with me. In fact, years earlier, I'd been with her when she consulted her lawyer about a "do not resuscitate" order (DNR). It was something she planned on signing but never had. Then, upon admission to the hospital the day before, she had received a form in her information packet: standard material for all incoming patients. She mentioned the option to me and said she probably ought to get it out of the way in the event that it might someday be needed. Again, she did not follow through.

"I do not wish to be kept alive by artificial methods." Commonly referred to as a living will, the DNR document directs professional caregivers to take no heroic measures in an effort to save a person's life. People typically associate DNR with terminal illness or critical injury, times when machines can become a hindrance to the process of mortal passage: no heroic measures. For legal purposes, the term includes the use of a respirator to pump oxygen into the lungs. It can also mandate the withdrawal of nutrition and hydration: food and water, intravenously provided. What many people do not understand about DNR - what my mother and I did not know is the definition of "heroic" as it is carried out in practical application. Surely, I thought, aspirating into the lung would not qualify as a reason for halting efforts to help a patient breathe. Or would it?

Soon after Dr. Austin had delivered his news, I followed my mother, alert on her stretcher, up to the hospital's critical-care unit. Ignoring her muzzle-like oxygen mask, she kept issuing garbled instructions. As members of the ICU team wheeled her into Observation Room 3, she invested her last full gulp of air: "You're not going to run any more tests on me!"

"Don't worry, Mom," I called after her, "they won't." And then they closed the door.

Brought in on what had become my mother's "case," a lung specialist in his mid-thirties barely introduced himself before asking what was to be his only question: "I presume you've been told about DNR?"

Clearly, this was no rerun of "Marcus Welby, M.D.," where the mild-mannered hometown healer steps forward to battle the forces of death. "Why exactly are you even mentioning such a thing?" I asked. "You know what just happened to my mother. People don't have to die from spontaneous pneumonia, do they?" I had just inherited my mother's anger.

"She's severely anemic," he replied blandly.

"And that is a terminal illness?"

"Well, it could be irreversible."

Having evaluated the level of her distress, Dr. Austin made the decision to hook Mom up to an inhalator, but not before asking me a fourth time to consider a DNR order. At the main ICU desk, the hub of several curtained suites, I signed instead a legal permission slip to employ the inhalator; I prayed for my mother's full recovery.

Two days later, no evidence had yet been found in Mom's bloodwork, x-rays, or the failed endoscopy to indicate any serious medical condition. Each of four specialists had a different theory, a unique approach. On one issue, however, they concurred: Mom had a life-threatening illness.

"She's much too thin - severely malnourished," they worried.

"She doesn't eat," I replied. "She's stubborn. And very particular."

After three days, Dr. Austin removed Mom from the respirator. Now she could start telling everyone just what she thought of this fiasco. Our lives could return to normal. At her bedside, I reminded her of everything that had happened. She nodded and mouthed the word, "Okay" - over and over again, "okay." But it wasn't; she wasn't. Even as we spoke, she grew visibly weaker.

I began at last to understand the extent of her peril. When, like a coach to a profoundly weary player, I urged her to try, to inhale, she whispered breathlessly, "I can't."

The attending nurse advised, "Stay close. You may be asked to sign something. In case of an emergency, we wouldn't want to be without instructions regarding your mother's care." The thought curdled in my mind: what if they couldn't locate me? Why couldn't I sign in advance? At that moment, I became connected to a machine.

Another round of blood work and x-rays confirmed what anyone could see; on her own, Mom still could not get enough air to oxygenate her blood.

The second time I signed for my mother to be assisted by a respirator, an ICU nurse said in a confidential tone, "Be sure to ask the doctor what it could mean. When you continue to put patients on a machine, you reduce their chances of breathing again without it."

As the ICU team prepared to insert the tube in her mouth, my mother, confused but still feisty, showed some resistance. "Do you want this?" one of the nurses asked kindly. Oxygen-deprived, disoriented, Mom had no idea what she needed or why. Yet we all stood by, waiting for her to take responsibility. Then from the other side of the bed, a burly attendant who had just been caring for my mother's needs looked earnestly at me and said, "If she doesn't go back on the respirator, you know what will happen."

"Of course she wants it," I gasped.

When, a week later, my mother failed for the third time to be weaned successfully from the respirator, her cardiac specialist expressed a different attitude: "Sooner or later," he admonished, "you'll need to make a decision about how far you want to carry this. What are you going to do when this happens again? Just think about it." For a moment, I felt selfish, unreasonable. But only for a moment.

The fact was, I had been thinking. A story had long since begun to play out in my mind, its setting a sterile hospital room where a woman slowly suffocates. Still conscious, still alert, but too weak to beg for mercy, she stares into the eyes of the daughter who has cut off her oxygen supply. As the dying woman grips with the strength of residual panic the hand of her betrayer, the daughter offers tearful prayers for recovery. Poe might have relished such a scenario. But I was reminded of the second chapter of James's epistle where he tells us that refusing to provide life's necessities is the epitome of a dead faith.

Day and night, I kept watch in my mother's room, where something worse than death was lurking. I did not stand guard alone.

"No more tests!" my mother had insisted. So followed weeks of disobedience: four CAT scans, a scoping of the heart, two more endoscopic procedures, countless blood tests attended by the installation of tubes to ease the process, daily x-rays of the lungs. There I was, signing permission for every one of them. I studied nuances from the night chart, written comments of doctors interpreted by sympathetic nurses. Emotions advanced and receded out of context. The sun rose on schedule; the moon and stars retained their midsummer patterns. My family upheld me with prayer, love, and constant thoughtfulness. But I felt numb, incompetent. All I could do, going out or coming in, awake or late at night reawakened, was pray: "Let my mother live. Please let her live!"

Two months after what was to have been a routine examination, my mother came home from the hospital. Kept alive by a respirator, then an oxygen mask, W, and feeding tube, but in essence by the gracious will of God, she walked away from the obstacle course a still-frail woman not the slightest bit anemic, with one tiny ulcer already mending.

What-ifs that aim to reconstruct the past are vain illusion. Yet sometimes speculation can instruct the future. Had my mother signed the standard health-care proxy issued to every patient, would she have survived her ordeal? Or would doctors have been required by law to abide by "wishes" she would never have expected could end her life before the fight was lost? As medical specialists and staff continued to offer no hope for her recovery, might I at last have submitted, signed the DNR order, and so consented to her death? Might I in fact have caused it?

Other worries also shadow this near tragedy. Physicians today are being pulled in several directions at once. Their dedication to restoring health, traditionally the single focus of the medical profession, is being challenged by moral and ethical dilemmas caused by advancing technology and its enormous costs. Everyone, from health-care professionals to patients and their relatives, needs to be aware of the subtle ways in which legitimate concerns about costs and personal autonomy can erode care and even our regard for the sanctity of life.

Happily, for more than three years after this incident, my mother remained independent in her own home. She lived to celebrate the birth of two great-grandchildren and the ongoing support of her family. In 1996, she moved to a nearby nursing home where she made friends among fellow residents and staff. For the first time in years she was able to attend church regularly. She enjoyed the best of care.

My mother left this world just as morning was breaking. Moments before I arrived, she slipped away in her sleep. The head nurse said that, if such a thing exists, my mother's death was beautiful.

Leslie Goerner, a free-lance writer, lives in New Hartford, New York.