The anguish on their faces was palpable.
I had just finished sign-out in the ICU and was starting my shift in the ICU. As a fresh 2nd year resident, I was scared about how the night would turn out. Memories of 2 code blues the night prior were still fresh in my mind, and I wasn’t quite sure I would be able to make it to the next shift.
“20 year old male with subarachnoid hemorrhage coming to the unit (ICU) coming from the operating room after evacuation of hematoma” was the sign out I had received. I thought to myself that it may have been some traumatic injury of the head, a young patient who must have had some rational reason for why he had bled into his brain, was unconscious, and had cardiac arrest.
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As the patient was wheeled in and hypothermic protocol was started, I spoke to the neurosurgeon who commented on what he felt was the cause of this young man’s condition. The patient likely had congenital AV malformations, he said. Arterio-venous malformations in children are rare and can burst at any time. As per his family, he was athletic, a good student, a good son. He had gone to his parents and told them he was having a bad headache, collapse, and turned blue.
The patient had such devastating brain herniation that he could not keep his blood pressure elevated himself, did not have a gag reflex, nor a corneal reflex. Nuclear medicine perfusion of the brain showed no vascular flow to the brain, and brain death was declared. He was dead inside, his body and heart were still pumping.
I was busy, I told my intern to maintain talks with the family. During the course of this time, all I heard was sobbing from room 501 in the ICU, hallways filled with more than 50 family members wondering why their friend, brother, cousin, nephew who barely started his life, is now dead for a cause that was most likely a congenital abnormality that they didn’t know about. I felt their guilt. We tried our best to assuage their guilt.
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Two days later, he was being harvested for organs. Both lungs separated, kidneys removed, heart removed. I thank all the members of the team for talking to the family and helping them with this process. I thank my intern for being there for this family when I did not have the time to be there.
What I was told by the nursing supervisor was that the patient’s father said “He’s my little one, the youngest of my three kids, I know he’s already in the hands of God, I accept organ donation to help save other lives”, it made me feel that even though he was considered to be brain dead and the house of his body was “empty” so to speak, it wasn’t an empty home. It was a home that was cleared to make space for several others who would continue the positive journey that this young man had started for this life.
What he has gifted to others is the ultimate gift, and as a young budding physician, I am grateful and hopeful that I will be entrusted with the faculties to continually behold such devastating and anguish-producing moments in my career and place side by side with the inherent goodness of the human spirit, the inherent altruism of those who have perished and have left the world with such positivity.
It is with these deep philosophical principles that we adhere to that we should move forward with the practice of medicine.
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