“We have reason to believe that your daughter is brain dead.” The silence was deafening.
We had ushered the family into a room labeled “Conference Room” for this conversation. From the outdated décor, it was evident that this room was reserved for serious discussions, not conference calls. Various-sized couches and chairs lined the small room’s walls, and a box of tissues sat on a side table in the corner just out of reach. The family members filed onto the couches while the resident and I sat on the opposite side of the room. We already felt too far away, but I was scared to close the gap between us.
The patient’s family members included her mother and two aunts, all very young and beautiful women. At this point, their faces were expressionless, as if the resident had not said anything at all. He continued, “Since she was admitted, she has not had any of the basic reflexes: the corneal reflex, the gag reflex and the cough reflex. Additionally, she has a Babinski reflex. Because of this, she likely has no brain activity and is brain dead”.
The words hung suspended, like unanswered questions in the room. They hadn’t understood a word he said.
I wanted to step in and explain things more compassionately, to break the uncomfortable tension in the air. The patient was admitted following a car accident. A driver, intoxicated on heroin and meth, drove the wrong way onto an on-ramp and hit four cars; the patient’s car was one of them. The perpetrator was also a patient on the ICU floor, just a few beds down.
Recognizing that he had to reiterate the statement, the resident tried again: “You see, we all have reflexes. When I touch your eyelashes, your eyelid should naturally move; that would be the corneal reflex. The gag and cough reflexes are others that we all normally have.” The family nodded in unison; they were following. “When someone is brain dead, they lose all of these reflexes.”
“Since she was admitted, we have been unable to see any of these reflexes in her, making us suspect that she has no brain activity. To confirm our suspicions, we have to do a test that will tell us whether or not there is blood flow to her brain. If there is no flow, then she will be confirmed brain dead.” Every time he said “brain dead” the words rattled around in my head with no place to settle. At this point, tears filled their eyes; none of them uttered a word. Grief fell over them like a thick veil.
Then the avalanche of questions came. “Do we have to do the test now? How long will we have? I thought you did a test the other day. What are our options? How can you be so sure that she’s gone when you haven’t done the test yet? What if we don’t want to do the test?”
The resident took a deep breath and explained that he was not asking the family for consent; rather, he was informing them of what would happen. During rounds a few hours before, the attending told my resident that he would have to break the news to the family, suggesting that he emphasize how strong our suspicion of brain death is to spare them the cruelty of false hope. In trying to crush the family’s hope of life, the exhausted resident was cruel in other ways, offering them no tissues for their tears or empathy for their anguish.
The reality was that everyone on the ICU floor had known that the patient was brain dead except for her family, who had clung to the glimmer of hope that she would be okay. To medical professionals, it had been clear as day from the moment she arrived. Now, the patient had sat in her ICU bed for three days. There was no more time to give.
“If the test shows no blood flow to the brain, then we will have to withdraw life support within 24 hours.” All three women, with their heads turned down and their arms crossed, nodded silently. The resident and I left the room.
As we walked out, the nurse at the front desk complained, “You left them in there by themselves? They’ll never leave!”
There was not an ounce of compassion spared for these women. My heart was breaking for the family.
The next day was my last day in the Trauma ICU. By the end of the day, I was drained and ready to go home, but at 6 p.m., the test results were in.
Gathering the family, the resident and I entered the patient’s room. The patient lay there motionless, connected to the ventilator and countless lines. The resident walked to the computer and pulled up the patient’s scan.
“The blood shows up as black on this scan. You can see the blood here in the blood vessels of her neck, but here…” He was pointing to her brain. It was whiter than snow. She was officially brain-dead. Time of death: 18:00.
Then a sound followed that I had never heard before: the intense cry of someone experiencing profound loss. The wails of the family members that filled the room were gut-wrenching and primal in nature. We stood there in silence, letting their grief fill the room.
Tears filled my eyes. I was not going to cry in this room. I would not make this moment about me, the most insignificant person in the room. After a few minutes, the patient’s mother, possibly the strongest woman I have ever seen, looked up with tears running down her face and said, “I know you said 24 hours, but can we have more time?”
The resident bumbled through an explanation about how, by law and hospital policy, that would not be possible.
One of her aunts spoke up, “She has three children, one of them is 10, and the other two are 7 and 12. Her 10-year-old graduates from middle school tomorrow, and we wanted the kids to enjoy that before finding out their mother is dead.” The cries still pierced the air; family members were on the floor, clinging to one another.
Eventually, the resident and I left the room, but the whole ICU floor continued to hear their cries. As we walked through the halls that now echoed with the sounds of loss, I looked to the nurses who had cared for this patient tirelessly. They exchanged worried and tired looks, revealing a collective yearning to ease this family’s pain but we were all stuck; frozen in place. As the resident slumped into his chair, he sighed and looked at me with eyes weighed down by exhaustion. He turned his attention to the computer and said “Well, you did good today, you can go now.” It was as if he had not just announced the official end of that woman’s life. As if he had not just launched her family into an abyss of grief.
I left the hospital that day with a pit in my stomach. From the moment that patient entered the hospital, we had failed her and her family. As doctors, we were expected to be there for our patients in life and in death, ensuring that no one traveled in this life or to the next alone. I knew that the resident, who completed a 24-hour shift the day before, had no more emotional currency to spare. He was a shell of a human being, and he simply could not afford to offer any empathy.
To this day I am disappointed in everyone including myself. I think about those women every day. I wonder what would have happened if I had allowed myself to cry with them in that small hospital room. What could it have meant for them if I had offered a hug or a tissue? If I had even stopped to acknowledge the loss of life; a loss that they will never forget. What if I had allowed myself to be human at that moment and mourn the loss of another life? A single act of vulnerability could have provided the family some solace in those initial moments of grief.
Image Credit: “tissue” (CC BY-NC-ND 2.0) by tamaki
Ashley Newsholme is a third-year medical student at Florida International Herbert Wertheim College of Medicine in Miami, Florida, class of 2025. In 2020 she graduated from the University of Florida with a Bachelor of Science in biology and a minor in dance. In her free time she enjoys cooking, reading, spending time with her animals, and volunteering at Camillus Health Concern for street medicine outreach. After graduating from medical school, Ashley hopes to pursue a career in Emergency Medicine.