In the pediatric ICU, a call was received from another hospital to give sign out for a patient already en route. The child being transferred had experienced a traumatic brain injury. The child was intubated after receiving every sort of therapeutic management imaginable in a desperate attempt to salvage any remaining brain function, but the prognosis was dire. Residents, fellows and attendings alike looked at one another, a clear consensus of dismal expectations. For a moment, profound sadness clouded the room, but it was quickly cast aside by the need to act. If there was anything to be done, they needed to be ready.
Orders placed, plans established, we waited.
The patient arrived. The transport team gave their sign out and the fellow took charge. Waiting for the stat portable CT, we adjusted the ventilator settings and obtained multiple points of access. Step by step a plan was made and executed. Once the dust settled, preliminary assessment was done and imaging had been completed, the reality of the situation hit: significant neurologic compromise with cerebral edema in the setting of diffuse hypoxic injury.
The rest went as dreadfully as you may imagine: assessments for brain death, repeat imaging demonstrating progressive irreversible hypoxic ischemic encephalopathy, absent neurologic responses. None of us knew this child, but our hearts ached as if we did. The child was gone. Once the assessment was finished, I walked out of the room holding back tears, and as I looked around at the others, I realized I was not the only one. Rounds had to continue, however, as so many others awaited our care.
Midway through the resident’s presentation for a neighboring patient, the family arrived. Mom, dad, siblings, aunts, uncles, grandparents — all with the same undeniably shocked and pain-stricken somber gaze as their eyes met the name on the door of their tragically compromised loved one. The sibling’s wailing cry echoed through the halls. Seared into my mind are the sound and image of the sibling grasping at their own stomach and their eyes, panicked and wide, yet strikingly resembling those of the patient.
Silent tears were shed.
Life-supporting care was withdrawn and the patient was terminally extubated with family surrounding. Minutes passed as the residual brain activity gave way. The patient took a final breath, the heart conducted its final beat, the hands went cold, but the presence left behind was indescribable. The halls filled with immeasurable sorrow. My mind replays the scenes: a sibling collapsing in agony, the image of a father and mother, ghosts of their former selves as they contend with a new, unimaginable reality, the nurse silently crying into her hands at the computer station nearest the room where the final stage of life was experienced moments prior.
Humanity is fragile. Witnessing these incomprehensibly vulnerable moments in families’ lives is one of the most challenging things I have faced in my training. I am reminded of a mentor’s insightful reflection: “Life is a journey, each moment is fleeting. Pleasantries and pain are temporary, transient.” These moments of unfathomable heartache are seamlessly woven into the fabric of our lives, just like those of overwhelming joy. We share these universal human experiences. We suffer and we celebrate as a community, a family, in solidarity with one another.
I did not know you, but these silent tears were shed for you.