Tuesday, February 28, 2006
There's no good time
I never cease to be amazed at people who ask about organ donation when their family member is brain dead. If I were given that terrible news I don't think my first, or even my second or third, thoughts would be about helping someone else. I think that most people could, in time, see that donation is a positive thing, but to get the grim news, "He's not going to make it," and say, "Can he be an organ donor?" astonishes me. Yet that is exactly what my patient's family did today. He was not yet brain dead, but the prognosis was not good. His wife told me, "I am still holding on to that last shred of hope. But if he does become brain dead, I definetely want him to be an organ donor." She felt that it would bring some meaning to this senseless trajedy. He had beautiful eyes, and a good heart, and she wanted them to live on in someone else.
Knowing that the family had initiated discussion of donation, it was still hard to make that first contact. What do you say? When is a good time? It's even harder when the family doesn't expect you. I have to juggle my compassion for the family and when I think they're ready to hear what I have to say, with the needs of the recipients. The sooner we recover after brain death, the better the organ function. Many people think that a brain dead person can stay on that vent indefinetely, but within a few days, depending on the cause of death and their baseline health status, they'll go into multi-organ failure and then cardiac arrest. Brain dead patients can be very unstable.
That is why I have to ask families to make this decision in the middle of their grief. I'd like to wait, let them process it, but there's not much time. As it is, we decouple the approach. Let the hospital staff tell them the patient is brain dead and start the clinical process. Then, I'll meet with the family, assess what they understand so far and see if they know what the person's wishes are; did he have a living will, an organ donor card, etc. You'd be surprised(or not) at how many doctors have said, "He's brain dead. You wanna donate the organs?" It's not nice, it's not compassionate. People need to let it sink in. Especially when their loved one still looks alive:they're warm and pink, their chest still rises and falls. Many times I have to go over what brain death is, and why they won't recover. Some people surprise you, so you can never think, "Oh, they'll never go for it." The least likely people have said yes. Families that were in denial, families mad at the hospital and threatening lawsuits have said yes. Then, sometimes, people I swore would want to donate say no. It's a very personal decision.
Most people want to know if my job is sad. The short answer is yes. It's difficult to put into words why I feel called to do this. When I worked in the ER, I was the one nurse who didn't shy away from grieving families. Sometimes,(not often) you'd have one of those docs who'd tell the family the patient died and then run away and I'd be left consoling them and answering their questions. I guess the only way to describe it is to say that I feel blessed to be around grieving people. I want to help them to navigate their way through those confusing first moments. I don't feel like I'm a particularly consoling person. I'm not very touchy-feely. I don't have a lot of meaningful phrases that I use or anything. Instead, sometimes, I feel like a death-midwife, helping this family transition to the next phase. I couldn't do this if I didn't feel like I was doing good for the families. I know ultimately I'm doing this for the recipients, but when a family makes a decision to donate, it really seems to help them. Like the wife of the above patient, it brings some consolation and a hope that a little piece of them lives on.
I don't usually take my work home. I used to get very anxious when I worked in a trauma center, worrying about bad things happening to me and my family. Now I'm a little more calm about dying-when your times up, it's up. It has made me appreciate my family and my life more than ever. So while it's always on my mind, I don't usually worry about it. But today was different. I got called back to the hospital tonight and as I was getting ready I was convinced that something was going to happen to me. Maybe it was the talk I had with the wife earlier, now a widow. Maybe it was the blog I read (I can't now remember which one, I know I had a link somewhere) about a woman whose husband died of cancer when their baby was 4 months old. I started thinking about what my family would do if something happened to me. What would I do if something happened to them? How would I go on? Like I said, this stuff doesn't usually hit me, but when it does, it hammers me. Really, I was practically in tears. So I gave Love Monkey and Dear Kid extra hugs and I whispered into Laughing Baby's ear, "I love you." That's all I can do.