Because I write about end-of-life issues, I thought I might have some insight into what we were likely to face. More than that, I simply wanted to be there for my husband, Erik, and his family.
By the time I got to the ICU, Erik and his younger brother were hovering near the doorway, while Vince’s girlfriend stood at his bedside, crying.
A tube ran from Vince’s mouth, held in place by heavily padded clamps on his cheeks and bits and pieces of tape. His chest moved rhythmically up and down. Other tubes snaked out from under the sheets. Monitors tracked his vital signs: blood pressure, respiration, oxygen saturation. Having read that even the most severely injured people may still hear, I set my iPhone on Vince’s pillow and played Joni Mitchell’s “Blue.”
Vince had a very small scrape on his forehead, covered with a butterfly bandage. We’d been told by the police that he had suffered a fall — but clearly something more serious was involved. We later learned that paramedics had restarted his heart three times en route to the hospital from the parking lot where he had collapsed.
Over the next few days, family members and friends kept a vigil at Vince’s bedside. Nurses came and went, changing bags that fed the IV lines, drawing blood, checking his vitals. It was becoming clear that we would soon be faced with decisions not about his future but about whether to end life support.
Like so many Americans, Vince had no advance directive and had not named a health-care decision-maker. In such situations, Maryland law designates decision-makers, starting with next of kin. In his case, that meant the responsibility would fall to his only child, Tory, who at the time was only 23.
Tory was among those who kept vigil as we awaited word from the neurologist about Vince’s prognosis. When he finally arrived on Monday, the doctor began what seemed a peculiar sort of ritual. He shook Vince’s sternum and shouted his name, loudly; he poked and pressed and prodded, and performed an array of tests, all designed to gauge whether his patient was brain-dead. I tried to steer Tory out of the room, but she stood with her hands in a meditative pose, eyes closed, calm.
A complicated process
At the end of the exam, the doctor explained that by all indications, Vince had probably suffered brain death. His fall had likely been precipitated by an aneurysm, which can lead to massive bleeding in the brain.
Although Vince’s condition met almost all criteria for brain death, the concentration of sodium in his blood was slightly low. To meet legal and medical standards for confirming brain death, that number needed to reach a certain level. Extreme levels can mask the signs of core neurological functions and lead doctors to conclude inaccurately that a patient is brain-dead. This process would take several more hours of IV fluids.