Thoughts on Brain Death: The Last Time I Felt Like a Healer
Finding the balance of empathy and professionalism is a skill that not enough of us recognize as essential, and even fewer seek to teach.
I gathered his family into a small room lit with fluorescent lights and stuffed with uncomfortable chairs. The mother and father were surrounded by 5 adult daughters, while 2 sons waited in the intensive care unit. The room fell awkwardly silent, so I began by asking everyone their names. While slowly progressing through the pleasantries, they all knew what was coming. They held their breath as I spoke, wishing and hoping they were wrong or didn't understand the facts.
For a family like this, who had been wrestling with the mortality of their loved one for 72 hours, my job was fairly straightforward. This family, like all families faced with the shock of critical illness, was in desperate need of closure. They looked to me for certainty and direction. Medicine is complex, with very few certainties, but in this case, I gave them the answers they were looking for.
"Your son will never wake up," I said. I half expected a burst of tears or some other expression of unbridled emotion, but they simply answered, "Thank you. That is what I...we needed to hear from you."
This family had spent 3 days feeling that unease that one feels at the pit of the stomach when freefalling down a cliff. They knew that he had overdosed on opioids and that his brain had been deprived of oxygen for enough time to make this hospitalization different from the rest. They knew that I had been giving him hormones to regulate his body water, breathing for him with a ventilator, feeding him through a tube, and generally taking over the functions of his brain. They watched me earlier in the day carefully and methodically test for any signs of brain function, often in painful ways.
With my words in that moment, all of the "what if?" melted away and a clear direction and purpose brought this family closer together as they began to really mourn the death of their loved one. I spent a few moments answering questions of a more technical nature, followed by praise for the strength and courage they all displayed. He was 35 years old, claimed by a drug overdose.
I left the room and continued to care for the other critically ill patients who populated the 24-bed cardiovascular intensive care unit that my team and I staffed. I went by bed 7 later in the day and noticed a crowd inside the room, weeping. I peered inside and saw a greyish-white face, all signs of life gone for at least several minutes. I saw the mother giving instructions about funeral arrangements. I wait for a few moments and give my condolences.
Unexpectedly, the mother reached over and gave me a hug. She thanked me again and told me that I had a gift. In the moment, the heaviness of the scenario hit me, when so many times before it had felt routine. I am reminded that navigating patients and families through the acute phase of critical illness and death has a huge impact after they leave and I go about my day. I am reminded that my interaction has the power to prevent subsequent depression, anxiety, and posttraumatic stress syndrome and affect quality of life for a whole family, even if my patient dies.
Finding the balance of empathy and professionalism is a skill that not enough of us recognize as essential, and even fewer seek to teach. I was lucky that this family was able to communicate their needs to me clearly. Many faced with the sudden and unexpected demise of a loved one don't maintain their composure. Sometimes, healthcare providers may perceive it as rudeness or some other form of deliberate abuse. I resolve to always remain calm and supportive, and to recognize what it really is: an expression of immense pain and suffering. And I will always remember that my reaction has the potential to harm as well as heal.
Dr Khandker is a staff physician at the Ochsner Clinic in New Orleans, Louisiana, where he practices neurocritical care with a special interest in critical care EEG. He earned a BA in Management at Michigan State University and completed his medical school training at Wayne State University in Detroit, MI. He completed a residency in neurology at University Hospitals Case Medical Center in Cleveland, OH, and fellowship in neurological critical care at University of Pittsburgh, PA. His professional interests include vascular neurology, neurophysiology, critical care neurology, and the role of technology in healthcare.