I was sitting in a consultation room of our ICU. I was having a discussion with the family members of one of our patients in the ICU who was not doing well. Not doing well is an understatement. On the brink of death may be more like it. With me were the cardiologist, our senior ICU resident, and the patient’s nurse.
There were several family members in attendance there in that room. Most of them don’t speak English, or understand very little of it, if at all. We were talking through the patient’s grandniece who speaks English, albeit with a distinct accent.
Our patient was a Cambodian man who collapsed at his home. When the emergency responders arrived he had no pulse and was not breathing. After gallant efforts to resuscitate him, which took them almost 30 minutes, they were able establish a heart rhythm. He was then brought to the hospital and eventually was admitted to our ICU.
We placed him on hypothermia protocol to try to preserve whatever brain function he have. This intervention is used in out-of-hospital cardiac arrest survivors as studies showed that this improves mortality and neurologic outcomes. The intervention entails lowering the patient body core temperature to 33-34 Celsius through cooling blanket and infusion of cold IV fluids.It also involves deeply sedating them and medically paralyzing them, while placing them on life support. This process is an effort to slow the metabolism of the body and thus prevent further ischemic injury especially to the brain. After 24 hours of cooling them, they are rewarmed, and sedation and paralytics are weaned off.
The moment of truth comes after the patient’s body is rewarmed. If the patient will show signs of recovery, they will wake up. If not, they will remain unresponsive or show signs of brain injury from hypoxia(low oxygen supply) stemming from the cardiac arrest. And that will be a very poor prognosis.
Sadly to say, our patient did not wake up. After rewarming, he remained comatose and he was even having seizure-like activity, a tell-tale sign of severe hypoxic brain injury. And that was what brought us to this consultation room. To tell the family the heart-breaking news and help them decide further direction of care.
After we presented the bleak situation to them, the grandniece interpreted for the whole family what we have said. What followed was back and forth discussions among the family members in their native tongue. Some spoke animatedly. Some in whispering tones. No doubt I was lost in their discussion as I have no idea what they were saying.
After anxious moments, one by one the family members started crying, some softly, some more loudly. I don’t have to guess what they were saying anymore. I don’t comprehend their words, but tears is a universal language. I understand it loud and clear.
After more minutes, the grandniece spoke to us, and stated that the family was in agreement, that they just want to have a Buddhist monk come and say a prayer for the patient, and then they will take him off all life support.
Not too long after we left the consultation room, a Buddhist monk garb in a traditional orange robe came. There were about 20 people who came and crammed in that small patient’s room. Usually our ICU regulation only allows 2 to 3 visitors at a time, but this was loosely followed to accommodate family’s needs. I heard incantations and prayers through the closed-door. Then this was followed by sobs and weeping.
Grief. It transcends cultures, religions, and language.
Postscript: The above article was published in Manila Standard Today on July 1, 2012.