Posted by The hospital staff lined up at the side of the hallway, as his bed slowly rolled by. Two nurses were pushing the bed, while another staff was navigating the IV pole, and another one guiding the ventilator. It was like a victory parade. Though unlike in a parade where the mood was joyous, here the mood was solemn and glum.
When the bed reached the end of the hallway, it made a turn and stopped in front of the elevators. His bed stood there for some moment of silence. Before his bed entered the huge elevator, his mother gave him a long embrace.
Our patient was in his mid 20’s. He was born with severe cerebral palsy. He could not talk. He could not walk. He could only grunt and drool. But he could smile and make eye contact, and would flail his arms to show excitement and perhaps happiness.
Despite of his condition, his mother loved him so much and kept him as long as she could. She dedicated her life of taking care of him for more than 20 long arduous years. He survive all these years because of her devoted and persevering mother.
But the past few months has gotten more difficult. He was hospitalized a couple of times because of pneumonia. And that was the reason once again that he was admitted this time, only worse, as he ended up landing in our ICU requiring mechanical ventilatory support.
While he was in our ICU for more than a week, he also experienced multiple seizures. After working him up, including imaging studies of the brain, we determined that the shunt that was inserted in his brain when he was a child, was not functioning properly anymore. Because of his cerebral palsy, there is an increase build up of water in his brain called hydrocephalus. A shunt (image below) is necessary to reduce the pressure in his brain, and without it he would not survive.
After meeting up with the doctors, including the neurosurgeon, the mother was told that taking down the existing brain shunt and placing a new one would be a serious undertaking and the patient may not do well during and after that extensive surgery. That was when the mother made the painful decision that she would not subject her son to undergo any more invasive procedures. His frail little body can only take in so much, and perhaps the best course is to do nothing and allow nature take its course.
The mother further made the decision to take his son off all life support and allow him to go peacefully, but also donate any viable organs of his son, that other people may still be blessed even if his son will pass away.
And that leads us to this “honor walk” which is akin to a hero’s parade, as our patient made his way to the operating room.
How they harvest the organs requires complicated procedure and strict ethical rules. When the patient is taken off all life support, which happen in the OR, the members of the harvesting team is not allowed in the room. The patient will be observed for 90 to120 minutes after off all life support and monitor if the heart would stop. It needs a full 5 minutes of no pulse and heart activity before the patient can be officially pronounced dead. It needs an attending physician (not associated with the harvesting team) to be present all this time, who will be the one to formally declare that the patient is dead.
Only when the patient was pronounced dead will the surgeons from the harvesting team come to the room and perform their quick surgery to get the organs they planned to harvest. These organs have already patients assigned to receive them, so these organs, like the heart, or liver, or kidneys, will be transported very swiftly by ground and by air (may be in different parts of the country) to their respective recipients who are waiting for these invaluable gifts of life.
If the patient who was taken off life support will not expire within 2 hours, then no organ harvest will be performed, as that is deemed too long for these organs to be viable with low blood and oxygen supply. The patient will be taken back to the ICU were they will be observed until they pass on.
After the mother gave him her last embrace, she wiped the tears in her eyes and stepped back from the bed. He was whisked inside the elevators and taken deep into the bowels of the hospital.
In my thought as I witnessed this all transpired, perhaps she wished that her son’s heart will continue to beat and live for someone else. And who knows, maybe on that next life that it will give, it can talk and sing, or walk and even run. And perhaps that someone with her son’s heart can hug her back.
Maybe. Someday.
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(*images from the web)