I had just walked in the house from my third 12-hour shift. After kicking off my shoe- and-socks and taking off my jacket I headed for the kitchen for a tall chilled glass of ice tea. Then I sat down at my computer to scan messages, jokes and pictures on my facebook page. It was MY time to block out all of the “beeps, rings and buzzers” that I had listened to all day. All I heard was silence and the purring of my cat, Cybil, as she tried to get my attention by butting her head into mine and obscurring the screen and sitting on the keyboard before I put her on the floor.
In the distance I could hear the ringing of my cellphone and it was the tone set up for work. As I crawled out of my chair, my first thoughts were, “what did I forget, what had I done wrong or do they need me tomorrow.” These questions are probably asked by all nurses of themselves when they get an unexpected call from their job. Looking down at the phone it was, indeed, a call from my floor Intensive Care. “Hello,” and before I could say anything else I heard the almost unrecognizable voice of my close friend. “Tyler has been in an accident, I don’t know what to do, the doctor said he was really bad, can you come right away.” Then Leslie, my friend, started to sob and I interrupted her to let her know I was on my way.
Hurriedly I scribbled my husband a note as I was putting my shoes and socks back on. “Going to hospital. Leslie called and Tyler in accident. Call later.” I put the note where I knew he would see it and out the door I went. A million things go through a nurses mind when they get a phone call like that, because instead of just guessing, we know the ramifications of what “really bad” could be.
Arriving at the hospital and out of the elevator there stood my friend with a small group of people and her husband, Bo. Both of their faces were tear stained and eyes swollen from crying. At the moment Leslie saw me coming toward her, a wail came from her throat that I had heard so many times from other women. It was the sound a mother makes when she loses, or thinks she is losing, a child. It sends a chill up your spine immediately, and I then I knew I had to click into nurse mode for them and for myself. “What room is he in, Bo?” He nodded toward room 15 where I could see a flurry of activity going on inside.
All of the nurses inside I had worked with for many years, and there lay Tyler. If I hadn’t known it was Tyler, I would have a very hard time identifying him. His head was swollen at least twice its normal size. He had on a neck brace that was probably put on him in the field by the rescue team because it wasn’t one of ours. He was on a ventilator, and after checking the settings it was doing all the work with no effort by Tyler. Bags of IV fluids where hung everywhere, and the monitor showed me a stable blood pressure and heart rhythm. Liv, a nursing friend, came to my side. “I take it you know this family?” she asked. “Yes, I do,” I answered. “His mom and I are pretty tight and she called for me to come. What happened?”
“From the report I got from the Emergency Room staff per the rescue crew, he and a buddy had been on dirt bikes and this one was going way too fast and slid on gravel. His body slammed into a chain link fence with his head meeting the fence first. The trauma doctor had been in, and Tyler had already been to x-ray and all lab work had been drawn. He’s gone. The only thing keeping him with us now are the drips and the vent. I don’t know what else to say, but I’m so sorry.” Liv gave me a hug and continued working with Tyler, adjusting the medication in the drips. About that time Dr. Andrews and Dr. Matthews walked in the door together.
The look on their faces was very grim, and they asked me if Liv had filled me in and I nodded yes. Dr. Andrews asked me if he was a family member, and I repeated what I had told Liv. “I’m going to have to go back out and talk to them in a little while,” I said as a tear trickled down my face. In my head I was thinking that bad news is always hard to give, particularly when the patient was so very young, and even moreso when you knew the patient and family. He was just a kid who had made a stupid choice.
Looking into their faces I asked, “My friend told me on the phone that you all had talked to them and said he ‘was bad.’ What are his injuries, and what is the prognosis?” I knew before they answered, but was hoping they would tell be something different then Liv had–something to give me more hope. Dr. Matthews explained that Tyler was gone. He met all phases of the brain death protocol, and now all that was keeping his young body going were the medications in the IV bags and the ventilator. Dr. Matthews also explained that besides his broken neck at C2 his brain was so traumatized that they were just hoping to keep him alive until we could talk to the family. “You know these people, Lin, we would like you to be in on this conversation; and perhaps you could persuade the parents to let us harvest the organs.” It was Dr. Andrews looking at me hopefully that brought me back to reality, because it was his son who had received a donor heart or they would have lost him at 15 in an automobile accident. He said, “You know how important this is to someone else, somewhere else, to another family.”
How many times had I done this before, but now it was my friends. I would try to help someone else in the agony of their loss. “I will try,” I told them both and went out to my friend and her husband waiting outside the door. “What do you think,” Leslie asked hopefully when I came out the door. “Have they changed their minds? Is it as bad as what we are thinking?” I put my arm around her shoulder and led her and Bo into a room to sit and wait, explaining that the doctors would be in to talk with them shortly. “It is bad, Leslie. The only things that are keeping your son alive are the medications and the ventilator. He is already gone, honey.”
Leslie threw herself against me and screamed, “NO you are wrong. He’s still here. He’s lying in there on the bed and his heart is still beating, and he’s breathing. He can’t be dead, he’s only 13!” Bo was sobbing silently, trying to put his arms around his wife for comfort. “What do they want to talk about?” she asked.
I took a deep breath and started to explain to her how the injuries were all mostly his head but the rest of his body was intact with only cuts and bruises. Then I attempted to talk to two grieving parents about how their loved one’s organs could help someone else and how many times we had been able to change people’s lives through organ donation. “No!” Bo looked at me in a dead stare. “If he has to leave this world, then he’s going to go with all of the parts he was born with.”
I stared back at both of them and tried to encourage them in what I had been trained to do. “You both know that Tyler was full of life. I don’t remember him ever in a fight, and he was always so popular on the ball teams. He was so good to the kids on the team that were disabled. Remember that little guy last year that was going blind and how upset Tyler had been and kept asking us how we could help him? I am just asking you guys to let his life mean something to so many others. I know in my heart that Tyler would have tried to help, but the final decision is yours. I will tell you this, we have gotten letters back from people who were helped by organ donations. One was from a mom that got to see her baby for the very first time and another from a young man who was dying of kidney failure and went on to live a normal life. There are so many more stories I could tell you.” It was then that both of the trauma doctors came into the room.
Looking at both of my friends, the doctors asked Leslie and Bo if they would consider this “gift.” Leslie, holding tightly to Bo’s hand, asked if she and Bo could have a little time with Tyler and make a decision. Bo, looking surprised, held her hand and followed her into their son’s room and closed the door.
Through the windows we could see them embracing each other, talking, crying and Leslie bending over the bed hugging their son and kissing him on the swollen cheeks. Bo was holding Tyler’s hand and talking to him like Tyler could hear him, but we could hear nothing behind the heavy insulation of the room. We had to wait and hope.
After about 30 minutes they came out of the room holding hands and looked at both doctors and me. Bo spoke, “He would have been a great man, and would have helped others in real life. He was always so compassionate; and we think that if he would have been given this choice, he would have chosen to give.” The last few words came out in a strangled sob, but Leslie was smiling when she looked at me (a, “this is Tyler giving his all just like he always has done in the past” kind of look.)
The harvest team were called; and through extreme pain and loss, people were given new hope in other cities and towns. As hard as it can be, never miss the opportunity in guiding a family into giving and changing multiple lives. Some will say “no,” but it’s the ones who say yes that give new hope to others who had no hope.