Mother Dearest

Within a year of working at the Neuro ICU, I remember overhearing my coworkers talking about the story of Mrs. I., a woman in her forties who was declared brain dead as a result of a massive brain bleed. I had never been assigned to her, but for several days, most of her nurses displayed frustration towards the current situation.

Mrs. I. was a single mother of a five-year old boy named Jessie. From what Mrs. I.’s has told the team, her daughter was always known to be compassionate, putting others above herself. She volunteered for non-profit organizations and was well known in her community for her caring nature. What made Mrs. I. unique was how she had become a mother. Mrs. I. became a single mother by choice. Having been in two past relationships that did not work out, she had decided to conceive a child through a sperm donor. Since then, she had raised Jessie on her own with the support of her own mother.

When an individual is declared brain dead, the ICU team treats him/her as a potential organ donor. Although there was initial uncertainty regarding her status, the work to preserve the organs begins until there is confirmation of her ineligibility (refusal or other criteria rendering the organs unusable). The team had found that her health card was signed, signifying her consent for organ donation. According to her mother, that decision was congruent with Mrs. I.’s beliefs and altruistic way of life. However, her brother resisted the idea of her being brain dead. Despite concrete proof and repeated explanations that there were no signs of life left in her, her brother was adamant that a miracle could happen. Such reluctance on his part led to a seven-day delay and eventual loss of chance of retrieving her organs. Although the team could have gone ahead and start the organ donation process, additional consent was not given by her mother as she did not want to cause tension with her son. Furthermore, the team did not want to tarnish the grieving process of this family as it was clear that Mrs. I.'s brother was in the first stage: denial.

Upon hearing about the dilemma, I remember thinking about the impact all of this could have on Jessie. I remember thinking to myself "Man, I don't want to be in that room when they have to announce the death to the little boy.". Once Jessie's uncle had accepted his sister's condition, a family meeting was planned to impart the unfortunate news to the boy. On that day, one of my colleagues was taking care of Mrs. I. Given that she was doing an eight-hour shift, at 14:00, my assistant nurse manager asks me if I am willing to go to the family meeting instead of her as it would not make sense for my colleague to attend and not be able to carry out the extubation process that would occur afterwards. It was my serendipity. Despite stating my fear of having to tell a five-year old boy his mother is no longer living, something in me urged me to accept the responsibility. I tell my assistant nurse manager that I will be at the family meeting.

As the time for the family meeting soon approaches, I, for the first time, meet Mrs. I., her mother and her brother. They recount details of Mrs. I.'s life and talk about Jessie. A few minutes later, a boy with short dirty blond hair and crystal clear blue eyes comes onto our unit holding the hand of his babysitter. I remember seeing him for the first time and having conflicting emotions within me. I was in awe of his innocence and heartbroken at the news he was about to get. I notify the social worker, the residents and the intensivist that the boy has arrived. We, along with the family, make our way to a private room in order to deliver the news.

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Jessie was sitting on the couch between his grandmother and his uncle. The social worker starts by introducing herself and the team. Then, with very carefully chosen words, she breaks the news to him in a gentle but factual way. In health care, we learn to divulge bad news in the most straightforward way as possible. No euphemisms. No comparisons. No abstract concepts. When speaking to younger children, although it may seem harsh, it is important to depict the situation as it is so there is no misinterpretation.

“Jessie, your mom has been very sick for the past few days. The team did their very best to take care of her but she was still sick.” said the social worker. During this time, Jessie is behaving like a typical kid his age; he is not sitting still he is moving his legs constantly and looking at the ground. The social worker then continues. “I’m sorry Jessie, your mom is dead.”. A long pause ensues. I glance around the room and find everyone alternating their stares to the floor and to the boy, nervous of the reaction he may have. Jessie continues to move his legs. His grandmother attempts to stop the movement of his legs. “Jessie, did you understand what the lady said?”, she asks. “Yes”, said Jessie. “What did she say?”, replied his grandmother. With the most innocent and calm voice, Jessie states “Mommy won’t be able to come home with us. She will stay here and go to heaven.” A strong silence filled up that room. Shortly after, Mrs. S.’s mother began sobbing. Jessie then stopped moving his legs, knelt on the couch facing his grandmother, held her face in his tiny palms and kissed her on the cheek. “It’s okay grandma”, Jessie said in an angel-like tone. At that moment, the intensivist spoke with Jessie. “Jessie, I’m very sorry. Do you have any questions for us?”. “No”, replied the boy. The intensivist then got up from his chair, patted Jessie on the back and signalled everyone to leave to offer the family a moment for themselves. Before I left the room, I saw all three family members huddled together in an embrace that evoked loss, grief and love.

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Once the family returned to the ICU, Jessie made his last farewells to his mother who lay in her bed, intubated. “Take all the time you need”, the team states to the family. Jessie, without hesitation, reaches for his mother’s hand and caresses it. He then gets on Mrs. I.’s bed, lies down beside her, and gives her the biggest hug. “I love you mommy”. Once he is done saying goodbye, his babysitter brings him out of the room. Mrs. I.’s brother and mother remain in the room to witness her extubation, and her last assisted breath…

Rest in peace Mrs. I.

Jessie, you are a wonderful kid, and have a wonderful mother. Your caring demeanor and maturity at such a young age shows so much about the way Mrs. I. raised you; with so much love, care and humanity. May her legacy live through you.