One might imagine that the main purpose of ICU interventions is to do everything possible to save lives. That is true to a certain extent, but an equally important role of the ICU medical team is to decide when there is no longer anything that can be done to improve a patient's health, and to help the family through the difficult decisions and experiences that follow. Usually, this happens in a predictable way: families have been kept up-to-date on the patients' progress, and are not surprised when the medical team comes to them with a discussion about end-of-life issues. But there are some times when family members are not on the same page as the medical team... and some times when family members are not on the same page as each other. In those cases, it is our job as a team to help families get to a place where they are able to let their dying family members go.
Today, after months of medical updates, ethics consults, and intense conversations, we managed to get two family members who were not on the same page about how to care for a patient to agree on how to move forward. And though I think many of us on the medical team (and some family members) felt great relief to know that the family and the medical team were finally in agreement about what was best for this patient, there was also a great feeling of sadness to realize what that meant.
There are many sobering moments in my line of work, but none so sobering as when we see families make the selfless decision to let go of a loved one who is suffering. The "easy" choice is to keep a loved on alive at all costs. It is much more difficult to recognize when the pain and suffering felt by a person being kept alive by artificial means outweighs the pain and suffering that the surviving family members will be left with after that person's death.
These next few days will not be easy. For the first time in this job, I have offered to come into work over the weekend if I am needed. I do not pretend for a moment that this family with whom I have spent at least an hour every working day for the past few months will go quietly from my mind after their loved one has died. They have become a part of my daily routine, and I can already imagine the tug I'll feel at my heart when I walk by their room and it is empty or occupied by a new patient. But as I came to accept long before the family, this patient is ready to go, and will find peace soon in a way that was never found in this lifetime.
Go in peace, sweet one. Go in peace.