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  • Writer's pictureMara Cao

Learning About Life And Death In The ICU

He lies before us, the heart monitor beeping, the ventilator inflating his lungs up and down. His eyes flutter behind the closed eyelids. Suddenly, he jerks, his eye open and roll back, and his body shakes. His heart accelerates like a racecar to 170 bpm. The virtual lungs on the monitor move like butterfly wings. As we watch, he becomes still again. The episode has lasted less than a minute.

Standing against a corner table, I looked around, overwhelmed by the beeping bed alarms and the traffic of nurses moving back and forth. In a room across the hall, a large sedated man was being tucked into the bed while a nurse hooked him up to IV lines and ventilator. My senior resident told us this new patient had a cardiac arrest while being transported and they had to do CPR. She had just examined him and the prognosis was bad.

Just hours earlier, this man had gone to sleep after having beef ribs for dinner. He woke up in the middle of the night short of breath. He called his wife to get him his medications. She could not find them. He told her to call 911. When the EMTs arrived, he was fighting to breathe. They wheeled him onto the ambulance. Then his heart stopped. The EMTs started CPR and it took 10 minutes before they could get a pulse again.

The door slides open and an old woman comes in. She wears a fitted denim jacket, jeans, and a cap. I ask her how she is and she responds, “I’m good! God is good. God is good. He will carry my boy.” Her boy is the 50-year-old man who lies sedated before us.

I introduced myself, “I’m Mara. I’m a third-year medical student on the ICU team taking care of your son.” She nodded, her face stoic as she looked at her son intubated and hooked up to beeping monitors. I assured her that the medical team was doing all we could do for Lenny. I could feel the somber heaviness as the winter sun diffused through the frosted glass doors, softening Lenny’s features. As I stood with Lenny’s mom, I wanted to know more about the man in front of me. I asked, “Where did Lenny grow up?” She said, “Lenny grew up in Oakland.” I told her I was from nearby Berkeley and I had spent much of my childhood in Oakland. As I listened to her talk about Lenny, I imagined him as a young man roaming up Broadway Avenue and crossing the vine covered gates of California College of Arts where he studied graphic design. I asked her what she did in Oakland. “I teach cosmetology, you know, make-up, at night at Laney College.” I once took painting classes at that same college. I told her my mom used to own a nail salon down by Alcatraz and Telegraph. She knew the exact corner I was talking about.

My mom learned to do manicures while in a refugee camp in Sacramento long before I was born. She dreamed of one day owning her own shop and worked and saved her money until she was able to do so. My mom had to close her salon after the man who managed the snack store next door was shot and killed in a robbery, and after she and my aunt, who worked with her in the shop, were robbed by two men who entered pointing a gun at them.

We talked about how Oakland had changed so rapidly in recent years, from a once run-down town with whole blocks of shuttered abandoned store fronts, to a city crowded with high rises and new apartment buildings, with more construction under way everywhere.

I was in the ICU for two weeks. I checked on Lenny every morning during my rounds and talked to his mom, wife, and brother who took turns standing vigil. I thought of my uncle, my mom’s brother, a heroin addict, who had died alone and abandoned in an ally way in Vietnam. I remember my mom receiving a letter about her brother’s death and saw her cry. Many people die alone with no one to hold their hand or close their eyes or whisper words of comfort into their ears. I am not a religious person, nor do I know if there is anything that comes after we die, but I believe the last moments of a person on Earth should be accorded a measure of respect and dignity.

At the beginning of my second week in the ICU, I learned that a code blue had been called on Lenny overnight. He had lost all brainstem reflexes and his pupils were blown and nonreactive. The attending physician told us we would have to move toward declaring Lenny brain dead.

To declare someone brain dead means the medical institution is no longer obligated to continue providing life support even if the family wants it. It means the person is legally dead. To make this determination, a brain death exam must be completed by two physicians, one of whom must be a neurologist or neurosurgeon. The neurologist must confirm that the patient has complete and irreversible cessation of brain function. The second confirmatory test is called the apnea test, during which ventilator support is removed; a positive test is defined by total absence of respiratory effort.

Lenny never regained consciousness. The tests were administered. He did not pass either of them. His family made the decision to donate his organs. On my last day in the ICU everyone lined up silently on both sides of the corridor for the Honor Walk as Lenny’s body was wheeled away to the operating room for organ removal with his family marching behind.

Mara Cao, MS3

October 2019

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