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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000426699.34449.cd
Reflections

The Hardest Decision

Richmond, Amanda L. BSN, RN-BC

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Author Information

Amanda L. Richmond is a nurse based in Salem, Arkansas. Contact author: amandalrichmond@gmail.com. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@comcast.net. Illustration by Barbara Hranilovich.

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Abstract

Summoned from overseas, a husband and father finds a drastically altered future.

That she was still beautiful made her situation all the more tragic. She had little visible damage. An EVD tube snaked out from under her hair and deposited its contents into a drip chamber. Her chest rose and fell at a preselected rate of 14 breaths per minute. iv lines disappeared under her gown and terminated into a central line. On the monitor, her vital signs were flawless.

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Her outward appearance did nothing to suggest the chaos lying under her skull. A passenger in a vehicle that had flipped multiple times at highway speed, she'd suffered a severe traumatic brain injury. She was the only person injured out of the five involved. In the near future, the other four would come to visit her and find themselves racked with guilt while they thanked God that they'd been spared. She had two young children, a three-year-old and a newborn, as well as a military husband who was stationed overseas.

He arrived in the middle of the night, still in military regalia. His hand trembled when he shook mine. He was dry-eyed, but I could see the muscles bunching in his jaw. He followed me into his wife's room. “She doesn't look that bad,” he said, with hope in his voice.

I quietly explained her injuries to him.

We spoke about her care and condition and then I retreated to give him some privacy. He sat in the chair I had placed next to her bed and took her hand. I could see his shoulders shaking and I knew he was grieving for her—and for himself and their children as well. I could see his lips moving, but I don't know if he was pleading to God or to her, begging for her life back.

He stayed for a couple of hours, and I silently wove myself around him to tend to her various lines. When he finally stood to leave, he said, “Call me when she wakes up.” I didn't have the heart to remind him that she wouldn't. Instead I just told him I would call if there were any changes.

When I arrived at work the next evening, he had again taken up his vigil at her side. This time he had a crying baby with him. Noticing the tension and frustration in his face, I went in to see if I could help out. He angrily thrust the baby at me. “My own son doesn't even know me,” he said. “I've been gone since before he was born.”

I wrapped the baby up like a little burrito and jiggled him gently as I paced the room. In a little while, he stopped crying. Silently praying that he wouldn't start up again, I handed him back to his father, who tentatively folded him into his arms.

Looking at his wife, he said, “I can't do this by myself. I need you to wake up and help me.” His voice was almost shrill, and I could see he was on the edge of losing it. I sat down next to him and he started talking. He shared stories about her and their life together. As he talked, he cried, and I funneled tissues to him until he ran out of tears. When the hiccuping finished, and the last deep breath was gone, he looked at me sheepishly, then down at his baby, who'd slept through it all. I patted his shoulder and left.

The next few nights passed uneventfully. He would often bring their two children in. On one occasion the three-year-old pointed to the ventilator and said, “Daddy, what's that?”

“That's mommy's TV,” he replied, “and it's playing a really boring show.”

He struggled daily to make the correct decisions for her. Would we fit her with a tracheostomy and a feeding tube or would he withdraw care and say goodbye? He had no idea how to proceed. On the fifth night by her side, he asked me what I would do. Of course, I couldn't tell him. Instead, I challenged him to consider what she would want, to make decisions based on her needs, not his own.

The following night he made the decision to withdraw care. We asked everyone—her parents, two children, and husband—to step out as we removed the tubes and lines sustaining the patient. Then we invited the family back in to spend the remaining time with her. With everything removed, she was back to being the beautiful young woman she had always been, if only for a short time. Her breaths got farther and farther apart until there were no more. I stood in the doorway and watched a family subtract a member right before my eyes.

Her husband was the last to leave the room. As he did, he hugged me tightly and said his wife would have thanked me too if she could have. I was amazed and humbled that in his grief he would think of my feelings.

© 2013 Lippincott Williams & Wilkins, Inc.

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