letting go

I accompanied a patient in the ICU as he was to have an electroencephalogram or EEG done. The purpose of which is for prognostication- to know if the patient still has some brain function or if he is already brain dead.

A little background, the patient is hypertensive on hemodialysis which he has to continue for life, who came for sudden difficulty of breathing. He had a heart attack. And things started to unravel from there- with the patient having seizures, eventually going to cardiac arrest, but was revived. In the ICU, he was in a coma. His heart was still beating well, but there were no signs of brain function. And thus, the need for EEG to confirm.

The patient is a husband of a medical technologist in our hospital. As a healthcare worker, she is used to seeing patients who are terminally ill. When i was talking to her, she cannot stop the tears from falling. She knows that there is little hope of recovery but she'd like to do everything for now.

The EEG showed very minimal brain activity and that return to normal function is almost none. This was explained by the primary physician to the wife and she was also advised regarding advance directives (like a "do not resuscitate" order, or DNR). The wife came inside the room and I guess out of shear humanity (or stupidity), I asked if she was okay. She explained that she was expecting it but acceptance is really difficult. Ordinarily, in her line of work, it is easier to tell the family regarding the prognosis. But now, that it has happened to her, she does not know how to react. And she also has that burden of telling her children and to discuss the condition of their father.

After the procedure, the wife came to me and asked me if we can explain to their children the condition of the patient. She cannot fully explain it to her children without tainting it with emotions. I said they can talk to us anytime (though the best people to ask would be their attending doctors).

I've always thought I was callous when it comes to explaining the poor prognosis of patients. Maybe because in my years of residency, I was slowly trained to lose such emotions. However, seeing this family, no amount or length of exposure to death can ever make one accept the loss of a loved one that we tend to hold on and do whatever heroic measure or god-like act we have to do as we gamble that little chance for life.

But maybe, this thinking might just be wrong. Maybe sometimes, loving simply means letting go.

Feb 17, 2012


"Love is of all passions the strongest, for it attacks simultaneously the head, the heart and the senses"
--Lao Tzu