It’s another Christmas Eve in your local emergency department. I’m heading in for the night shift as I make the walk up the steep driveway to the ambulance entrance doors. I notice a vehicle parked in one of the ambulance bays. Gift of Life is painted on its side. Our local organ procurement and transplant program vehicle’s presence means somebody is giving the ultimate Christmas present – their life. It is an exchange that will save many.
Trauma may be the worst disease of all. Its victims, often in the prime of life, start their day in a “business as usual” manner never expecting the truth of its outcome. Some end their day clinging to a drastically altered life. Some get a second opportunity to value life in a whole new light. Others do not escape trauma’s clutches and succumb to injury. Tonight, somewhere in my hospital, there is someone in the latter category.
“He meets brain death criteria”, is a statement I’ve heard too many times in 25 years of emergency and trauma nursing. It’s one of those phrases that led me away from working in the Trauma ICU (TICU) back to the Emergency Department (ED). The ED is all about hope; the TICU is all about reality. The resuscitation that counts as an ED win, often turns to a TICU loss. There, my colleagues are left to the minute by minute care of someone gravely ill. A family desperate for good news sits longingly at the bedside. Yet, TICU nurses posses the foreknowledge of how “this” is going to go. The evidence lies brutally in front of them – no life remains in this seemingly alive body.
Yes, there is a heart beating, lungs operate via the ventilator attached to them, kidneys continue to make urine but the essence of who this person was – the mind – is gone. This determination is not made impulsively. Rather, every chance for life is taken into consideration; brain death certification exams take place twice, and hours apart. This moribund crossing of the T’s and dotting of the I’s by a neurologist confirms death. Only two options remain in this moment – life or death.
Death comes with the withdrawal of futile care. The alternate comes with the decision to give the gift of life – organ donation. The gift of the heart gives a grandfather, laden with cardiomyopathy, the opportunity to experience the joy of his grandchildren. The gift of the lungs provides a breath of life to those suffering from idiopathic pulmonary fibrosis. The gift of the kidneys frees two people enslaved to three times weekly hemodialysis treatments. The corneas give sight, the pancreas “heals” diabetes, the face erases disfigurement, the hands give back touch. Skin, bone, tendons and veins dramatically improve the quality of life for up to 50 people.
One tragedy yields blessings upon many. “Opposites” meet on the level playing field of greatest need – black saves white, Athiest saves Christian, man saves woman, gay saves straight, straight-laced saves former addict. There couldn’t be anything more true to the Spirit of Christmas then what I’ve seen in my years on this nursing battleground. I only wish I could show the grieving family, in an inverse It’s a Wonderful Life kind of way, of what their love and generosity bring. It might ease their pain knowing that this gift, not bells, are of what angel wings are made.
Well my patients await me and I need to get started. I walk through the ambulance doors praying for the grieving family, those awaiting transplants, my beloved colleagues working in the TICU and those working by my side tonight. I also remember to give God thanks for the un-guaranteed moments given to me to laugh, love and live a most full life.
To learn more about organ donation visit https://www.unos.org/