It was in the late 1970's; I'd been out of nursing school and working nights in the Intensive Care Unit long enough to feel confident in my skills and comfortable in the face of the mysterious events that happened there, a place of extraordinary illness and extraordinary healing. Within the confines of that small, seven-bed unit, amazing things happened all the time: patients who should have died recovered without a hitch; others, who should have recovered, slipped out of our grasp.
This particular occurrence--the strangest of them all--happened at the edges of my professional life. I observed this story from a clinical distance, as if I were eavesdropping, peeking around the corner into the lives of others. The care of this patient, a young woman in her early twenties, had been assigned not to me but to other nurses. While I often helped her primary nurse with the duties of bathing, turning and suctioning, I remained mostly at the periphery. I was a compassionate and, eventually, an awe-struck witness.
I don't recall if it was some catastrophic illness or an accident that brought this young woman to Intensive Care. I remember that she was, even in her coma, even with the endotracheal tube distorting her mouth and her features, beautiful. If memory serves me, her hair was long and dark; her nurses would braid it or rubber-band it into two ponytails. I never saw her father, but her mother was ever present at the bedside, praying and talking and holding her daughter's hand. Not a nurse herself, perhaps not even familiar with any part of our medical world, this mother nevertheless guarded her daughter fiercely. No one drew blood, gave a medication, changed a ventilator setting or came within two feet of her daughter's body without being questioned: Why are you drawing more blood? What is the medication you're giving her? Are you giving her more oxygen today or less? Is this treatment really necessary? I overheard, more than once, this mother's calm but decisive, no, you're not doing that. I saw, more than once, usually taciturn doctors take their time to explain what was happening and why.
I'm not sure if the patient's mother ever went home to rest. She seemed to be there, sitting with her daughter, whether I was working my usual night shift or picking up an extra day or evening shift. As I cared for my own patients, looking through the clear glass partitions that separated one patient from another, I watched this young woman's heart line, a red tracing leaping across the cardiac monitor, and I could see the erratic blood pressure readings that sometimes dropped so low I wondered if she was dying, and other times rose so high I was sure a stroke was imminent. After the second week, when there was no change in her condition, the doctors that came and went from her bedside grew grim and, perhaps to protect themselves, began to spend more time with the chart and less time with the patient. Then one day, after a huddle of doctors in their white coats had gathered around the bedside, hiding both the patient and her mother from my sight, I heard a cry of anguish followed by an explosion of anger: No, the mother shouted. No, you will not take her off the respirator.
A few days later, when I came in at eleven for the beginning of my night shift, the patient and her mother were gone. Had the mother relented and allowed the doctors to take away the tubes and machines that were, apparently, keeping her daughter alive and breathing? No, the charge nurse said. The mother refused to let her daughter be taken off life support and so the hospital discharged her to a long-term rehab hospital in New York, ventilator and all. A few of the nurses shook their heads and said things like if it were my daughter, I'd have let her go. Who wants to live like a vegetable?
I didn't say anything. Even though keeping this patient on life support seemed to fly in the face of all medical advice, and even though the mother's decision to cling to her daughter's life seemed based solely on intuition--a mother's intuition--I silently agreed with her. I hoped that, if necessary, I would have that mother's courage and faith, even if, after all, the eventual outcome was uncertain. The mother's words--it's only been two weeks; can't we wait to be sure--stayed with me.
A year later, when I was no longer working in ICU but putting in my time on the oncology unit, I heard the final outcome of this story. I met a nurse, a colleague from Intensive Care, in the cafeteria. She asked if I remembered the young woman patient and her mother. Sure, I said. Who could forget?
"Apparently," my friend went on, "the patient went to a rehab hospital where she stayed on the vent for another week. No one could talk the mother into extubating her. She kept insisting that her daughter would recover. Then one day, the daughter squeezed her mother's hand and a few days later opened her eyes. It took months of physical therapy and occupational therapy, but"--here my friend paused and popped a French fry into her mouth--"guess what? She and her mother walked into the unit yesterday to say hello. Pretty wild, right?"
I've thought about that young woman and her mother many times in the years since I stood across the unit, watching them. Why did this patient survive when it seemed, according to all medical indicators, that her life was over? How could she be labeled "hopeless" one day and, a few weeks later, open her eyes and begin her life all over again? And what if--how frightening to think this--what if the mother had said yes, let's take out the tube and let my child go? What if we caregivers, relying on whatever we think is the most up-to-date information of our time, consign a patient to die when, with a bit more time and vigilance--and perhaps a lot more faith--we might witness a different outcome? How do we know? How do we ever know?
I wonder about my own conviction in the face of what might seem to be the overwhelming medical evidence presented to me if I were sitting vigil at a loved one's bedside. I can only hope that I would be like that mother, resolute and ever on watch, not prolonging a life indiscriminately but also not abandoning life too soon. And now that so many years have gone by, now that I've seen so many miracles during my long nursing career, I also look at this story from the young woman's point of view: when I'm the patient, will there be someone who loves me enough, trusting in the grace that lies beyond our medical knowledge, to wait to be sure? Will there be someone there to honor my life in just that way?