A forty year old woman with cocaine addiction unfortunately presents with a massive stroke from drug use. She is clinically brain dead; although her heart, lungs, kidneys, liver, intestines, and other organs are uninjured, she has no neurologic function. She is homeless, but our social worker (sometimes I think of them as miracle workers) discovers that she had a son who she gave up for adoption. The son had turned 18 a month before, and he had left his foster home and was living on his own. We contacted him and he came in to see a woman he had never met, his biological mother, and to tell him that she was going to die (technically, she was already dead because brain death is equivalent to death).
I could not imagine what must have been happening in his mind or heart. How hard it must be to grow up for 18 years without a mother, having those emotions brew and churn, struggling to find closure. How earth-shattering it must be to have that world change. What a shock and scare it must be to finally meet one's mother in an intensive care unit, unresponsive, on a ventilator, at death's door. It is hard enough for any family member to see a loved one in the ICU, but to have a teenager wrestle with death for an estranged parent - that was something else. Although I did my best to support him, I leaned heavily on our social workers and chaplain to guide him through this terrible ordeal.
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In ancient Greece, the asclepion was a healing temple dedicated to Asclepius, the God of Medicine. Asclepius learned the art of surgery from the centaur Chiron and had the ability to raise the dead. The Rod of Asclepius is a roughhewn branch entwined with a single serpent.
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Hi! I am Craig Chen, a third year resident physician in anesthesiology at Stanford Hospitals and Clinics. I went to medical school at the University of California, San Francisco. Prior to medical school, I studied philosophy and biology at Stanford University, along with a minor in creative writing.
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3 comments:
That sounds really tough, in many ways. One question that comes up for me is whether one requires permission to contact the next of kin in this situation? Does the mother have to consent to letting her son know--or does the child always have the right to know regardless of what the parent wants?
That's a great question, and there are many conflicting ethical interests. Patients obviously have a right to privacy and ideally would give permission for their health information to be shared. On the other hand, this patient was unable to make decisions for herself (though technically she was brain dead so there wouldn't be decisions to make). Usually in this case, the priority to find a surrogate is more important than privacy (take an example of a patient coming in altered; most clinicians would err on the side of contacting the surrogate to find out what the patient would want). Of course, in this case specifically, the surrogate we found was not a good surrogate at all since he had been estranged from his mother.
Ultimately, our social worker and case manager felt that had the son been under 18, we would not have contacted him. But because he was over 18, they felt that we would assume she would want him to know, and thus contacted him. I'm not an expert in the legal details and there were a few big differences between the actual real life scenario and what I blogged, but that is what ultimately happened.
Thanks for your comment!
That makes sense. We are trying to increase the number of patients with advance directives at our clinic for this reason, but it seems like this is one among many things that is harder for vulnerable patients, since there are so many things going on. Thanks for sharing!
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