So I don't really have a title to this post. I just finished my month in the pediatric ICU and it was actually a lot of fun. The kids are fun and most of the time, they recover from illness so much faster than adults.

Except Saturday. Saturday morning is a day I hope to forget but probably won't. We got a 16 year old boy medi-flighted to us from a rural hospital. He had overdosed on drugs on a camping trip and had a full cardiac arrest. When he got to us, a brief neuro exam told me he was most likely brain dead. To actually declare him brain dead requires what we call a "brain death exam" and we can't do it until his body temperature and pH are normal. In other words, there can't be a metabolic reason why he has a positive brain death exam.

So how do you tell a mom that? I had an hour to contemplate this before she got to the hospital-before the whole family got to the hospital. I took a long, audible deep breath and just told them straight out. How sorry I was...his brain was without oxygen too long....he overdosed....and he was most likely brain dead. Then the worst came: His mother didn't believe me. That's the hardest part. You don't want to be mean, but you also don't want to give them ANY hope that their loved one will turn around, because they won't. Brain dead IS dead. To tell them any different would be cruel and it would only draw out their pain. My attending came in and reiterated what I said. More family showed up and a fight broke out between them, pointing fingers and blaming each other.

I drove home completely depressed and it stayed with me the whole day. I felt guilty when I enjoyed my favorite song on the radio. I felt guilty getting to watch college football later that night. People complain that doctors seem so removed from compassion and deliver bad news without emotion. It's not that they don't care. They really do. But there comes a point when you let the daily grind of other people's tragedy completely destroy you.

The next day I went in and the resident on call told me that overnight our patient stabilized enough to complete a brain death exam. He was dead, as I figured he would be. His mother wanted him to be an organ donor, but his organs were too damaged from lack of oxygen. His ventilator was turned off. And that was it.