Her Work is Done

Her Work is Done

It is not enough that she was only seven months old, that her three year old brother could make her giggle, that, she appeared perfect in every way - a little angel. It is not enough that she never harmed a soul, that she was beautiful when she was a born, with rosy cheeks and pudgy thighs, that she had a sweet disposition; she hardly ever cried. It is not enough that she looks like she could be napping as she lies in her bed; eyes closed, skin fair, curly brown hair with a bow in one tiny wisp. She is the treasure that many families have hoped for, have prayed for, would love and cherish every day of her life. She is the child that would fill the void in an empty heart. Despite all of what she is and what she could be, nothing could prevent someone from hurting her, for taking her life from her, from bringing her to this point, this work that she must do.

She lies in repose in front of me with technology, nurses, and her grieving family surrounding her. At her bedside, I struggle to understand the why, the how… It always comes back to the why.

 As I review her story, nurses scurry about, “packaging” her for the operating room. I glance at her vital signs, and the drugs that are keeping her alive; multiple infusions that control her tenuous blood pressure and heart rate. I get report from the ICU nurse that has cared for her faithfully these last days. There is tranquility in the infant’s room; a peace that is unfamiliar to those that frequent intensive care units. There is calm where hours earlier there was mayhem. Earlier, fluorescent lights, monitors, and the sun poured in, painting the room and all in it with a preternatural glow. Now, as the struggle of the last days is over, the struggle to somehow save this infant, the lights have been dimmed and all speak in whispers. Now the parents weep inconsolably, sobbing as their future without their baby daughter becomes clear  Now their little one will do the work that she must do. She will give of herself to other infants, so that they might survive. That is the work that she must do.

We try to speak to the parents; to ask if they understand what will happen next. “Will she have any pain? “ her mother sobs. “Will you stay with her?” “Will you keep her warm? Her feet have been so cold for so long” We tell them that we will keep her warm and safe, that she will feel no pain and  that we will care for her as if our own. We ask if they would like to follow us downstairs to the door of the operating room, if they would like to have a prayer before we go, if there is other family that wishes to see her off. We arrange the IV lines in the bed beside her; secure the wires, the catheters, and the tracheal tube. We cover her with warm blankets and I grab one of her many toys and place it under her arm so that she might cuddle it close at her side. All is made ready; each detail checked and rechecked. This all too familiar caravan begin its slow journey. I put my hand on the mom’s shoulder. “ We will take good care of this sweet baby.”

We hang outside of the operating room doors as the parents and grandparents, aunts and uncles, neighbors, pastors and her big brother, seeing what no three year old should ever see, say their last good byes.  Mom suffers at the bedside, holding her daughter’s tiny foot gently between her fingers as if to keep her from going the rest of the way. A nurse begins to cry, and I, the jaded veteran of the health care wars, the “expert” with all the training and experience, that has seen it all before, break down, tears streaming into my surgical mask. , My thoughts drift for a second and I think about all the times before that I have made this journey, taking a cherished child to their last stand, to the work that they must do.

I place her on the operating room table, holding her one last time as we transfer the infusions and the monitors. The room is sweltering; she cannot maintain her temperature. She is prepped with dispatch, covered with the surgical blue, the instruments brought to the bedside and the work begins.

 The surgeons come to the surgical field; one sighs while holding the knife over the chest and scoring the skin in an instant. They are efficient in their dissections; they have done it many times before. They isolate the kidneys, the liver, the bowel, the heart and the lungs.  Each will go to another little person in another town in the east, south, north, and west and each, at this very moment is struggling to survive in another operating room, in another medical center. This little one is working for them.

We struggle to maintain the organs that are being harvested. More fluid, more drugs, anything to keep the blood pressure up without damaging the heart that by nightfall will beat in another chest, the liver that will save the life of a child born with a congenital disorder that, at the age of one, rendered theirs ineffective, or the tiny kidneys that will help two three year olds survive to see their children, their children’s children.

The surgeon that has come to retrieve the heart speaks to the three others that are huddled with their instruments in the tiny belly. “ We’re ready up here, whenever you are,” he whispers, without lifting his head, without so much as a flinch.

“I think we’ve got everything ready at this end, another surgeon interjects. “Ready to perfuse? “

“We are ready”, the perfusionist answers. “We are ready,” I offer peering over the surgical drape. I put my hand on her head at the head of the bed, warm for the last time.

The thoracic surgeon, addressing the room says in a calm voice. “I am going to cut the veins to vent the heart, then we will cross clamp.” This time he looks around the room as he speaks, making eye contact which each and every one – surgeons, nurses, medical students technicians, and me.

One finger lifts the heart and the Metzenbaum scissors sweep deep into the open chest. Dark blood wells up in the field. He places a small clamp across the aorta. “ Perfuse, please.” He looks across the drapes at me. “Lungs down, please and vent off”.

We disconnect the circuit that has been ventilating the child. All of the waveforms on the screen are now flat. We turn off the intravenous pumps, seven in all, that have been sustaining her. The surgeons are working quickly now to excise the organs from their place in the chest and abdomen. Soon they will leave a hollow cavity behind. One will close the incision with dispatch. We will clean her up and wrap her in a blanket for her trip to the morgue. She has finished her work. Now she rests.