I think that generally is enough; in their grief, families do not wonder why I didn’t bring up donation or feel misled, but it is always a moment where I feel pulled between my two mandates — one to this person and the family and the other to whatever it is that comes next. Though television shows would have you believe that the same doctors and nurses are also caring for the patients who will receive these organs, that is not the case. We never know where they will go.
Discomfort grows more acute in the coming hours or days, when a patient has been declared brain-dead, but whose heart is still beating as a result of our medicines and machines, and who is being worked up as a potential organ donor. This is the time between that Friday and Sunday, the space between death and donation. Now, a member of the organ bank is helping to direct the patient’s care from behind the scenes. Asking us to check labs. To do procedures.
The first time I had to do a bronchoscopy on a brain-dead patient, sliding a camera into the airways to visualize the lungs, I kept reminding myself that I was doing this to help save the life of someone who could not breathe. A colleague told me that when he does a cardiac catheterization on such a patient, to see if the heart is viable for donation, he knows the patient is gone and yet he still gives numbing medicine before he nicks the skin. I have seen our nurses talk to patients still, even though they have died, even though they are no longer present to hear the words.
I will confess — back in my intern year, with the mother who had overdosed, there was a part of me that resented the organ bank representatives. And I think that’s a natural response, in a way, to this moment. We are asked to perform the rituals of critical care on deceased patients, so that their organs can go to someone else.
Years later, I no longer feel this way. Maybe it’s because I have cared for enough transplant recipients, and for those who died waiting for organs, that I know how remarkable it is to be able to donate. Maybe it is because I have seen so many tragic deaths that have no positive ends, nothing for anyone to hold on to after. Maybe because I have realized that in these moments, I am still caring for my patient and their family — I am doing what I can to make sure that their wishes are carried out and that some aspect of them persists, even in death. So we do the procedures. We check the labs. The family visits. The life is over, but there is this coda.
My patient’s son held his mother’s hand as they wheeled her body out of the intensive care unit. I remember that. He was wearing a baggy sweatshirt; he must have been a teenager. Her death certificate will mention only that first date, when we declared her brain-dead, because that is the day she died. There is no second death, as much as it might feel that way, despite what the headlines suggest. That second date, the punctuation mark at the end of the story, is the moment when loss turns to hope, when a stranger gets a second chance at life.