University of Michigan Health System, Ann Arbor, Michigan, United States (Spring 2011)
I work at a large teaching hospital as an Emergency Department social worker. It is easy to get lost in a place that large, so I am accustomed to helping people get to various areas of the hospital. But on this day, I was not prepared for the charge nurse’s request to take one of our adult Emergency Department patients to the pediatric operating room.
“Why?” I asked. “Can someone else get him over there?”
“His kid is in the operating room, and it doesn’t sound like he will make it out of surgery. The OR medical staff want to talk to his dad right away. I thought he might need some support on his way over there.” The charge nurse looked at me hopefully.
“Show me where he is,” I told him. We found our patient in the waiting room, sitting in a wheelchair. He had come for an evaluation of an injury that made it difficult to walk. I introduced myself and explained that I wanted to wheel him over to the OR to talk to his son’s physicians.
“That’s not good, right?” he inquired. “I mean, why would they send a social worker?” I couldn’t disagree.
We arrived in the pre-operative area where a nurse found us some sterile scrubs. Dad was whisked on ahead into his son’s OR. When I arrived shortly afterwards, the scene in the OR was surreal. On the table in the center of the room lay the tiny baby, his skin so translucent that he appeared more alien than human.
The premature infant had been born in an emergency Cesarean section earlier that day. Now oxygenated by a special ventilator, the baby’s chest did not rise, giving the illusion of death. The surgeon described a tumor that was so entwined with the blood vessels in the baby’s chest that it could not be removed. In this Level One Trauma Center, I am not used to hearing the words, “There’s nothing we can do.” The baby would not live much longer. They wanted to give Dad some time with him.
I watched Dad touch his son’s tiny hand, looking down at him with an unreadable expression. Engrossed in the moment, I didn’t even ask where Mom was. She had been admitted to an ICU in the adult hospital following a complication during the birth, and soon several ICU staff members accompanied her stretcher into the OR. Jostling all of the equipment and bodies into the room, everyone hushed as a nurse placed the baby in Mom’s arms, minding the myriad tubes coming from his body. I distributed tissues to the parents and staff. My eyes met those of the surgeon’s, and I couldn’t help noticing that she looked different; I had never seen her with tears in her eyes before.
The OR was muggy; whether tearful or stoic, everyone was sweaty and uncomfortable. Expectantly waiting, we shared quietly in the experience with the family, each feeling sorrow in different ways. Finally Mom broke the silence, “I can’t hold him anymore.” Having just been extubated, Mom was exhausted and overwhelmed. Ice chips and pillows to revive and support her could only help so much. Mom said goodbye to her son, sinking back against the pillows. Dad held the baby next and said goodbye to his son. Mom spoke up again, “Can I leave before you take the tubes out?”
Dad gave the baby back to the OR staff. The ICU team wheeled Mom out of the room. I took Dad back to the ED. Walking slowly; I answered his questions about funeral arrangements, the death certificate, and a letter for his employer. In an instant, their lives had changed: the pregnancy, the baby’s life, and that family’s expectations for him were all over. I was completely drained. I had just shared in the most devastating experience a parent can endure; I couldn’t help empathizing with his parents’ pain and emptiness. As he was called to see a physician, Dad gave me a hug, and I smiled as I left him with his wheelchair and his grief in the ED exam room. As painful as it is to lose a child, Mom and Dad had been able to spend time with their baby and say goodbye to him. The uncertainty of his surgery was over, and they had an answer regarding the baby’s diagnosis. The parents could now start to piece together what it would take for them to work through their grief.
Still feeling dazed, I headed toward my office. My pager sounded. It read, “Code blue arriving in trauma bay C.”
KELLY KLEIN, LMSW is a clinical social worker at a large teaching and research hospital in the Midwest. She has worked in the Emergency Department and covering the entire hospital on evenings, weekends, and midnight shifts. Because her hospital contains the county morgue, families frequently arrive at all hours requesting to see their deceased loved ones. Working with these families has taught her the importance of saying goodbye as part of the grieving process, and she advocates for families and friends to have this opportunity whenever possible.