My day began with a consult order for an ICU patient who’d just transitioned to “comfort measures only” (CMO)—no more curative treatments.  David, 52, was found down the night before in a home south of Portland.  Paramedics restored his heartbeat and breathing (with intubation), but tests at the hospital showed only minimal brain activity, as well as fentanyl and meth in his blood.  His only child, Isaiah, a young adult, was by law his surrogate decision-maker; together with David’s mother, Jean, and his brother, James, they concluded their only option was to let him die in comfort.

I enter David’s ICU room and introduce myself.  These three, plus other family members, turn to me with tears in their eyes.  Isaiah takes my outstretched hand, then pulls me into an embrace.

“Thank you so much for coming.  This means the world to us.”  I hold him as he weeps softly, then he hands me off to his grandmother, Jean.

“Thank you for being here,” she begins.  “It’s not supposed to be like this, I’m supposed to go first.  And I’ve already lost my only daughter.  James is all I have left now.”

James, who has been pacing, shouts “Come on, David—get up!” and then “I can’t take this anymore,” and leaves with his wife.  The room settles once again into somber quiet.

“I want to let you know I’m here for anything you need,” I begin.  “A listening ear, prayer, whatever.  I also want to offer you a comfort quilt.  They are made by volunteers for times like these; I like to say they have prayers sewn into each seam.  Do you think that’s something you’d like for David?”

They nod in unison.  “Definitely,” Isaiah affirms.

“Great, it’s so much more personal than a hospital sheet.  Did he have any favorite colors?”

Isaiah replies quickly.  “Red and gold.”  I raise my eyebrow and he continues.  “49ers, his favorite football team.”  All in the room smile and nod.

“OK, let me see what I can find.  I’ll be back shortly.”

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The decision to transition to CMO is always difficult, especially when the patient can’t speak for themselves.  It is doubly difficult when the patient’s condition arises suddenly, as David’s did, and even more so when the family is divided (see What Would Dad Have Wanted?).  In this case, fortunately, the sense of family closeness and cohesion was palpable from the moment I stepped into the room.

Regardless of the situation, the offer of a comfort quilt is almost always soothing to loved ones, and most accept it.  It humanizes an otherwise sterile setting, and it allows those gathered to feel they are doing something for their loved one, shortly after they have surrendered hope that they can do anything at all.  I even once had a daughter say, “Mom used to participate in a quilting bee that made these … now it comes full circle.”  I am so grateful for this practice, and I welcome each opportunity to offer it.

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Bearing a red and gold quilt, I find the family in the ICU waiting room, as the staff needed time to prepare David’s room and person to receive visitors saying their good-byes.  The group has grown to include Isaiah’s wife and his 10-week-old son, as well as Isaiah’s mother, Amy—once upon a time David’s wife.  They beckon me over, put a chair in the middle of their circle, admire the quilt, and give me their attention.

“It will be a few more minutes before we’ll be able to lay the quilt on David,” I begin.  “What would you like me to know about David that would help me be with you at this time?”

The responses are immediate, heartfelt, and often irreverent if not hilarious.  The universal sentiment, never spoken aloud, is that they want me to know David not for how he died, but for how he lived.

Isaiah starts.  “He worked in construction, worked harder than anyone I’ve ever known, and loved every minute.  He’d call to tell me he was on top of some tall building, or on the tarmac at the airport, and always say ‘Isn’t this just the coolest thing?’”

“You’d feel he was your friend 30 seconds after you met him,” said another.  “He knew everyone, I mean everyone.  You’d walk into a restaurant and he’d know the cooks and dishwashers.  He lit up the room.”

“His house was yours, and yours was his.  He’d come over, walk into your kitchen, open the fridge, and say ‘Whaddya got?’”

I ask if he ever got to meet Isaiah’s son.  Amy smiles and says, “He came over to my place just last month.  He walks in unannounced and says, ‘I’m here to meet my grandson.’  He was over the moon.”

“Did he open your fridge?” I ask.  “Of course!” she responds, and everyone laughs.

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The time comes for me to lead the closest family members back to David’s room.  We gather around the bed, and Isaiah and Jean spread the quilt over David.  James pulls out a 49ers t-shirt and lays it on top of the quilt, over David’s chest.  The family has told me they are Christian, so we hold hands in a circle and I offer prayers in their tradition.

“Dear loving creator God, thank you so much for the gift of your son David.  Thank you for the way he brought your Light into the world and spread it among everyone he touched.  Thank you for blessing him with a child, and now a grandchild.  Help us to keep alive the spirit and warm memories he left us with. 

“But, God, right now all these hearts are torn apart and hurting.  You promise you are here when we gather in your name, so help us to feel your presence among us, bringing your deep comfort and peace, now and in the difficult days ahead.  We ask these things in the name of your son Jesus Christ.”

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A short time later I consult with the nursing staff and then go out to meet with Amy, Isaiah’s mom, who has emerged as the go-to person for the unavoidable administrative details of this situation.

“I have a few things I need to go over,” I begin.  “The staff thought you might be the best person for me to talk with.” 

Amy nods.  “Isaiah is the decision-maker in the end, but I’m trying to take as much burden off him as I can.  He’s still young, and a new father, and David meant the world to him.”

I hand her our pamphlet What Do I Do Now?  “I know you haven’t had time to think about any of this, but it’s a great resource for all the things you’ll need to do, like selecting a funeral home and obtaining a death certificate.  Step 1 is to take care of yourselves—this can all wait a day or two.”

Amy lets loose a long sigh.  “I have been thinking about this, but I’ve had no idea where to begin.  This will be a big help.”

I pause, then continue.  “I also want to let you know that David is eligible for evaluation as an organ donor.  Is that something you think Isaiah and the family would want?”

Just then Isaiah joins us, and when I repeat this he is enthusiastic.  “My mom and I have actually talked about it, and we’d like to do it.  My dad always looked up to heroes, wanted to be a hero, wanted to save others, and this would let him go out a hero.  We absolutely want this—for him, and for us.”

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One of the many things I love about my hospital is that we are a center for organ donation, as well as kidney and cornea transplantation.  It’s always heart-wrenching to see organ donors on the ICU census, whether from our hospital or transferred from another, as they’re usually on the young side—younger than David—and most have died sudden deaths, like overdoses or motor vehicle accidents.  No matter the location or circumstances of their death, we always try to treat donors and their families with compassion and respect.

In particular, whenever possible, we conduct a ritual called an honor walk (or hero walk), “a ceremonial event to commemorate a patient whose organs are donated.”  Family and loved ones are invited to join hospital staff to line the hallway from the patient’s room to the elevator leading down to the OR suite, where the organs are removed and and life support is discontinued.  It is a solemn and moving ritual, offering the family some positive closure to an otherwise tragic death.

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The following evening I enter the ICU waiting room 15 minutes before David’s honor walk and I’m stunned to encounter at least 25 family members and friends, most decked out in 49ers jerseys, scarves, or other swag.  Isaiah, draped in a 49ers flag, strides over to greet me and wraps me in his arms, flag and all.

I greet the family members I know, and meet others I don’t.  Friends, co-workers, in-laws, the whole gamut.  There is some light banter—Seahawks fans grumbling about wearing 49ers gear—but the love in the room is overwhelming.  The sadness is overwhelming, too, especially for David’s mom Jean, but she is strong and supported by the most important people in her life.

Soon it is time.  I lead everyone in and help them line the path David’s gurney will take.  Isaiah, Jean, James, and Amy join the care team in David’s room, then walk alongside his gurney as it traverses the path to the elevator lobby.  After many hugs, family and friends head off into the night.  I stay with Isaiah, Jean, and Amy; along with two nurses from the organ donation program, we wait for the elevator to arrive.

Isaiah reaches for one last hug.  “You’ve been with us from the beginning, I’m so grateful you could be here tonight, when we get to make Dad a hero.”  The others share similar sentiments, and all I can say is that the blessing is mine to accompany a family with so much love.

The elevator arrives and the nurses lead them in, along with David’s gurney.  The doors close behind them, taking them on their hero’s final journey.