Thread by @rn_critcare

"I don't know why she's here, she just had a sore throat," my patients son said to me.
We had just admitted his mother into our ICU, now so infectious it was putting her in septic shock and multi system organ failure.

This boy looked like my own son, a big stocky football player. Just old enough to be considered an adult but still so young to be making life or death decisions for his mother.
He was lost.
My heart was in pieces.

She was with us for weeks as we battled to sustain her life. It was a rollercoaster of emotion: one day able to talk and the next day would spiral and end up intubated, sedated and on multiple forms of life support.

I was compelled to work my shifts with her. First, because I felt I had invested so much energy into saving her life I had to see it through, no matter what the outcome. But then the lines blurred & I was just as invested in the well-being of my son. Her son.
Ugh. Blurred lines

His father was estranged from him. He didn't live near his mom's relatives to know them well enough to understand the support he could find in them. Though they tried so hard.
They were strangers to each other with their common thread lying helpless in bed.

It seemed we were asking the world of him: do we do CPR? Then she would arrest and we would recover her. Do we do CPR again? What about a trach? Would she want a trach? What about her infected leg? Would she be ok if we cut it off? Kidneys? Is it ok to start dialysis?

Over the course of those weeks I watched this boy sit at his mother's bedside. And every day I would go home to my own son, hug him far too long, and go over for the hundredth time what would be acceptable as my life-saving measures if god forbid it were to come to it.

On my lunch break when buying my coffee I would often grab him a slice of pizza and a pop. Sometimes I would just hang out with the family in the waiting room and listen as they shared their memories. We would often praise the the son for how strong he was through this...

Despite our best efforts we knew we were losing the battle. Her organs were failing. She kept requiring more support instead of less.
We called the family in to discuss what to do next.

The son was very clear: we have done enough to her. We must let her go in peace.

As we all rallied around him and his brave decision I couldn't help but think of my own son. How would he react if this was him? Does he know how proud I am of him? How much I love him & would never purposefully leave him?

I snuck away to call him to remind him. Again.

"Mom, just tell me, are you dying?" He asked with genuine concern when I called to check in. "Because I want to be with you if you are"

I realized my lines were so blurred that it was spilling out onto my own son.

I should have recused myself from her care. That reality didn't hit until a much later time, through the help of a great deal of self-reflection.

So here we were, family at the bedside, ready to start the process of withdrawal of life support, and the son runs out.

The family is bewildered and unsure what to do. I tell them to stay in the room, I would go talk to him.

He says he's tired of being brave and strong. He's tired of the people. There's too many people in there for him to just let his emotions out...

It dawns on me what is happening. I go back into the room and explain to the family:

You have all known her your whole lives. But you've also known your own families along the way. This is the only family he has ever known. He needs to have this time with her to himself

It's been just the two of them for as long as he has had life. And now that he is losing the one who gave it to him can we allow them to just let it be them as she leaves?

They all agreed. Each took a private moment to say goodbye before he came and sat beside his mother

We disconnected her life saving infusions and replaced them with comfort meds. We removed the wires and tubes. And then we closed the door to let them have their final moments together.

He comes out and offers a hug, which I accept. He asks what's next.

I want to bring him home to throw a football with my son.

I take him to the waiting room where his own family awaits. The embrace him. They love him. They are her blood and his lifeline.

And I go home to mine.
Determined next time to not blur those lines.