Physicians are accustomed to seeing patients at the end of their lives. It is difficult to let families know they may lose their loved one. Clinicians are often accepting of patients DNR orders before family members are ready. This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention. It taught me an unforgettable lesson.
During the first ICU rotation in my second year of pediatric residency, we arrived at the bedside of an 8-year-old girl, who looked like any other kid her age. Rose had long dark hair, green eyes, and freckles. I have always loved children with freckles. Maybe they remind me of her. Rose was diagnosed by chest x-ray with an “anterior mediastinal mass” and was being temporarily transferred to a different hospital for radiation treatment. She would return to our care in the afternoon. When the other second-year resident got to the “plan” of his presentation, the cardiothoracic surgeon interrupted and said this was a “ticking time bomb.” I did not understand what he meant until later that evening.
The surgeon continued, explaining if she had difficulty breathing we were to run a full code. Manage her airway, intubate her if necessary, and if that was not working, cut open her chest to pull the mass up off her heart and lungs until he could arrive and perform surgery. The plan seemed oddly pessimistic in light of the fact Rose was sitting up and breathing comfortably while we were standing outside her room having this conversation. Our attending physicians seemed skittish; they kept repeating we should be ready for anything.
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