Where Does the Good Go?

We had this baby in the PICU who had suffered a devastating brain injury. After rounds one day we completed the requirements to pronounce him brain dead. I always wondered how this was done. There is a procedure to be followed which includes diagnostic tests such as EEG's and nuclear scans as well as the clinical exam at the bedside. We all stood around his little body to complete the last step in the process, which was the clinical exam. I watched as the intensivist shined a light into his non-reactive pupils and cringed when she demonstrated his absent corneal reflex. I filled the syringes for the cold-caloric testing and held my breath as we stopped the ventilator and watched as his little chest did not rise for over 8 minutes. And then the intensivist pronounced him brain dead, the nurse restarted the ventilator, smoothed his hair over and covered him back up with his blanket. There was no screaming or crying. Really nothing happened at all. That was it. And then we all went to lunch.

I think you would be surprised at how unremarkable many remarkable moments are.

Later that afternoon I walked by his room and he was still in there, but his name was erased off the board. The ventilator was still running and fluid and nutrition dripped into his veins. His body was being supported so that his organs would be healthy for transplantation. There was no family at the beside anymore and it seemed odd to me, only for a split second, that a few hours ago he was a patient, and now, he was merely a reservoir. But nothing had really changed. I mean except his name being erased off the board. I found myself wondering when he had left. Does that make sense? I mean us declaring him gone didn't make him gone. He left way before that. But when did it happen? And where does the good go in the meantime?

Maybe that all depends on your views about heaven and hell and life after death. But no, that doesn't really help me either.

The next morning I came in to find that his body had been moved and in his room was a new little boy who had just received a heart transplant. And while I know that in all honesty, this was probably just a coincidence and that it was much more likely the heart came from someone else somewhere else in the region, I couldn't help but wonder if the two events were related.

I couldn't help but wonder if maybe that's where the good went.

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