Just a week ago, he was driving long distances to the grave of his long since deceased wife…to pay his respects, to tell her he loves her…again. Now, he is helpless and confused, clinging to life in the ICU after a terrible car accident. His family, exhausted by the days of worrying and rapid changes in his status, has gone home to rest. Suddenly, his heart is racing wildly, his blood pressure drops precipitously. “Can you meet me at the beside of Mr. Jones? He’s not doing well…”, I hear the desperation in my residents’ voice. I glance at his labs and morning chest x-ray then dash upstairs.

It’s my first day back to work in 8 days. I don’t know Mr. Jones. I don’t know his story, I haven’t seen his CT scans. I didn’t do his first operation. I have never met his family. I walk into his room to find the monitor over his bed showing his heart rate is 175, his blood pressure rapidly dropping. I order medications to slow his heart and increase his blood pressure, to treat his pain and calm his agitation. I ask for another battery of lab tests. I make changes to his ventilator. I call the OR to cancel his surgery for today…he’s not stable enough for a trip down the hallway, let alone general anesthesia. His heart, liver, lungs, and kidneys are failing. He has injuries from the car accident that would require more surgery. This isn’t going well.

I call the phone number listed in the medical chart. It’s time to make decisions. It’s a grandson. “Come as soon as you can,” I tell him firmly. He arrives and I begin relaying the events of the morning. He politely cuts me off, “Ma’am, I’m only his grandson. I love him but I can’t make those decisions. You’ll have to wait for my dad.”

The rest of the family trickles in. I finally get the chance to meet them all in a cramped circle outside of his room in the ICU. There are adult children and grandchildren, 10 or 12 in all. I update them on their father/grandfather’s status. With all of the gentleness I can muster, but with some sense of urgency, I request that they speak for him, tell me what he would want. Does he want dialysis? Is he willing to have lines and tubes, at least for awhile? Is he ok with going to a nursing home? Then I responded to their questions…No, he will never completely recover. Yes, the kidney damage could be permanent. No, you can’t live without a liver. No…he won’t ever be able to drive to your mother’s grave again. I’m sorry…

There are some tears. Lots of heads looking down. A few sad nods. One granddaughter storms out yelling, “I won’t give up on him!!!” In the most ill-timed of all times possible, my pager chirps, “Trauma One-3 min by ground”. I have to leave this intense family meeting. And I have to leave now. I excuse myself with a hundred apologies and promise to be back as soon as I can.

When I return, the family has calmed. We circle up again outside of Mr. Jones’ room. We review the latest lab work. It’s worse. It’s becoming clearer that we can do a lot of things to his 90 year old body, but we can’t give him his former life back. Through the silence, I feel each family member making the same decision in their head. Then one daughter-in-law bravely clears her throat, looks right at me and asks, “Doc, what would you do if this were your father?”

In those few seconds, I am stunned, honored, and speechless. My mouth goes dry and my eyes suddenly feel damp. “Ma’am, I will answer you with raw honesty. I just got off the phone with my daddy. I needed his advice on something. I love him more than life itself. And if this were my dad, I would make the same decisions that you all are. To let him be peaceful. To stop trying heroic things that might keep his body here but rob him from living the life he loves. I say all this because I know my dad is at peace with Jesus and I know he doesn’t fear death. And I, too, know Jesus and I know I will see my dad again one day.” It was quiet for a minute, then she tearfully whispered, “Thank you. That’s what I thought.”

The family talked some more and quickly came to a consensus about the next steps. They verbalized to me what they knew he would want. We decided to take a tempered approach, dialing back the invasive and dramatic for the simple and compassionate.

The next day, I had a moment to think about what had happened in that ICU. A stranger, a woman who I had met only hours earlier, looked at me and asked me what I would do if I were in her shoes? Somehow, she trusted me as a surgeon. As a critical care physician. Somehow, she understood that I must have coached other families through these moments. How did she know that I love my daddy so much? How did she know that I would identify with her struggle between honoring her father-in-law and selfishly wanting him to stay with her forever? Somehow, she trusted me as a daughter, a friend, and a fellow traveler of this world…even as a stranger.

There are few times in our lives when we look to someone who we have only just met and ask them to help us navigate what will turn out to be one of the toughest days of our lives. The honor and the privilege of this place is what has been given to me as a surgeon. The manner in which I conduct myself, the words I choose, the cadence of my speech, the placement of my hands and eyes, will be seared into the hearts of those families for a long time to come. These are the moments I pray about. These are the times I am reminded that to be a surgeon is an honor. To be a counselor to a stranger in their greatest time of need…that is the gift of ministry. It is heavy. And it is humbling. Philippians 2:3 “Don’t let selfishness and prideful agendas take over. Embrace true humility, and lift your heads to extend love to others.”

As I was walking away to attend to another patient, the grandson’s wife stopped me, “Excuse me, ma’am, what is your name again? Thank you for all of you have done for us today.” I smiled and showed her my badge. In this moment of clarity, I realized that the aching of the human heart, the gravity of some human moments, and the power of the human connection, don’t even need a name…

Disclaimer: My viewpoints are not necessarily reflective of my employer, or any local, regional or national organization that I belong to. As a matter of fact, I pretty much just speak for myself. Please keep that in mind.