When is it time for patient families to stop praying for healing and start saying goodbye?

What happens when the family’s emotional well is drained from the stress of anticipated grief and they become unable to endure good-byes? What happens after the priest leaves and they’ve cried until they’re dry and they can’t find another tear? What happens when the emotional stamina of the family
fails to outlive the patient?

Sometimes they do what little Nicole’s family did in our Neonatal ICU – they spend a day saying their best good-byes and instruct the staff to remove life support only after they’ve left the hospital.

“I’m sorry,” the parents tell Nicole’s nurse, Mia, as she prepares to remove the life support, “We’re not staying. We just can’t stay.”

“That’s okay,” Mia assures them. “You’ve done all you can do. Don’t worry; I’ll stay with her.”

The parents search Mia’s eyes for judgmental disapproval, but none can be found. Mia repeats her offer. “Really, honestly, it’s okay.”

A few more tears erupt and the parents whisper “thank you.” Mom cries a bit more in Mia’s embrace and then draws back to look at Mia again. The parents choke back whimpering tones and quietly fade into the busy sounds of the hospital and out to their car.

The other nurses exchange some quick glances with Mia which affirms their belief that none should die alone. Each of the nurses had held their share of dying babies for parents in absentia and, understandably, each hoped not to hold another.

The parents leave a deafening silence in their wake. As I enter the unit, the only sounds I detect are the sniffles of a few nurses, the unfolding of a privacy screen, and the sounds of a few parents oblivious to the drama on our side of the screen.

The other nurses turn their attention toward other little patients as Mia removes the tubes and wires that concealed Nicole’s personality for so long. Slowly, as the feeding tube is removed, she is transformed from the” Jones baby” into “Precious little Nicole.”

Nicole’s no longer alone, but Mia is, so I slide up onto a stool next to them both.

Mia takes Nicole and wraps her in a colorful blanket made by nurse volunteers and exchanges artificial warmth for the last human warmth she’ll ever know. Mia leans back in the rocking chair and, with a discriminating touch, peels the blanket away from Nicole’s face.

Nicole lifts her little hands to find her own face – perhaps a bit alarmed at the sudden absence of 100% oxygen. “It’s okay, Nicole,” Mia says in a coo, “I gotcha,” and Mia’s rocking chair finds a soothing accompaniment to the melodious humming of a nursery song.

Mia and I bounce glances back and forth between each other, Nicole, and her monitors. Within minutes, blood pressure, respirations, and pulse drop below a life-sustaining level. Nicole’s arm settles to one side providing a pillow for her face as she settles in for a long nap. Her face begins to ashen.

“Janet,” Mia calls, “Do you have some Kleenex over there?”

Janet shifts from the routine and responds with the rush usually reserved for a critical medical instrument.

“Here you go,” she says, as she strokes Mia’s shoulder and offers to take a definitive listen with her stethoscope. Mia lifts Nicole’s gown and Janet leans over to listen.

“Nothing but random electrical activity,” Janet says with a sympathetic tone usually reserved for parents. She removes her earpiece and with a push of a button, the life monitors fade to black.

The other nurses offer consoling whispers. “She looks so peaceful,” says one. “It wasn’t meant to be,” offers another. “She’s in a better place,” explains a third.

This was the third baby that day to depart for a “better place,” so I dropped my head in a private prayer. “Thank you, God for the divine image I see in this nurse. Thank you for those that make the commitment that none would die alone.”