I knew that being in the pediatric ICU for a month would probably mean there were some tough moments. No one likes to see people suffer, let alone children. But what I didn't anticipate was how quickly one of those tough moments would come.

Day 1 in the PICU. It was a Tuesday morning, and we were rounding at about 8AM when we got word from the ED that there were two car accident victims, 12 and 16 years old, sisters. They were on their way to school when they were hit while making a turn. The 16 year old was stable, but the 12 year old was critical. So we stopped rounds to prepare for the 12 year old to come up from the ED. In a whirlwind of activity, then prepared one of the bigger rooms for the new trauma patient, brought up blood and warm fluids, a crash cart, equipment for tubes and lines that would come out of every orifice of her body.

We were all assigned roles. I was the first to start chest compressions if her heart stopped... again. It had already stopped three times and they'd managed to get her back each time.

Her major injury was an open skull fracture. I'll save you the details, but when we looked at the CT of her head, we all knew it was most likely a non-survivable injury.

She came up very unstable, needing blood and fluids, chest tubes on each side because of collapsed lungs, arterial lines and venous lines and central lines. Surprisingly, she didn't code again. Her parents and step parents arrived and stayed at her side through many of these procedures. We talked to them about signing a DNR. We all decided not to escalate care if she started to go downhill again. No medicines to keep her blood pressure up. No CPR. If she went again, we would let her go. Her father, a 6'4", 300 lb man, sat holding her hand with his head down, and we could see the tears dripping off his nose and onto the floor, mixing with the blood of his youngest daughter.

When we'd done everything we could to stabilize her, everyone stepped back, took a deep breath, and we looked at the situation we were left with. She'd shown no signs of any brain activity. She didn't respond to pain. Her pupils were not reactive. She was not breathing on her own. The only thing left for us to do was warm her up. Her body temperature was 93 degrees, and in order really assess her brain function, she needed to be warmer. So over the next six hours or so, we worked to get her temp up. Once it reached an acceptable level, we did an official brain death exam. She had no response to any of the tests. Not surprisingly, but very tragically, she was definitevly determined to be brain dead.

We had a family meeting. Her parents didn't want her sister to be there at that time, so it was just the immediate family and their pastor. We told them we'd done everything we could, but she showed no signs of any brain activity. She was dead. Somehow, in the waiting room, her sister who had been driving the car, heard the news. We heard her screaming from our conference room. When she came in to see her parents, she collapsed and cried, "I did this to her, it's my fault, I killed her." Her parents insisted it was not her fault but their cries fell on deaf ears.

I left for the evening immediately after that family meeting. They still had the burden of deciding whether or not to donate their daughter's organs. When I came back the next morning, she was still there, still on all the same support she'd been on when I left the night before. The family had decided to donate her organs, and she was awaiting her trip to the OR. Her family was already gone though. They'd said goodbye to their daughter the night before, taken their other daughter home, and began their new and forever changed life without their baby girl.

When I went home after the family meeting, I sent a message to my own sister, who was celebrating her 21st birthday that day. I told her that I felt like I should tell her I loved her, in addition to happy birthday, and when she aked why I told her about my day. She told me to tell the sister, if I saw her again, that her sister knew how much she loved her, even if she didn't get to tell her. I didn't get to see her again, but I hope someone got to tell her that her sister knew she loved her.

So, today, tell someone you love them. Even if they already know. Because you don't know when you won't get to say it again.

The next PICU story won't be so depressing, I promise.

Until next time,
Kari