|Marc Fadden is an ACCS Anaesthetics CT3 in West Yorkshire.|
The following case is without question the most shining act of selfless bravery that I have ever witnessed.
The patient in question was a 50-year-old gentleman (Mr SS), who had suffered a C5 spinal injury in his early 20s. I met Mr SS on ICU after he had unfortunately developed a hospital acquired pneumonia. He required invasive ventilation and the subsequent long respiratory wean resulted in a tracheostomy.
His recovery was blighted again and again with repeated respiratory infections. It soon became clear that he would never be able to successfully wean from the ventilator and surviving this admission was looking less likely by the day.
Several difficult conversations followed during which Mr SS expressed his opinion that being ventilator dependant and the further anticipated gradual respiratory decline would not provide him with a satisfactory quality of life.
Mr SS made the decision that he would like the ventilator support to be withdrawn. He also declared his desire to be an organ donor. Over the course of the next week, several more conversations ensued between Mr SS, the medical and nursing team as well as the expert input from the SNODS (specialist nurses in organ donation) team.
Once capacity and consent issues had been clarified, a withdrawal and organ retrieval plan was decided and documented. Ventilatory support would be withdrawn later that day, once the organ retrieval surgical team had arrived.
I came on for the night shift at 8pm to receive the ICU handover. There were no specifics to the plan documented, just to provide symptomatic relief post withdrawal. Slightly alarmed by this, I went to speak to Mr SS and review the 'plan'.
Mr SS made the decision that he would like the ventilator support to be withdrawn. He also declared his desire to be an organ donor.Marc Fadden, ACCS Anaesthetics CT3
Despite the tracheostomy, after such a long ICU stay, we were now able to communicate pretty clearly with each other. I was amazed at how calm, how at peace he seemed. In fact, he seemed positively jolly, definitely the happiest I had seen him since meeting two months previously. Even more surprisingly he remained in this upbeat state even after I explained my concerns to him about the 'plan'.
I was worried about how distressing the symptoms of sudden withdrawal would be. I was also acutely aware of the thin legal line that I would be treading, premedication measures would have to ensure his own respiratory drive was maintained at the point of withdrawal. Mr SS actually ended up reassuring me about the plan.
I noticed he had a solitary bottle of lager on his windowsill. He had been deemed 'feed at risk' by SALT, but with all things considered I thought the benefits now outweighed those risks! I offered to chill it in the staff fridge whilst I discussed my withdrawal strategy with the on-call consultant.
Whilst waiting for the organ retrieval team, I watched from a distance as Mr SS (with help from his nurse) enjoyed his beer, surrounded by his loved ones. He was tranquility personified, despite knowing that the surgeons could arrive at any moment and then soon things would all be over. It was incredible to observe.
At near midnight, the time finally came. Speaking to Mr SS alone I went through the plan again and gave him one last chance to change his mind. He looked me dead in the eye, smiled and mouthed to me 'get on with it'.
Mr SS passed away 15 mins after the ventilator was withdrawn, surrounded by those he cared about most. He was strong and dignified right to his last breath. I like to think that with the pre-emptive and symptomatically administered drugs, he suffered very little, if at all. I hope so anyway. It was one of the (very rare) occasions that I momentarily wished the law permitted us more allowance to avoid unnecessary further suffering.
Mr SS successfully donated both of his kidneys, his heart valves and his corneas, transforming the lives of several unknown, no doubt very thankful individuals. The ICU and SNODS teams were all deeply moved by Mr SS's selflessness. I felt incredibly well supported by all involved, but I am not ashamed to admit to shedding a tear or two later that night whilst in my on-call room. I did so again whilst sipping my own beer several days later, after finishing that run of shifts. Cheers Mr SS.