Abstract
It seemed that everyone had spoken to Bruce at length regarding his mother's condition. I spoke to him for over an hour one day, explaining in detail that his mother's brain had been deprived of oxygen for too long and thus was no longer functional – and never would be. Bruce insisted that the brain can grow back. Those were his exact words. He told me that his mother would never leave him stranded like this – she cared far too much for him to go before he did. The fact that she was 30 years older than him and thus statistically likely to predecease him made no difference. The psych liaison nurse practitioner, who was exceptionally good at counseling family members in distress, spoke to him daily, to no avail. The palliative care nurse practitioner fared no better. He refused to speak to her initially, because to him palliative care was tantamount to giving up.
One day, Bruce swept into the ICU with a glint in his eye. I remember all of us swiveling around in unison. There he was, gesticulating wildly, several papers in his shaking right hand that quickly fell to the floor. He picked them up at once, speechless with excitement. He handed the first couple of papers to a nurse. We all crowded around to look at it. It was an article from the Internet, describing a few anecdotal cases of patients with anoxic brain injury, deemed to have brain death, who were administered a daily dose of Ambien® for several days with apparent improvement in brain function. There did not seem to be a clear hypothesis for Ambien®'s mechanism of action for the purported result. But there were positive results reported in several patients, one of whom eventually came off of life-support and apparently recovered some speech and movement with rigorous, prolonged physical, occupational, and speech therapy.
Well that did it. Bruce had found the Holy Grail, and all he needed to do was convince us to do the right thing. It didn't take much for us to decide to administer the Ambien®. There seemed no real harm in it, and who knew? Maybe there was something to it. That night, we administered Ambien® via feeding tube and Bruce waited with bated breath. I think deep down many of us were just a little bit hopeful. Several hours passed. Bruce continued his bedside vigil. Visiting hours came to a close, but no one had the heart to show Bruce the door.
There was a shout from behind the curtain that had us racing inside the room where Bruce's mother lay in bed. Bruce was yelling, his voice no longer raspy. “Mom is awake! Mom is awake!” We all rushed to the bedside. There seemed to be no change whatsoever. Bruce pointed a shaking finger at her face, and then began to frantically shake her shoulders. She snapped her head back and seemed to shudder. Her mouth wobbled. Bruce took this as a sign that she was about to speak.
It was apparent to all that there was no real change in Bruce's mother's condition. All except Bruce, that is. We tried to explain to him that her twitches were no more than a primitive brainstem reflex. He told us that we were all wrong. For the next several days, we continued to administer Ambien®, and there were many more shouts of “Mom, wake up! Hey everyone, Mom is awake!!” We began to tune out his ramblings, knowing that Bruce's denial of his mother's condition ran far deeper than any dose of reality that we could provide. Our multidisciplinary team decided to move toward tracheostomy and percutaneous endoscopic gastrostomy (PEG) feeding tube placement, which would allow his mother to continue in her present state in a long-term acute care (LTAC) facility. That way she could finally transfer out of the ICU. The appropriate physicians were consulted for said procedures. Our psych liaison nurse practitioner made one last ditch effort. And suddenly, Bruce let go of his denial. He agreed to the withdrawal of life support and he stood at his mother's bedside as she passed. I remember being so worried about what would happen to Bruce once she died. Would he snap? Try to harm himself? He had no social support as far as we were aware. No one ever came by to see him or hold his hand. The only other visitor that I ever saw was a physician who was a distant relative of Bruce's mother by marriage. He briefly came by to see her and simultaneously ordered Bruce to “let her go.”
After his mother's death, Bruce seemed very preoccupied with details of her funeral, will, and her affairs in general. The psych liaison nurse practitioner told me that this was consistent with Bruce's schizoid personality disorder, which is characterized by a lack of interest in social relationships, tendency toward a solitary lifestyle, and emotional detachment. She didn't seem overly concerned about Bruce's complete lack of social support, because she felt that he didn't particularly need it. I asked her what she had said to Bruce to finally convince him to let his mother go. She told me that she had just reiterated that there was no chance of recovery. She had no idea what made Bruce finally see the light.
I never saw Bruce again. He swept out of the ICU, mumbling something about his mother being in a peaceful place and his being glad that she was happy, and that was it. To this day, I still wonder how Bruce is doing, how he coped in that initial phase right after his mother died. I know that he has the features of schizoid personality disorder, and I accept that his need for emotional support, the company of friends and loved ones, is perhaps different from that of others. Still, the fact that he hung on to his mother so persistently for so long tells me that he does have a very human need to bond, to connect, and his singular attachment to his mother shows his capacity for love. Not just because of his constant bedside vigil and never-ending quest to bring her back, but because in the end he unselfishly let her die in peace. If the definition of love includes placing someone else's needs before your own, then Bruce certainly loved his mother … probably more than any of us knew.