Dad was in the middle of making coffee when his heart stopped. From the next room of the house they shared in San Antonio, his new fiancée, Robin, heard the thud when he hit the ground. He was purple by the time she made it to his side.
Robin, a career nurse, immediately started CPR and called 911. When the EMTs arrived and took over trying to beat Dad's heart, she called my sister, who then called me. Sis was a mess, barely able to get out, "It's Dad. I think he's dying. He might be dead." Confused, I asked her what happened, and in a traumatized voice, all she could say was, "I heard it over the phone, Travis. I heard them shock him."
When Robin arrived at the hospital that night, the attending physician told her it was time to let him go. Dad wasn't breathing on his own, so they had to put him on a ventilator. But there was no use continuing to breathe for him, the doctor explained. He had been gone too long. He wasn't coming back.
"That is not happening," Robin responded. "His kids are 1,000 miles away—they can't get here until the morning. Your job is to keep him alive until they can make a decision about withdrawing treatment." The doc fought her a bit but eventually yielded. In order to give him the best chance of surviving, they began what's called the Arctic Sun protocol, which involves inducing hypothermia with the goal of slowing any brain damage.
By the time Sis and I landed in Texas on Dec. 30, 2019, all of us knew the score. Sis and Robin are both nurses, and I'm a bioethicist; we've all dealt with end-of-life cases, albeit in very different ways. The attending physician's pessimism was well-grounded. Dad had been without a heartbeat for more than 20 minutes, so any blood going to his brain had to be pushed there manually. But it's really hard to beat someone's heart for them—especially for that long—and so the default presumption in a case like my dad's is that his brain was starved for oxygenated blood. And without oxygen, brain cells die. That's anoxic brain injury. Everyone watching my dad assumed that had happened to some degree.
To what degree? Well, that part was impossible to tell this early, but too much would mean that he's never waking up; moderate amounts would mean that he might wake up but with severe impairments. That was basically all we knew as the Uber from the airport pulled up to the hospital, Sis and I got out, and I met my dad's fiancée for the first time.
When I walked into Dad's intensive care unit room, the first thing I noticed was how connected he was to machines. The tube down his trachea was attached to one machine, the wires stuck to his chest attached to another, and the IV in his arm attached to many little machines stacked along multiple metal poles—each one regulating some medication that was keeping his body carefully balanced in its precarious state.
The first couple of days were awful and confusing. Here we were: three professionals who have fairly significant knowledge about and access to health care, and we were lost. The number of doctors who came through was overwhelming, and they all gave different reports on my dad's status. While they all agreed that he'd suffered a major cardiac event, there was no agreement concerning what kind of event nor what his prognosis was. Indeed, it was difficult even to find someone to talk to about prognosis. Each specialist who came in chirpily reported that some specific organ was doing just fine.
So, everything looked OK—except for the whole "heart stopping" and "being in a coma" thing.
The coma was something else to process. I had always imagined that a coma is what someone enters when their brain shuts off and doesn't come back online. But we didn't actually know if Dad's brain was offline of its own accord. We couldn't, because he was hypothermic and on a ventilator, so he needed to be in a coma. They sedated him with propofol and benzodiazepines and threw in opioids for good measure. Many of his ribs were broken, and if he could feel anything, we wouldn't want him to be in pain. We didn't know if his coma was just medically induced or the result of catastrophic brain injury.
