The patient looked as though she was taking a nap, lying in her bed in ICU 16. The boyfriend of this slender 33-year-old woman described the scene. “We were standing at the kitchen counter making meatballs when she got a very strange look on her face and fell on the floor.” EMS personnel intubated her in the field; and on arrival to the ED, she was profoundly hypotensive and had no spontaneous respirations. The CT scan of her head revealed a massive subarachnoid hemorrhage with extensive cerebral edema, most likely from a ruptured cerebral artery aneurysm.

My examination was sobering. No response to verbal or tactile stimulation, pupils dilated and fixed, no corneal reflexes, no doll's eyes, no gag, and no cough. Cold caloric reflex testing failed to generate any eye movements. It was hard to believe that this woman with a smooth complexion and pink cheeks was not sleeping but actually brain dead.

As I explained the situation to her family, her sister, Jeanine, became enraged. “This is all your fault! If you had only called neurosurgery sooner, my sister would be fine!” Jeanine insisted we transport her sister immediately to one of the large academic centers downtown so they could drain “something.” “Why aren't you doing anything?!” she said again and again. Unfortunately, there really wasn't anything to do.

The patient's boyfriend and father, on the other hand, were in a total state of shock and nearly speechless. “Maybe if I started CPR sooner...,” the boyfriend murmured to himself. Dad simply stared at the floor shaking his head.

My efforts to console this family seemed almost as futile as neurosurgical intervention would have been for this young woman.

A little later in my shift, Jeanine cornered me outside her sister's room. “Show me something!” she said with gritted teeth.

“What!?” I responded incredulously.

“Show me a wrecked car, show me a burned-out house! Show me something! She doesn't have a mark on her. How can she be dead?” replied her distraught sister.

I stood there with my mouth open not knowing what to say. Slowly, I reached up and pulled the stethoscope from around my neck. I looked directly into her eyes and simply said, “I am so sorry about your sister.”

Jeanine's eyes welled up; she wrapped her arms around me and began to sob uncontrollably. I held her there in the middle of the ICU for who knows how long, ignoring the stares of other visitors and staff.

Jeanine and her family eventually left after arrangements were made for organ donation. I made my way home wondering about my role as a clinician. As medical professionals we're taught to maintain boundaries and make our highest priority the needs of our patient. Sometimes, those who need our care and compassion the most may not be in the hospital bed.