A Good Friday?

On a Wednesday afternoon I got a call to the ER. A middle-aged man had been transferred, unconscious, from another hospital after a suspected intracranial bleed. A tearful daughter was with him, and I spent some time with her as we waited for the results of the CT scan. He was transferred to the ICU, and for the rest of that day anxious relatives came and went.

On Thursday it became clear that the patient was not going to recover. The team began the careful steps to determine whether he could formally be declared brain dead and began the precise therapeutic dance to keep him that way. Later in the afternoon I went with the attending physician to let the family know that their father was being kept in that nonlife we call brain death. Then came the tentative suggestion about organ donation. The family was surprised. The patient had been both a heavy drinker and a smoker: Who would want his organs? But they agreed. It seemed a strange irony to me that a few months before, in the same unit, a family had refused to allow the donation of organs from a young, previously healthy trauma victim. Perhaps we can beg, but we can't always choose.

The nurse from the provincial organ donation agency arrived, and I accompanied her back to the stuffy little family room to listen as she went through the long list of screening questions with the family. Has you father had many sexual partners? Any homosexual partners? What medications was he taking? The litany seemed remorseless, no matter how gently canted. (Did we really learn any infallible truth from these questions? Or did we protect our own interests at the family's expense?) By now it was evening, and the family were exhausted.

So they said goodbye to a dead father who looked alive, with his chest rising and falling rhythmically, his urine draining and the monitor traces threading evenly across the screen. Some families say goodbye through the ritual of a bedside prayer, but not this one. They left without ceremony, with just the sympathy and support of the staff. And when they were gone I asked to watch the organ retrieval.

I was fired up to make this request by an education session on organ donation that a fellow chaplaincy resident had recently organized. I don't know if I was more worried that the staff would say no, or that they would say yes. The organ donation nurse had no objection, and as it would take several hours to put retrieval teams together I went home for a while. The nurse paged me at midnight, and I drove too fast back across the city, worried that they would start without me. I wondered what I would say if I were caught speeding, and what the police would make of my bizarre excuse.

When I arrived the ICU was quiet, the patient was stable, and I wondered what to do next. A perfusion technician came into the unit, and taking a deep breath I explained that I would like to watch the retrieval. As if this were the most normal request in the world, he took me back to the operating suite where, feeling rather stupid, I repeated the request to two women in surgical greens. They suggested I get changed. I picked out some clothes that looked about the right size and put them on in the deserted changeroom. I was instructed to put on hair and shoe covers, was shown to a spot at the edge of the operating room, and was told not to touch anything.

I felt a stranger in a different world. Here, the role of chaplain was superfluous, meaningless. I wondered how to stop my glasses misting up behind the mask, and surreptitiously experimented with moving the mask up and down until the fog cleared. I was sure that the physical aspects of the next few hours wouldn't upset me — would they? The radio in the corner was tuned to a lite-pop station, and I pondered the distance between the saccharine music and the reason we were there. I found myself praying — for the staff, for the patient, for the recipients, for me. Eventually, the patient (or was he a body?) arrived. I could not hold “alive” and “dead” together in my mind, even though I was seeing it. I was struck by the gentle way he was transferred to the table, and how much care was taken to cover him. Perhaps it was easier to pretend that he was alive rather than dead.

The teams from London and Toronto took longer than expected to arrive; it was pouring with rain, and there were cell phone conversations detailing just how close they were to the hospital. Just like my “put the oven on” calls as I leave work. Very ordinary, somehow.

And then it was all business. He was shaved, swabbed, covered with surgical drapes. One of the surgeons suggested I move closer for a better view. I did, and wondered if watching the first incision was a good idea. What was so natural for these people was not so for me, and I was glad of the mask to hide behind. I worried unnecessarily, because it was impossible to be anything but awed by the careful and precise way that the surgery proceeded.

As I stood and watched, I wondered about the recipients and their families. It was a dark and rainy Easter weekend where they were, too, as they made the necessary last-minute arrangements. They must have gone over this in their minds many times before tonight. What anxious dramas were being played out as friends and relatives called each other with the news that tonight was the night … . I became aware that Holy Thursday had become Good Friday. This one patient, through his expressed choice and his family's consent, was going to give new life to possibly five people, and new sight to two people who were becoming blind. For me, the Gospel parallels were profound. I was already a witness to a death that allowed a sacrificial gift to redeem the lives of others and offer the hope of resurrection.

The teams worked on together, and at last the patient's own blood supply was replaced by the perfusion solution. Then, first the liver and then the lungs were lifted like a baby from a sectioned womb and placed almost reverentially in basins surrounded with ice. The teams checked their prizes again, packed up their gear and left. After the long drive back to the recipient's city, the same surgeon would transplant the lungs. He didn't take the heart; in the end, it wasn't suitable. Someone was going to be disappointed: no resurrection for them just yet.

Another surgeon came to retrieve the kidneys. No big rush here, nor for the corneas. They would be recovered at a civilized hour later in the morning. Finally, everyone was gone except the two nurses and the chaplain. The place was a mess. The body was a body, plundered and, yes, now dead. I felt as though I should pray, give some sort of benediction. Never at a loss for words, suddenly I could find none, and my dismissal was silent. One of the nurses commented that everything went more smoothly than usual. I joked that it was because there was a chaplain present. Perhaps I was only half joking. Maybe having anyone observing would have had the same Hawthornian effect, but I know that I really did not need to go to the Good Friday service later that morning. We had enacted it in the operating room, and it had been a sacred time and space.

Later, when I told my supervisor what I'd done, he mused that I should perhaps go and check the morgue on Sunday morning.