Sometime around 2:00 AM on October 31 my 21 year old nephew went to bed after having a little too good of a night. We know the approximate time because he made an outgoing phone call around that time. Then at about 5:00 AM his mom, my sister, found him and started CPR. She directed her daughter to call 9-1-1 and after the paramedics arrived they worked on him for 40 minutes until they got a pulse.

I got the call at 11:00 in the morning that he was in the ICU with only a 2% chance of survival. Then at about 3:00 PM I got call, by this time at work, that he was dead. Then at about 4:30 I got another call that his blood pressure had stabilized and that he was still alive. That night I couldn’t sleep. I might have gotten an hour and a half at the most. I then packed a bag, hopped in my truck, and made the long drive to Portland by myself, with nothing but a few podcasts, my thoughts, and the periodic rain of a Northwestern fall day.

Even though I had done my best to mentally prepare myself for the sight, I wasn’t ready for what greeted me in that hospital room. The next 47 hours were hell.

There had already been neurological exams at or around admission and again a few hours before I arrived. So I knew going in that there was no brain stem activity and that there was virtually no hope. At one point, I was left in the room alone with him. The nurse came in to draw some blood samples and for some of them he had to turn off the medication delivery. With the three vasoconstrictors stopped, there was a near immediate and very rapid drop of blood pressure and the nurse had to draw the samples as fast as he could and get the medication turned back on before my nephew’s heart would stop.

Friday rolled around with the final neurological exams. Again, no evidence of brain stem activity. My sister insisted on a second opinion, and I can’t blame her for that. Since each exam required two neurologists and by the sounds of it they only had three on site that day, they had to call one in on his day off. I got to watch that one, but there wasn’t much to see.

Once the doctor had left the room, I asked what he had done and how that would show anything. The amount of “noxious stimulation” provided would cause a healthy person to come swinging and even with minimal brain stem activity it would prompt some kind of eye movement (such as away from the blinding light) or some kind of twitch. There was nothing.

I wasn’t present for the apnea test. The confirmatory test for brain death is where they turn off the ventilator while still providing 100% oxygen and when CO2 levels reach 60% spontaneous respiration should begin. They went for 10 minutes and the only thing that happened was that he turned blue. At about 1:00 pm on November 2, 2012 we had a formal pronouncement of brain death, a formal pronouncement that my nephew had died.

If you have any doubt that we are nothing more than the meat between our ears, try spending three days in the ICU with someone who is brain dead. There’s nothing there, the person you knew and loved is gone.

The real mindfuck of that moment is how traditionally we view a person as being dead or alive based on whether or not they have a pulse. Someone who is brain dead but on life support has a pulse, blood pressure, respirations, normal temperature, normal O2 saturation… all the vital signs you think of as meaning that someone is alive. But in that situation, if you were to turn of the machines or stop any of the medications the facade of life would cease.

In the end, my nephew’s wishes were honored and he was able to donate three organs. While it is little consolation, while my family was grieving the loss of our loved one, three other families were be spared that. Our tragedy was their salvation. What has greater impact, at least for me is the way it honors the memory of my nephew. His final act wasn’t the stupid thing that cost him his life, it was saving three lives.

In short, it was the most brutal and heart breaking experience imaginable for a family, especially for his mother and 14 year old sister. It will certainly take weeks if not months for us to all recover from this. It was fucking horrible and it’s all a haze. Heck, I’ve been working on this blog post for almost a week.