The tension between Olivia's parents and staff had boiled over. Eleven-year-old Olivia's parents were "done," had reached their limit of bad news, and refused to enter the conference room. They didn't want more information or what they perceived as pressure to withdraw life support.
Olivia was crossing a busy intersection near home when she was struck by a delivery truck. Perfectly healthy and athletic, she stepped off the curb, and the driver simply didn't see her. She suffered a severe head injury with multiple skull fractures and increased intracranial pressure, necessitating a bolt placement. No further neurosurgical intervention was possible.
The standoff well entrenched, I was summoned. The reason for referral was "difficult family, incapable of making any decisions." The ethics consult service, chaplaincy, and legal team had been mobilized. The family prayed for a miracle and considered the situation a test of faith. Meanwhile, staff experienced moral distress, believing they were inflicting unnecessary suffering on the child.
I considered Olivia's family to be facing an impossibly difficult situation, rather than being a "difficult family." I could offer myself, listen, assess their understanding, and shoulder some of the moral burden. I could strive to be present, not perfect. Most importantly, I could refrain from judgment. Olivia was failing. "Good luck," the team uttered. I felt like the human equivalent of a Hail Mary pass.
Before entering Olivia's room, I paused for a deep breath and knocked. I would be admitted or dismissed based on those immediate, almost imperceptible impressions. I demonstrated my respect. "May I please come in?" Casual greetings would not do. I was in full restore-the-trust-of-the-team mode, and I was an intruder, a potential threat.
The parents granted permission. Parents are "sentinels at the bedside" and I wanted to get it right. I sat down and introduced myself as the nurse-psychologist. "I wonder if you would be willing to meet? I understand that Olivia has been very ill, and there has been tension." I gazed at Olivia and noticed her pale skin, shaved scalp, and well-loved stuffed dolphin.
Then an inspiration came. "I imagine if we meet, the last place you'd like to go is the conference room. Perhaps we could go to the garden. We could walk and you could tell me about Olivia." The father shot a glance as if to say, at least you get the part about the conference room, and not wanting more bad news.
The Prouty Garden welcomed us in full splendor. We trod the well-worn paths, around the green lawns and splashing fountain. We lingered under the shelter of the majestic dawn redwood tree. We admired the owl statue-a Native American symbol of wisdom and protection-and I could not imagine a better omen. Walking side by side encouraged gentle conversation and was less intense than sitting in the tainted, windowless conference room.
As we talked, I learned about Olivia. A spirited child who loved swimming, singing, and her cocker spaniel, Lucy. She loved life and playing. The stories tumbled out, and I listened. Speak less and listen more.
I wasn't prepared for what happened next. As we approached the garden's beloved St. Francis statue, a little sparrow stood perched atop his head. Suddenly, the sparrow took flight. Olivia's parents stopped, looked into each other's eyes, and the father simply said, "We have our answer. She wants to be free." The humble sparrow was their messenger and, in their words, "a sign from God." It was what they needed to steady and sustain themselves.
Perhaps 20 minutes, but yet a lifetime, had elapsed. The tensions between family and staff naturally eased and life support was withdrawn. Olivia was free indeed.
I learned some meaningful lessons. Decisions are not always made analytically; sometimes decisions arise. More information is not necessarily better, and for some it can overwhelm. I learned to trust in myself, never mind the uncertainty, drama, or not having all the answers. To promise to ask, and help ponder, the questions, and to listen carefully-no matter how fragmented or tormented the answers. To bear witness and affirm. And I experienced the inestimable value of a healing garden-of a verdant, timeless sanctuary that cradles people during times of greatest vulnerability and need. Regardless of diagnosis, age, circumstances, or ability to pay, nature willingly extends her gifts and does not forsake us.
The team was surprised upon learning the family's decision to discontinue life support and thought I was a miracle worker. Hardly. True, Olivia died with dignity, and her parents knew emotional and spiritual sustenance. What did I say? I mostly listened. What did I do? I brought the family to the Prouty Garden-and there, the mystery unfolded.