1. Morse, Judy ASN, RN

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"You have a harvesting for a patient in the ICU," said the voice on the other end of the line. It was Saturday, I was on call, and my morning routine-laundry, housecleaning-was officially over. This was to be my first organ procurement. I got in my car and began the 15-minute drive to the hospital. I had some idea about my role, but was unsure about specifics: What instruments would I need? Where would I get the ice? How long would it take? How would the family react?

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Soon after arriving at the hospital, I began to prepare the operating room with Ruth. She and I had worked together since I began on the unit three years before. She was very experienced, which gave me some comfort, especially on call. I counted on Ruth to get me through.


As we gathered instruments and supplies, Elizabeth, the transplantation coordinator, came to brief us on the patient, a 45-year-old woman named Lynne who had brain death following a stroke. Her briefing was just that-brief-before she returned to the family.


When the transplantation team was ready, Elizabeth came to let us know. Ruth, the anesthesiologist, and I followed her to Lynne's room in the ICU. Family and friends surrounded her bed, visibly shaken, mourning the death that was to come. Some were crying, others were hugging, and one elderly woman sat quietly in the corner. I was unsure about what would happen next. Would the family leave before we wheeled Lynne to the operating room? Would they follow, as other families did? How could I walk over to the bed, unlock the wheels, and push the patient to the operating room as I had done so many times before? This time, there would be no return. I could not reassure Lynne's family that we would take excellent care of her.


Elizabeth introduced me to Lynne's sister. Instead of shaking her hand, I touched her arm. The three of us walked toward Lynne's bed, and Elizabeth told me of the family's request that Lynne not be left alone at any time. Her sister handed me a neatly folded pile of clothing-underwear; plain, dark slacks; and a long-sleeved, striped T-shirt-and asked that I dress Lynne after we were done. That's all they wanted.


Lynne's family stayed behind as we wheeled her out of the ICU.


In the operating room, I fell into my usual routine. Tending to the patient, keeping things in order, assisting the anesthesiologist, documenting-these were all tasks I had done many times before. As each procedure was completed the team grew smaller. Within two hours, Lynne's liver had been removed, the sutures were in place, life-support had been withdrawn, the medical team had gone, and Ruth had left to clean the instruments. I was suddenly alone with Lynne.


How little I knew of this woman. But there were tasks still to be done. I needed towels, warm water, and soap. I set out to retrieve them. At the door, I stopped and looked back. Lynne's body was exposed, alone in the big, empty room. I remembered her family's request. Returning to her bedside, I covered Lynne with a blanket, sat down on a stool beside her, and waited for Ruth.


Ruth returned about five minutes later. Noticing that the body and the room remained unchanged, she looked surprised. "I was waiting for you," I said. "We can't leave her alone." She smiled. Together we cleansed and dressed Lynne, then brought her to the morgue.


Outside the operating suite, Lynne's sister was standing in the hallway. She was alone. Without a word, she looked me in the eyes. I gave her a nod. She returned my nod, turned, and walked away.