The Family Meeting

By: Jennifer Caputo

I stepped off the elevator onto the stepdown unit and was immediately hit with the scent of disinfectant. I’m certain they clean the entire hospital but for some reason only this floor seems to hold on to the abrasive chemical smell. My heels click against the off white tile that never quite looks clean as I head to the conference room full of administrators and take a seat. After a few minutes of heavy silence the door opens and she walks in.

I stand and offer my hand, “I’m Dr. Caputo.”

“I’m D’s mom,” she replies and sits in the chair beside me. She’s still wearing her kitchen apron and name tag from a nearby fast food restaurant.

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D is one of patients, an unfortunate young man who went into cardiac arrest in our Emergency Room three months ago. We were able to get his heart restarted but in the process he suffered severe brain damage. He can’t talk or interact in any way. He has constant seizures which we cannot control with medications. He depends on a ventilator to breath for him, a feeding tube to sustain his nutrition and dialysis to do the job of his kidneys. There is no hope for recovery. He will be in this condition for the rest of his life, however long that may be. That means he doesn’t need the hospital any longer. I explain this to D’s mother who stares dejectedly at the table in front of her. She has no questions for me, she’s been hearing this for months now.

At this point the social worker begins explaining the process of transitioning to long term care. Unfortunately our state has no facilities that can meet his need so from our standpoint there is only one option, a facility in Maryland. For the next 20 minutes we talk in circles. The social worker and I explaining in as many ways as we can think that we have reached this next step and with every pause for reaction D’s mother repeating “I can’t send my son out of state.”

With every repetition of that sentiment, the tension was building. The windowless room was becoming stifling, our voices becoming more grating. Then someone from the opposite end of the table asked the simplest of questions, “why not?”

D’s mother turned and looked me in the eye for the first time this afternoon and explained she was working a part time food prep job to support her other 5 children. She relied on the limited bus system in our city to get to and from work and the hospital. Visiting her son in Maryland would be out of the question. She’d never been on a plane, never left the state of Florida, so she didn’t know how she’d get to Maryland in an emergency. And with that she stood and holding back tears said “I am not sending my son out of state. I’m going to see D now,” and walked out of the room.

Jennifer is a hospitalist and Assistant Professor of Internal Medicine at the University of South Florida. She can be reached via Twitter @jennifermcaputo.

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