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Surprisingly, the fresh round of epinephrine Julia had administered, coupled with more transfusions, had raised Sabrina's blood pressure to above normal. After hours of crashing pressure, they now had the opposite problem. ''You guys are doing an amazing job," said an anesthesiologist, watching from the doorway. ''I didn't think she was going to live this long."
''We might be making some progress," conceded M.J. around 6:45, just after Kevin had left to check on his son in another part of the hospital. ''I think because we pumped so much fluid into her, we're starting to catch up." In fact, M.J. felt encouraged enough to call the lab to chide them for not getting blood test results back quickly enough, something that would not matter if she had given up hope.
Yet, almost immediately, Crawford returned with a consulting neurosurgeon at his side and snuffed out the first hopeful moment of the day. Despite the team's heroic effort, Crawford said, ''She's still not going to make it because of her head." The family had talked extensively about just this kind of situation following the media coverage of the Terri Schiavo right-to-die case in Florida, and Sabrina had a living will that called for an end to lifesaving efforts if there is no chance of a quality life. The family was determined to honor her wishes and wanted to keep her alive only long enough for her organs to be donated.
At a little past 7:00, M.J. walked out to where Julia was briefing the night nurse and wrote the simple instructions: ''No CPR. No defib. Pressors for organ donation." The effort to save Sabrina was over.
Standing next to a ''crash" cart of medications they never got to use, M.J. told Julia she was reassured by her performance under pressure. Unlike another ''sick admit" a month earlier, when Julia reacted slowly to a warning that the woman could be in respiratory arrest, Julia made no judgment errors this night. One reason, M.J. said, was that Julia had swallowed her pride.
''In this type of full-scale, hard-core resuscitation, your role is basically what you did," M.J. said. ''You're doing the things that you know you can do. We would never expect you to manage this resuscitation on your own. There's just too much critical thinking happening so fast."
Julia smiled wearily and put her hand on M.J.'s shoulder. Though the ending was tragic, Julia's teacher had led her through an important -- and inevitable -- milestone for a critical care nurse: the death of a patient despite an all-out effort to save her. ''Thanks," Julia said, simply. ''That was a good experience."
''I'm glad we could go through this together," M.J. replied.
M.J. was too wired to leave the hospital when her shift ended at 7:30. She wound up staying until almost 10 p.m. -- 15 hours after she started work -- to greet Sabrina's family and friends as they arrived, and help them cope with the fact that Sabrina was about to die. ''I left that night feeling like I did what I had to do for the family," M.J. said.
Julia had left at 8 p.m. to be with her two sons while her husband was away on business, but first she held Kevin's hand and told him that she shared his grief.
''I don't think it's important what you say. It's more important how you say it," she explained later. Julia was known for her warm, reassuring manner with patients and families, but she wondered whether she would have had the presence of mind to make Kevin feel truly supported amid the chaos, the way M.J. had. The setting was clinical and impersonal, but M.J. had found a way to connect.
''By that time, I was so busy concentrating on my tasks, I probably wouldn't be able to find the right words," Julia admitted.