My Queen’s Square reflex hammer was my constant companion throughout 30 years in neurology practice.
I used it daily to check reflexes as I endeavored to determine the neurologic status of those who sought my medical advice. It was also used to see if all reflexes were gone, as life itself had ended.

He had been declared brain dead by the ICU doctor and the neurologist. Legally, the ventilator could be stopped now without asking the family first. After all, dead is dead.

The staff, instead, met with the spouse and extended family to explain what brain dead means. The decision was made by the family to gather in the room as life support was withdrawn.

In the past 30-plus years, I had declared brain death more times than I can remember. There were children, sometimes beaten to death; there were victims of meningitis, anoxic brain injury and gunshot wounds to the head.

The result for all was the same: no cerebral function as evidenced on standardized neurologic tests, electro-cerebral silence on EEG and no blood flow on brain scan. There was not a great variation from declaration to declaration as brain death always looks the same.

On this day, something was different. Now, I was looking at the brain dead person and the family from the other side of the reflex hammer.

Now, I was the chaplain, listening as the situation was explained, standing silently and observing the responses of the family members.

As a neurologist, I had often stayed with the family until the deceased was extubated, especially if the patient had been in my care. Now, I was staying for the first time in the role of the chaplain.

As more family gathered, I became the messenger of what had been done and said already. As they encircled the bed, I stood behind the deceased’s wife.

I offered to pray and read a favorite Scripture before extubation. Psalm 23 was requested, followed by a prayer that most knew, “The Lord’s Prayer.”

In reverent and almost priestly fashion, the nurse skillfully suctioned the endotracheal tube, loosened its ties and ever so gently slid it from the airway. The in-room heart monitor had been turned off.

Over the next few minutes, cyanosis engulfed his face. Within a few minutes, the heart stopped.

Recalling the response of the family when told he was brain dead and seeing the response that filled the room now, it became clear to me that the finality of this man’s life was only appreciated after the last breath was taken and the last heartbeat had faded into eternity. Now he was, in the minds of those who loved him, truly dead.

Cries began to fill the room and tears flowed freely as, one by one, the moment seized the hearts of all gathered. Then came my turn, as my eyes, blurred by tears, surveyed the room of modern medical equipment that could not prevent this moment.

It was the first time I had stood as the one who was supposed to offer spiritual comfort as needed, yet I was on the verge of being overwhelmed by the moment. I did not see this coming.

To an outside observer, the scene may have been just like so many others in the ICU. But what I was experiencing was a moment of the ineffable, a sense of something changing inwardly.

Here I was, sharing this space with fellow travelers I hardly knew. But this was more than just a room; this was sacred space into which I had been invited. For me, and I hope for others, this was a “thin space” where we glimpse God.

As Elizabeth Barrett Browning once wrote, “Earth’s crammed with heaven; and every common bush afire with God.”

How many other events or situations seem to be a certain way from the eyes of the clinician, but quite another through the eyes of the chaplain? What about through the eyes of the patient and the family?

I feel I was an empathetic doctor (not all would agree), but I now know there was a certain inability to fully appreciate what the families were experiencing.

Now, standing on the other side of the reflex hammer, reading Scripture, praying with them and seeing how they define death, the view is much different.

Bill Holmes is an ordained Baptist (Cooperative Baptist Fellowship) pastor and part-time hospital chaplain. He retired from medicine after 34 years of practicing and teaching pediatrics and pediatric neurology. He is also a doctor of ministry student at Louisville Presbyterian Theological Seminary.

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