Christmas in the Intensive Care Unit

James Hospitalization, Life Lessons, Living Wills

Leaving Hawaii is hard, but Christmas in the Intensive Care Unit is worse. People often tell me how lucky I am to live in Hawaii. When they say this I usually suspect that they have a picture in their minds of soft sandy beaches, palm trees and mai tai cocktails. The truth for me is something quite different.

Pregnant mother with three daughters say goodbye on Christmas day as James flies out of Kona Airport to San Francisco to disconnect his sister from life support in the Intensive Care unit

My family and I live in a very small town in the North Kohala district of the Big Island.  There is no traffic, no fast food establishments, nor any real reason to go fast.  Those of us lucky enough to call Kohala home, are blessed. Kohala is filled with the beauty of the land and the charm and character of the people. Aloha is truly alive in Kohala.


So, as I kiss my wife and children at the airport on Christmas day, I know I will be homesick before long. I also know that I am going to San Francisco. There I will be thrust into the intensity of what most call “progress”. What I do not yet know, is that I will soon be forced to make multiple difficult and painful decisions. Ultimately, this will lead to the decision to let my sister die.

The elevator to the Intensive Care Unit (ICU) on the 9th floor at UCSF Medical Center is very fast. It moves between floors quickly, but it seems to sit idle for a disproportionate amount of time when the doors are open.

We stop seven times before we reach the 9th floor. As the doors open I look into a large room filled with people. Some are sleeping in chairs next to tables scattered with empty pizza boxes and other fast food bags. Rambo is stitching up his own arm on the television. I quickly turn right and walk past that room. Days later I find myself in that room despite the feeling of helplessness it conjures up in my mind.

A Strange World of Beeps and Moans

Behind the glass doors of the ICU I enter a world that never stops. There are beeps, moans, alarms, strange smells, miles of tubing, coffee cups here and there, giant rotating cylindrical beds, constant movement, stoic parents, brightly colored stuffed animals, white coats, tattooed nurses, monitors with jagged lines and flashing florescent colors, withered children, large windows with views of distant hills, blood soaked bandages, and finally, my sister, Jennifer.

My adult daughter, Audrey, who lives in the Bay Area, is with me to see her auntie. We are both somewhat surprised as Jennifer greets us with her big white-toothed smile. Then there is a sudden crash of hope when she tries to speak. Her voice is hoarse and her thoughts are muddled, but she is clear about one thing when she looks me in the eye and says, “Jim, I want to go home.” Before I can respond we are interrupted by a retinue of white coats all standing behind a smiling internist named Sriram Shamasunder who looks to be about 30 years old.

The conversation then switches to hushed tones as this team of physicians explains to me the seriousness of the situation. The medical terminology and speculation abound. Having been a paramedic when I was younger, I am able to follow much of what they are telling me about Jennifer’s condition, but I quickly become lost when the discussion turns to blood test data and transplant qualification criteria.

Liver or Death

The essence of what I learn in the first 30 minutes of being in the ICU is that Jennifer will die if she does not receive a liver, and perhaps even a kidney transplant. The conversation concludes with Dr. Shamasunder telling me that a final decision will be reached at a group meeting of “the team” on Friday—in just 4 days.

As the group departs the bedside, an orderly arrives with a unit of blood for Jennifer’s nurse. As the nurse and orderly enact a verbal dance involving blood type and patient identification, my eyes trace the tubing from the now almost empty bag of blood hanging above my sister’s bed, to a location on her neck where the central line appears to be leaking. When I point this out to the nurse she says, “Bleeding can be a side effect of liver failure because the liver also makes clotting factors. Currently, your sister needs continuous blood or she could bleed to death.”