The Call

Maggie didn't make her trip to Weill Cornell Medical College to participate in studies of patients with severe brain injury. Left partially paralyzed and perhaps even permanently unconscious more than a year after a brainstem stroke during her senior year at Smith College, she was now fighting her third bout of pneumonia in succession. Her mother Nancy called to tell us she had to cancel the visit. Maggie was just too sick and the doctors at Good Samaritan Medical Center in Brockton, Massachusetts, wanted to reinsert a tracheostomy tube to help her breathe.

The procedure is relatively simple and safe. A small incision is placed into the neck just below the Adam's apple and a plastic tube is inserted to create a new airway to the trachea and lungs. Just twenty minutes in the operating room, but Nancy agonized over the decision. As she saw it, it was a step backward. Maggie had a trach placed weeks after her stroke in May 2006. That tube served its purpose and had been removed. Unfortunately, Maggie had not regained a level of consciousness that would help her manage her secretions. Instead of safely swallowing them, they would pool in her mouth and eventually lodge in her lungs, setting up infections.

Nancy worried that by agreeing to the tube she was destining her child to a return to a breathing machine, which could be the next step in a series of medical escalations that were seemingly excessive in light of Maggie's utter lack of responsiveness. But the doctors were pushing hard for the trach tube and a bronchoscopy to take a look at the lungs. Harmless enough, but they would have to put her on a breathing machine to do the bronchoscopy. The pressure was intense. The doctors told her, “she's going to die, not for sure, but this is going to happen if you don't do something.”

Nancy was close to saying no and letting this end peacefully. She had watched her beautiful daughter, the child who had dreamt of becoming a veterinarian, traveled to Spain, and had amazing friends, struck down before her prime. In a photo taken before the stroke her eyes shone brightly full of hope and promise. She was now bald and swollen with eyes that were barely open.