Abstract

In lieu of an abstract, here is a brief excerpt of the content:Five More MinutesKristen Carey RockFive more minutes. How many times have you said the phrase, "I need just five more minutes"—perhaps to finish a note, clean up the kitchen, or read the kids a bedtime story? It is a seemingly insignificant amount of time. But what if you knew that these five minutes were the last five minutes you would spend conscious on this earth? The last five minutes you would spend with your parents and your young children before you would receive a sedative and be transported down to the operating room, where you would be removed from life support and then donate your organs? In a hoarse rasp through his tracheostomy, he kept whispering, "Please. Just five more minutes."This is the reality that I walked into one Friday morning in 2021 as I took over the ICU service at my hospital. I am an ICU doctor at a busy academic center in the northeast and was on the frontlines of our COVID response, including the care of patients who required ECMO (extracorporeal membrane oxygenation)—the last resort for treating patients suffering from severe lung disease.I did not have the privilege of meeting this patient until the morning of his death, but I knew he had been in the hospital for close to three months due to acute respiratory distress syndrome (ARDS) due to COVID-19. On the spectrum of COVID symptoms, this problem is the worst of the worst, and it left his lungs in tatters—so much so that he had relied on an ECMO machine to perform the functions of his lungs for many weeks in hopes that he would either recover or become eligible for a lung transplant. During this time, many hundreds of doctors, nurses, nurse practitioners and respiratory therapists had gotten to know him quite well. They met his father, former wife, and his four school-aged children. They learned of his service to our country as a member of the Air Force and his subsequent devotion to his community as a religious leader and beacon in his community. As he recovered to the point where he was able to be awake and interactive with a tracheostomy, allowing him to mouth words, they also got to know him as a kind and gentle man with a fierce will to live and devotion to his family.Yet, after many weeks of ups and downs, progress and setbacks, it became clear that he could not survive without the help of his ECMO machine. Though it is possible for someone to survive for many months on ECMO, like most forms of life support, it is a bridge rather than a destination therapy. More complicated and invasive than other forms of life support, it is resource-intense and fraught with medical complications. And one day, came the heartbreaking news that due to too many blood transfusions during his illness, he would not be able to receive a lung transplant. He and his care team realized this meant there was no path forward. It came as little surprise to those who knew him that when he realized that he could not live independent of machines or outside the walls of an intensive care unit, his final act would be to help others. He would give others the opportunity for the organ transplant that he so cruelly could not receive.And so, the date and time were set. The transplant teams from other hospitals began to arrive. His final morning on earth would be spent with his family, except for a last trip outside to see the sunshine. With masterful coordination, his ICU room was recreated on the roof atop our helipad. As an army of caregivers attended to his tubes, pumps, and machines, he was able to feel the warmth of the spring wind as the Air Force sent an honor guard of fighter jets to pay their final respects. I watched him smile as the planes flew overhead, unsure if he could see or just hear them. Even though someone had the foresight to place a pair of sunglasses on his face, he still grimaced at the sunlight after months of artificial...