As a child, everything is explored and many things go into your mouth. In this case, playful writing chalk went into this child's mouth. He coughed and aspirated the chalk into his lungs. His respiratory status decreased over time, leading to progressive modes of oxygen delivery. He started on a nasal cannula, then to continuous positive pressure ventilation, then to intubation on a ventilator, and then to a high frequency oscillatory ventilator. This sweet boy became critically ill, requiring high ventilator settings and continuous vasopressor drips to keep his blood pressure stable.

After a few days of being in the PICU, an unforeseen issue occurred. He suddenly stopped responding to stimuli and his pupils were unresponsive. The staff immediately notified the Intensivist and Neurosurgery team for evaluation. As the child was showing multiple signs of increased intracranial pressure, the neurosurgeon inserted a intraventricular drain and monitor at the bedside. The monitor indicated extremely high intracranial pressures. The PICU staff rushed him to CT. The results were devastating. He had suffered from a severe occipital stroke in his brain and his intracranial pressures were increasing to levels that were not compatible with life. The Intensivist, Neurosurgeon, and nursing staff suspected the worst - this sweet boy was brain dead.

At this time, Tiffany Copeland was the nurse that was to take over the care of this sweet boy. She started her day by joining the PICU team in providing the mother and family with the devastating news of what they expected and the next steps of brain death exams. She provided a spiritual and compassionate support for the family that I find hard to describe. Tears rolled down her cheeks during the family meeting, but she sat with the family in a strong silence. She did it all - provide the family with mountains of Kleenex, provided space and time to process the information, held that sweet boys hand when the family couldn't bring themselves to come into the room, provide excellent critical care even when emotions are high, make hand prints for multiple family members, keep all the disciplines informed of the care, and skipped meals to provide a continuity of care that she insisted he deserved.

Tiffany shined as a compassionate, kind and sincere person when she asked the mother about the father, who had not been at the bedside. The mother explained to Tiffany how the father was in prison. Tiffany immediately started to work with case management to see if she could coordinate a visit for the father to see his son one last time. The prison system denied the request and only gave him limited phone calls. When the father was able to call the PICU, he wanted to speak to a physician. The Neurosurgeon was in the OR and the Intensivist was in the middle of a sedated procedure at the time. The father had only that moment to discuss his son. Tiffany took a deep breath and took the responsibility of giving the worst news a parent could ever hear. She explained his son was suspected to be brain dead and would not make it. She spoke to him in the most loving, compassionate, clear and calm manner I have ever heard. I sat beside her for support and I even felt a sense of peace through her. She offered our chaplain as support to him and answered all of his heart wrenching questions. Her courage astounded me!

As the day went on, it was confirmed that the sweet boy was indeed brain dead. After much discussion, the family decided to withdraw care and let the child go in peace.

I will never forget the way Tiffany spoke to that father. She went above and beyond to speak to him with dignity, respect, compassion and love.