Wednesday, 6 AM. Time to hear about the new admissions before rounds. An infant was found unresponsive in his crib. He was pulseless at the referring hospital. He needed 30 minutes of cardiopulmonary resuscitation to recover his circulation before transport to our pediatric intensive care unit.

I go examine him. He is tiny, handsome, and motionless. He breathes irregularly over the ventilator. His pupils do not react to light. He does not withdraw from pain. His parents, crestfallen and scared, look to me for information. I am told they do not speak English, and the Arabic interpreter does not arrive until 8 AM.

They are young. The mother wears a full black burqa. The father wears a tee shirt and jeans. He approaches me.

“My wife found him,” he says. “She heard a choking sound. He was limp. We drove him right away to the hospital. We didn’t know about calling an ambulance. Doctor, will he be okay?”

The Arabic interpreter arrives. All communication goes through the father. The mother speaks only with permission. At first, I feel sorry for her. I dislike him. But soon I see the gentleness between them. He loves her. She is protected by him. A pair of loving parents is losing their only son.

Friday night. The infant shows no signs of recovery. He takes a few breaths per minute but shows no additional brainstem function. His only other brain activity is seizure. We work to schedule a meeting with the neurologists, social workers, the pediatric intensive care unit team, and the Arabic interpreter to discuss prognosis with the family.

Before the day of the meeting arrives, the father tells me in private that he understands his son’s condition. He believes his son died the day he came to the hospital, and he does not want extreme measures to keep him alive. He knows the baby will be severely handicapped if he survives, but this would crush his wife. “Doctor, what can we do?”

I tell him these words are compassionate and brave, and begin to explain their choices. “At any time, we can disconnect the ventilator. Soon after, your son will die. We will ensure his comfort, and you and your wife can hold him....”

“What?” This last part is revolting to him. I trip on the cultural divide between us. “No, we would not want to be present when you disconnect the ventilator. My family needs to discuss this, but my wife is too exhausted. She is destroyed. We will take her home to rest, and after the weekend we will have the meeting and decide what to do.”

Saturday. The mother will not leave the bedside. The father wants to proceed. The time is killing his wife. The Arabic interpreter arrives. We all meet together. I begin with a summary of the conversation with the father from the night before: “Your son’s brain was severely damaged when he stopped breathing…. The doctors were able to restart his heart, but the rest of him will not recover…. The ventilator is breathing for him, but if we took it away he would not survive…. His own breathing is now abnormal and would not be enough to support his life…. No other parts of his brain are working anymore, and he will never be the baby you once knew....”

Tears. Silence.

I look to the father. His face tells me I can proceed. “We will disconnect the ventilator and let him die.... He will not suffer.... He is in no pain....”

Silence.

We disperse to let the parents be alone. The mother now knows all that the father knows. Her silence is agreement. Then the father emerges, alone.

“I told her that you are not taking the ventilator away,” he says. “I told her you are just stopping some medicines, but I still want you to take the ventilator away.”

The cultural divide between us has now become a

chasm.

“We can’t lie to her,” I say. “We have to go back in there and tell her the truth.”

He faces me in honest disbelief. “Why? She is sick with grief. It will ruin her. Why can’t you just take the ventilator away but not tell her you did it?”

Why? How can I disconnect this baby’s life support without his mother’s permission? She labored for his birth just two weeks ago. She loves him. She has a right to know, a responsibility to make decisions for her son.

But I don’t say this. I don’t know what to say. I just say it’s not allowed. The father looks disappointed, but says he understands.

We regroup in a half-circle with the Arabic interpreter. Please interpret word for word. “Your son suffered irreversible injury when he stopped breathing four nights ago.... He is only surviving on machines.... We can take the ventilator away to allow him to die....I can’t imagine how hard this is for you.... Do we have your permission to proceed?”

Tears. Silence. A word in Arabic from the father, gently, in the mother’s ear. The mother, in English, through tears, from behind her black veil, chokes on a whisper: “Yes.”

He died anyway, and now she died too when I made her mutter that word: Yes.