At morning rounds three hours later, before we even had a moment to share our thoughts, the neurosurgeon and the medical team discussed Matt’s condition and the MRI report. To their surprise, the MRI showed contained bleeding in the ventricles rather than dispersed throughout the lobes of the left brain--leaving those tissues mostly intact. This good news was tempered by potential damage due to sustained swelling, and two areas of questionable ischemia (stroke)--one in the region of his AVM, and the other in the corpus callosum (the communication network between the left and right brain). Was this reason to be hopeful? Yes! Matt might live with some ability to interact and function. But there was so much uncertainty and there was no way to know what this ultimately meant. Would he be able to talk? Walk? Laugh? Love? The doctors had no answers. 

Based on all of our previous conversations, our family now conveyed our belief that minimally, Matt would want to be able to live independently and have a quality of life. He would not want to be incapacitated or dependent on others for his daily care. The neurosurgeon explained that it would take four to six weeks for the blood in the ventricles to fully reabsorb before we would have a clearer picture of the residual damage, and what that may mean for Matt’s recovery. But if we waited that long, Matt’s baseline function might improve enough for him to survive off life support, but not improve enough to achieve our desired quality of life for him. The neurosurgeon strongly advised us to make up our minds within the next ten to fourteen days. Collectively, the medical team and our family agreed to meet the following Friday, eight days hence.

Before our thoughts, like newly disturbed dust had had even a moment to settle, an ominous shadow of doubt and pessimism was once again cast over Matt’s future. As the neurosurgeons exited the room the critical care doctor pulled us aside to privately dissuade us from keeping Matt alive. He was convinced that because Matt’s brain injury was so extensive the best course of action was to take him off life-support, now. This off-putting maneuver to disregard the neurosurgeon’s advice caused undue angst.

When the doctor left and we were alone again, the room was quiet as we each tried to comprehend the morning’s twists and turns. We went from saying goodbyes to hearing there was a possibility that Matt could be okay.  Two big questions loomed over us: how long to leave Matt on life support and how to make an appropriate choice for Matt.  Mike’s brother, Kevin, a doctor, sat in on our meeting. Kevin helped us contemplate the what-ifs, possible scenarios, and potential options and called his colleagues as needed to provide medical insight.  In the end, we agreed to wait for an updated neurological assessment prior to our meeting next week and identified three parameters to further guide us: 1) Matt would be able to focus his eyes on us--and see us--and we would see our Matt. 2) he would respond to yes/no questions by blinking or squeezing our hand, and 3) if possible, Matt would participate in making this decision about his future.  With Matt stable again and our path forward defined, we had a short reprieve to release our death grip on the bedrails and take a pause and a deep breath.