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Paul got the call around 7 p.m. on Sunday, September 3rd.

For a few agonizing seconds, he was the only one who knew the terrible news.  We were with a bunch of friends celebrating Labor Day weekend; we were all enjoying ourselves.

Paul was told that our second daughter, Michelle, had attempted suicide, and that she was at a hospital in Bryan, Texas.  The police officer on the other end of the phone wouldn’t tell him anything more.

Paul came and told me what the police officer had told him.  We explained the situation to our hosts; they told us to leave Rebecca (our youngest daughter) with them so that we could get to the hospital as quickly as possible.

We left Fort Worth with trepidation in our hearts; since the police officer hadn’t been willing to give Paul any additional details over the phone, both of us feared the worst. While Paul drove, I looked up the phone number of the hospital and called them to see what Michelle’s status was.  After verifying who I was, the nurse told me that Michelle was in the ICU.  I asked her what had happened.

Nurse: She hung herself.
Me: (taking a deep breath) Did she succeed?
Nurse: (long pause) Yes. The paramedics were able to get vital signs back, but she was down a long time.
Me: How long?
Nurse: It took them 5-7 minutes to get her back, but we don’t know how long it took them to get to the house.

And we knew. We knew.

The three hours that it took us to drive down to Bryan were some of the most intense hours that we have ever known. Everything was talked about – we kept asking ourselves “Why?” (we still don’t know the answer to that question), we wondered why we hadn’t seen the signs (no one ever does, except in hindsight), we wondered how we were going to tell friends and family (phone calls and Facebook), and we wondered how we were going to get through the next few hours, days, weeks, months, and years (one baby step at a time).

I don’t remember much else about that drive. We talked and cried – and talked and cried some more.  I know that at some point we called Sarah (our third daughter, who still lives with us) to let her know that we weren’t going to be home that night.  We told her what had happened.  She screamed, then started crying – so much so that we asked her to call one of her friends to come and stay with her overnight.

That was the first of many difficult phone calls that we would have to make.

We arrived at CHI St. Joseph Hospital in Bryan, Texas after 10 o’clock in the evening. We were both tired, exhausted, and worried about what was waiting for us on the other side of the hospital’s doors.

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Since it was after hours, we had to come in through the ER entrance.  We told the person at the desk who we were, and they called someone to come and take us to Michelle in the ICU. The nurse who came started explaining what Michelle’s status was.

She told us that Michelle was resting comfortably, but the EMTs had put a cervical collar on her neck until the doctors at the hospital could determine the extent of her neck injury.  She was on a ventilator, but she was “overbreathing” it for now.  She had been without oxygen for an undetermined amount of time, but we would have to wait until the next morning to know what the extent of the damage to her brain was.

I’m not sure what we expected, but both of us audibly gasped when we first saw Michelle in that bed.

Surely this wasn’t happening – Michelle was a tiny little thing to begin with, but it was a jolt to the system to see our vibrant daughter lying so still, surrounded by so many beeping machines.  I rested my hand on her heart, just to feel it beating. Our tears started up again, and we just held on to each other for support.

The male nurse who was taking care of her that night was trying to wash off the words that Michelle had written on her arm in big, black, capital letters – “DO NOT RESUSCITATE” .

He apologized for not being able to get that washed off before we got there, but we told him not to worry about it.  In a strange way – for me, at least – it made it easier to face what I knew Paul and I were going to have to do sometime in the not-too-distant future.

Michelle wasn’t moving at all.
There was no squeeze back when we held her hands.
Her eyes were fixed; her pupils were tiny pinpoints.

Michelle’s body was still there, but we both knew that she was gone.

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Still beating

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The hospital gave us a list of hotels that had special rates for families of their patients; we called and finally were able to find one with a vacancy.  We checked in at around 12:30 a.m. with nothing but the clothes on our back.  The staff at the hotel were very kind and found us a few basic toiletries, but Paul still had to go to a 24-hour store to pick up a few necessities and some food for both of us. I put a post up on Facebook and left comments at a couple of blogs that I followed, asking for prayers.

We got a phone call from our oldest daughter, Rachel – Sarah had called her big sister to tell her what was going on. We had planned to wait to call Rachel until Monday afternoon – her father-in-law had died very unexpectedly just 4 days earlier, and she and her husband, Matt, were in Connecticut with his mother.  Rachel was scheduled to give the eulogy at the funeral the following day. Rachel was torn between what to do – we told her that the best thing that she could do would be to stay there and support Matt and his mom through the funeral on Monday, and then fly down to see Michelle on Tuesday.

We had been dreading the thought of making that phone call – we were relieved and grateful that Sarah had taken that burden out of our hands. When we were finally able to lie down, the tears started flowing freely again.  We clung to each other and talked some more until we both, exhausted, fell asleep.

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One of Michelle’s drawings

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The next day (Monday) was Labor Day, so the regular hospital staff weren’t all there; the ones who were there were all bustling about when we finally made it to Michelle’s room. The night staff had told us ahead of time that they would be putting a cooling blanket on Michelle overnight, in order to bring her body temperature down and to reduce any swelling. This would give the medical staff a clearer picture of the amount of damage her brain had sustained.

We were not prepared for how very cold her body was going to be – as parents, our first instinct was to cover her up with a blanket.  We were assured by the staff that she couldn’t feel the cold due to her brain injury, but it was still awfully hard to keep from wanting to warm her back up.

Because we had arrived so late, we missed seeing the neurologist when he made his rounds, but the doctor in charge of Michelle’s care showed up not long after we did.  After introducing himself, he proceeded to do a few standard non-invasive tests on Michelle, checking her eye response, her verbal response, and her motor response to stimuli.  Her eyes moved once, but never again; there were no verbal or motor responses.

The doctor said, “E-2, V-1, M-1,” to one of the other staff members in the room.  It turns out that he was assessing her on the Glasgow Coma Scale, and her score was a dismal “4”.  The lowest score possible on that scale is a “3”, and any score below an “8” is associated with a less than optimal outcome.  The doctor’s assessment merely confirmed our fears; we were facing the worst possible scenario – the one that no parent ever wants to face.

We immediately brought up the possibility of organ donation – since we knew that Michelle was gone but for the machines keeping her body going, we hoped that at least something positive might come from all of this.   The doctor seemed a bit relieved that he wasn’t going to have to broach that subject with us, and told us that we could talk that over with the neurologist when we saw him.

After the doctor left, we knew that we had to start making the phone calls which we had been dreading.  Both of our families needed to be informed, as well as our close friends.  Fortunately, there was going to be enough time for people to come and tell Michelle “goodbye” if they wanted to.

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No kidding: A cross street sign at CHI St. Joseph Hospital in Bryan, Texas

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From that point on, everything blurred together – we talked to a lot of doctors and nurses, as well as administrators and chaplains.  We were able to keep our friends and family who were on Facebook updated about Michelle’s condition – it was a real timesaver over the next few days, and we were grateful for all of the prayers and support from everyone.  Several people came to visit Michelle at the hospital, which was a welcome respite from everything that was going on around us.

My cousin’s husband, Greg, came to see us, as did a couple of Paul’s friends from work. My best friend Becky and her husband, Dave, drove up from La Porte to see us.  I had called Becky the night before – she had lost her son, Jonathan, in 2001 due to a car wreck, so she knew what we were going through.  A lot of hugs and tears were exchanged.

Our friends Teri and Bob, who had been watching Rebecca, drove her down to the hospital to visit Michelle.  We’re not quite sure if Rebecca truly understood what was going on (she has Down syndrome), but she was very concerned about how cold Michelle was due to the cooling blankets.  She brightened everyone’s mood by having everyone in the waiting room hold hands for Michelle.

Sarah drove down and brought us clothes and toiletries/medications from home.  She would be staying with us in the hotel for the duration of this journey. Michelle and Sarah were only a year apart in age, so they had been thick as thieves growing up. When Sarah finally saw Michelle, she let out the most heart-wrenching wail – and our hearts were broken all over again.  She couldn’t stop sobbing; she wanted to be alone with Michelle for a while, so we obliged her.

Later that night, we were able to meet with the neurologist and he confirmed what we pretty much had already guessed – Michelle’s brain had been severely and irreversibly damaged. Her neck had not been broken, so they were going to be able to remove the cervical collar and the cooling blanket, which was a relief, however small.  The neurologist said that she would be an excellent candidate for organ donation, so we started the ball rolling to meet with the transplant team over the next couple of days.

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More of Michelle’s amazing artwork

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Tuesday was a surprisingly busy day – several of Paul’s family members had made their way to Bryan to see Michelle and to keep us company.  Paul and his older brother, Tony, drove to the airport to pick up Rachel and bring her to the hospital.

Since Rachel’s husband was staying in Connecticut for a few more days to help out his mother, Rachel’s friends Claudia and Jessica were coming down that night to lend her some moral support – they had a room in the same hotel as ours.  My mom and dad were arriving from North Carolina on Wednesday, with plans to stay with us in both Bryan and Fort Worth for as long as they were needed.

We met with the people from the organ donation organization, Southwest Transplant Alliance.  They told us that Michelle had previously signed up to be a tissue and organ donor, which didn’t surprise us one bit.  They explained which procedures would take place and when – they were very professional and caring, and they made sure that we understood that Michelle would be treated with both respect and dignity throughout the process.

From that point on, the clock started ticking.  The transplant team and various hospital personnel started determining which of Michelle’s organs were viable for donation and then cross-matching her organs with patients across the country who needed those organs the most.  On our end, it was time to let everyone know that the window to visit Michelle was closing.

Everyone understood the urgency: if we were to have any hope of Michelle’s organs being viable for harvesting – thus giving other people a chance for a new lease on life – we were now on a limited timetable.

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Letting Michelle fly

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On Wednesday, my parents finally made it to the hospital.  We knew that seeing Michelle in that hospital bed was going to be very difficult for both of them, but it was going to be especially hard on my dad – he had a very special place in his heart for Michelle.

We tried our best to prepare them, but nothing can really prepare anyone for something like that.  For the rest of my life, I will be haunted by my parents’ cries.  My father just kept quietly sobbing – it tore my heart out.  We all tried to comfort him, but there really wasn’t much that any of us could do.

Amidst all of our sorrow, the sweetest little girl melted all of our hearts and gave us a lasting gift.

Rachel’s friend, Claudia, told us the following story:

Yesterday evening when I left to go be with Rachel, I explained to my daughter, Logan, that Mommy would be away for a few days…her friend Rachel and her family needed her to come be a friend, because they were going through something very sad. She said that she wanted to come with me and help, and I told her that I had to go by myself. She was deep in thought, and disappeared for a while. When she came back to me, I was standing in my kitchen, and she dropped two coins – a nickel and a penny –  into my pocket, and informed me that they were for Rachel and her family, to make them feel better. I regained my composure, hugged her, and said thank you. They stayed in my pocket until I got to the hotel room, and I handed them to Rachel, relaying my little girl’s message.

Rachel was very touched by the gesture, and when she got to the hospital, she shared the story with everyone in the waiting room, and showed everyone the coins.

At some point later that morning, someone went downstairs to get some drinks and snacks, and Paul gave them some money to get him something as well. When they came back, they handed Paul his items and his change. He absent-mindedly pulled out his wallet and put the bills from his change in it and put it back in his pants pocket. He went to pick up the coins from his change, and just started weeping.

Sitting there on the table in front of him was a nickel and a penny.

No other coins had been given in change, just those two. Needless to say, after that there wasn’t a dry eye among our friends and family who were in the ICU waiting room. As Claudia said, it felt like Michelle was using a small gesture to send a big hug our way.

Later on in the day, one of Paul’s family members came upstairs, quite excited. When they had gone to lunch, they had received a nickel and a penny back in change.  They brought their coins back and gave them to us. And of course the tears started up again.

(We figured out not long after that that the price of a bottled drink + tax was $1.94, so the magic was gone after that – but the first two times, none of us knew that, so everyone agreed that those two times counted.)

It was so nice to have a bright ray of sunshine at such a dark time.  We thanked Logan later that night when Claudia called home to tell her husband and children goodnight. To us, those coins were priceless.

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The nickels and pennies Michelle sent us

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Thursday came, but we weren’t ready for it to come.

Today was to be our last day ever with Michelle.
We were going to have to let our beloved daughter go.
We prayed for the strength to somehow get us through the next few hours.

We were told by the transplant coordinator that they had been able to find matches for three of Michelle’s organs – her liver and both of her kidneys.  It was a beacon of hope in the midst of all our grief. By the end of the day, three families might have renewed hope for their loved ones, and some part of Michelle might be able to live on. The transplant coordinator assured us that she would be with Michelle throughout the entire transplant process.

The transplant team came by to make sure we understood everything that was going to happen. Different hospitals have different protocols for “time” when it comes to organ donation. Once the machines are turned off, there is a time limit for how long the donor’s brain has to cease functioning before it is too late to make a live donation. CHI St. Joseph had a 60-minute “window of time” policy.

From the moment that the ventilator was stopped, if Michelle’s organs were going to be usable, her brain had one hour to die.  If she didn’t stop breathing on her own in those 60 minutes, her organs could not be used for transplant into a living human body.  The team would still be able to harvest her tissues for possible future use, but she would not be reconnected to any life support machines.  Michelle would be moved to another room in the hospital where she would be allowed to peacefully pass away.

A team of chaplains came by to pray with us and to bless Michelle.
Michelle was surrounded by the love of her friends and her family.
The morning had passed by much too quickly.

And then it was time.

Everyone followed Michelle’s gurney down to the hallway just outside of the surgical suite where doctors and nurses were waiting to receive her. Friends and extended family said their goodbyes to Michelle, kissed her, and told her that they loved her. They were directed to the Surgical Waiting Room right outside of the hallway.

Paul and I were allowed to stay with Michelle in the hall for a little while longer; we were the only family members who were allowed to be with her in the operating room.  When the nurse came to take Michelle back to be prepped for what we all hoped would be a successful transplant surgery, Paul and I went to the waiting room until it was time for us to be called back.

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Left unfinished, a drawing for Paul

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After Michelle was prepped, the nurse came and got Paul and me.  We washed our hands up to our elbows and put on OR garb.  We were told that her body had been draped, and that we couldn’t touch anything except one of her hands and the top of her head.  One of the nurses had used surgical tape to place a nickel and a penny in each of her hands – the same ones that we had gotten back in change the day before.

We held Michelle’s hand until the surgical staff had everything in place.  Paul and I were directed around Michelle’s draped body to a place by her head, which had been draped to just above her forehead.   There were two rolling stools waiting for us.  We both sat down and were told that we could speak to her and that we were allowed to touch and kiss the very top of her head, but not to touch below the draped part, as everything covered in blue fabric was a sterile surgical field.

Michelle was disconnected from life support at 2:09 p.m.

There is something very surreal about stroking the hair on the top of your beloved child’s head and praying that she will die in the next hour; as a parent, it goes against every fiber of your being.  But there Paul and I both were, telling Michelle that it was okay for her to let go, to please stop breathing before those sixty minutes were up.  We wanted the three people who were waiting for her organs to have a new chance at life.  A very selfish part of me also wanted some part of Michelle to go on living.

Fifteen minutes came and went.
Thirty minutes passed.
Then forty-five.
And then we found ourselves counting down – fifteen minutes…ten…five…one…

After that, we were desperately praying that sometime in those last 60 seconds, Michelle would stop breathing on her own.

But it was not to be – Michelle’s organs were not going to be able to be donated.

We kissed Michelle, told her that we loved her and that we would see her again in a little while.  We went back to the surgical waiting room while the OR staff got Michelle ready to go back to the room where she would breathe her last. Neither Paul nor I had eaten lunch, so we went to the hospital cafe, which was conveniently located just outside of the waiting room, to get some much-needed food.

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Our last family photo – Michelle, Rebecca, Paul, Rachel, Matt, Me, and Sarah

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About the time that we were finishing our lunch, one of the nurses from the OR came and found us. We told her that we were getting ready to go up to Michelle’s room. She seemed genuinely surprised, then she told us that while they had been taking everything down and preparing Michelle to move back to her room, she had stopped breathing.

Michelle passed away at 3:21 p.m. – 12 minutes after the 60-minute window had closed.

I remember saying “No”.
I remember feeling sorry for the three families still waiting for life-saving organs.

But mostly I remember being so incredibly sad and upset that we had not been there for the last moments of Michelle’s life. I had so desperately wanted to be there when Michelle slipped away – to hold her hand when she took her last breath; to kiss her forehead; to tell her how much she was loved and how much she was going to be missed.

Instead, she had been surrounded by strangers – caring strangers, to be sure, but still, they had all been busy doing their assigned tasks – and I couldn’t help but think that in a room filled with people, Michelle had been all alone when she died.

And that is when the tears really started to flow.

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Paul, Rachel, Sarah, and I went back to the room to see Michelle. The hospital staff had wrapped her in warm blankets to keep her from turning cold too quickly; all of the loud machines were gone, so we were finally able to see her beautiful face. We kissed her and told her how much we loved her, and we all cried and hugged each other.

The staff gave us plenty of time to spend with her, but all too soon it was time to say goodbye to Michelle for the last time.

So we kissed her again, held her close one last time, told her again how much we loved her, and cried and hugged each other even tighter.

Then we had to leave our dear beloved one forever.

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Our Beautiful Michelle

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We had Michelle’s memorial service the following Saturday. Everything just fell into place, and the service was beautiful. We had Michelle cremated, and her ashes are in a lovely wooden box on our mantle at home – we couldn’t bear the thought of her being alone; we wanted her at home with us.

We loved Michelle so much.
We miss her even more.

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Michelle Elise Koch
Beloved Daughter
August 16, 1991 – September 7, 2017

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Safe in the loving arms of home

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