Chapter 7: When Intervention Isn’t an Option
Sometimes, the kindest choice is to step back. This is the hardest part to write—and likely the hardest to read. About 5-10% of severe TBI cases reach a point where survival or meaningful recovery isn’t possible. Let’s approach this with gentleness.
Indications for No Intervention
· Massive Damage: Widespread brain destruction on CT—seen in 3-5% of cases—often means no recovery. If the GCS stays at 3 despite all efforts, outcomes are grim: 90% mortality.
· Age and Health: An 85-year-old with heart failure and a severe TBI faces a 70% mortality risk, even with surgery, per BTF data.
· Family Wishes: If a patient’s living will says “no heroic measures,” doctors honor that.
The Heart of the Decision
Imagine a doctor sitting with a family, scans in hand, saying, “We’ve done all we can.” It’s not giving up—it’s shifting to comfort. Palliative care steps in, easing pain and letting loved ones say goodbye. Studies show 80% of families find peace in this clarity, though the grief is still heavy.
If you’re facing this, I’m so sorry. It’s not a failure—it’s a redirection of love toward dignity. You’re not alone; chaplains, counselors, and nurses are there to hold space with you.
Leave a comment