I was working in the Pediatric ICU at a hospital in Orange County. We had a family with a child who had severe chronic medical conditions. This child had been in the ICU multiple times for pneumonia, heart surgeries and other assorted illnesses. This was a child that for all intensive purposes never was "awake" or conscious to the extent that she interacted in a way we could understand. Her family had gotten to know her moods and what stimulated her or calmed her. It is impossible to know what was going on inside this child. What did she experience? Did she know how much energy went into her life? She was not doing well having a very severe pneumonia. We all got the feeling that this could be the end of this patients life. I felt relief thinking that this child was a major pull on this families life. She required constant care, multiple doctor visits a week, numerous hospitalizations. I envisioned a family without many resources (no nanny, no "caretakers") other children and not a great sophistication of the medical world (read concrete and not highly educated). I thought "Well this will allow closure and this family to move on and not be drained by such a burden." What could they possibly have gotten back from this child? It sounds so cynical now so hard and uncaring but I was looking at a child who never opened her eyes, never spoke, never walked, talked or in any way interacted with her environment. The only way she was alive was due to enormous efforts on the part of many nurses, doctors and her family. Then something happened I will never forget.

It was the end of her life. Her pneumonia was taking over, antibiotics were not working and her heart was failing. I talked to the family asking how much do we do. How far should we go this time? After a lot of tears it was decided by her mother not to place her on a respirator and let her die if that was the way she was going to go. I stayed with them until the end and after her last heartbeat her mother holding her now lifeless child to her breast looked up at the ceiling and yelled "You Dance now! You dance and be beautiful! You dance!"

Her daughter had become what she always was in her mothers mind; a lovely little girl dancing, laughing and playing. I was stunned and realized what I had been missing. I missed the value this girl added to the world of her parents. They rose to the challenge. They incorporated this child into their lives. By whatever amalgam of church, social and ethic structure it worked. I am not saying they were saints and everything was great but this child was the recipient of great love. Any person that engenders such love has value. This is a goal to have someone to love so deeply and entirely that there is no end to one's devotion.

I have saved the cardiac monitor strip and have it as part of an art piece. I see the last three beats of a patients life. A patient we in medicine see (and not entirely wrongly I have to add) as existing only in this country only because we "can". But then I see the line go flat and the dancing laughing girl has come out and I just have to stand and wonder at how much I have learned from her.