by Fran Sullivan

A maze of corridors crisscrossed the lobby of the Nassau University Medical Center, making it difficult to locate my brother, Joe – better known to the rest of the world as Brooklyn Auxiliary Bishop Joseph M. Sullivan.

Not enough time had elapsed since the medevac helicopter landed and he was assessed by the trauma team for the computer system to know where he’d been taken. My husband, John, and I walked up and down the halls. It seemed like an eternity before a kindly guard led us to the second-floor trauma center.

We found Joe hooked up to the full range of medical equipment: A monitor reported blood pressure and heart rhythms, bags of mysterious liquids suspended from poles terminated in his arm and the life-sustaining breathing machine sent oxygen into his lungs via a rigid tube taped to his mouth. His 83-year-old body seemed massive under the stiff white sheets. His habitual smile lines had smoothed. He was still, but more than still – he seemed lifeless.

Less than 24 hours earlier, we were having dinner together to celebrate my husband’s 79th birthday and the visit of my niece and her two college-age children from Springfield, Mass. It was one of many such nights when Joe made the effort to join us.

When word of Joe’s accident came, we were driving home following a radiation treatment John had received for high-risk prostate cancer. Listening to one side of John’s cell phone conversation, I determined that the call was from Baisy Apostol, my brother’s secretary. I knew it was trouble when I heard John ask: “When did it happen? How bad was it? Where did they take him?”

My brother had a blowout on the Long Island Expressway and was rear-ended while he waited for Triple-A to arrive. He’d been taken to Nassau University Medical Center. It was 11:30 a.m., a half hour since the accident occurred. With the help of our GPS, we got to the medical center in 40 minutes.

As we stood by Joe’s bed, the neurosurgeon on duty visited. He chose his words carefully.

“Mr. Sullivan has sustained many injuries. He has a broken leg, a punctured lung, fractures in the spine. But the main problem is the brain injury.”

“Just how bad is it?” I asked.

“We don’t know how severe the injury is, but he squeezed my hand during the initial assessment and this is promising. I have seen people come back.”

“What can you do for him?”

“We’ll do another CT-scan this evening which will tell us much more. If there’s no increased bleeding that will be a good sign.”

He appeared to be holding out a small glimmer of hope. We clung onto that hope as we watched for any sign of movement from that imposing figure who had always been bursting with life. It seems such a small thing now, but I wanted him to be called Bishop Sullivan instead of Mr. Sullivan.

“Was Mr. Sullivan married?”

“No, he’s a bishop of the Catholic Church.”

“Does he have children?”

“No.”

“Not that we know of,” John added. Though his broad smile let the technician know it was a joke.

I realized that his elevation from priest to bishop, though highly regarded in the Church, meant nothing here. Here all that mattered was life and death. Joe would approve. He knew he was bound to all others by a shared humanity of sinfulness and grace.

So Clear in the Abstract

About midnight, I received a call from the hospital seeking permission for two medical procedures. As I gave approval, I became more aware of what it meant to be Joe’s health care proxy. The words of the advanced directive/health proxy that he had given me six years earlier seemed so clear in the abstract but not in this immediate situation.

On the third day, Joe’s neurosurgeon revised his initial assessment. The prognosis was not good, but he said anything could happen.

My thoughts shifted from how to care for him to how to let him go. He was not a man to give up. I shouldn’t either.

Hours spent by his bedside allowed me to reflect. Joe didn’t leave much doubt about what he believed. The day before his accident, he sparked a heated discussion by asking the priests at a luncheon where they thought the Church was headed. The conflicting opinions did not daunt him. The two things he thought the Church needed were collegiality and transparency. He practiced both.

A conference call between two experts – Joe’s colleagues in the health field – reassured us that everything the hospital was doing for him was exactly right. At the same time, they were ambivalent about his prognosis.

The second paragraph of Joe’s advanced directive/health proxy stated, “I intend that the ethical and religious directives of the United States Conference of Catholic Bishops (USCCB) guide my medical treatment.” I decided to do some research on the USCCB website, and I found chapter five of the Ethical and Religious Directives for Catholic Health Care Services, “Issues in Care for the Seriously Ill and Dying.” The well-crafted document was helpful and sensitive to the needs of the patient and family.

Day after day, Joe lay motionless, and the hoped-for signs of change did not come. The neurosurgeon summarized his status as bleak. My brother had sustained traumatic damage over a widespread area of his brain. He could have remained in that state for years.

I discussed Joe’s advanced directive with Sister Maureen Chase, O.P., hospital chaplain, and Joe’s friend, Father John Gilmartin. They were familiar with the USCCB ethical guidelines and asked me to consider this question, “Is the treatment prolonging life or prolonging death?”

I asked myself this question, but it was the medical director, Dr. Steven Wallenberg, who helped us understand Joe’s condition and the limits of treatment.

“What would Joe say should be done if he were here,” he asked.

I had no trouble answering that question, “Let’s get on with it. Face reality and get back to work.” My brother Pete and Father John immediately concurred.

Prolonging Life or Death

A few days later, I got a call from Baisy saying that Joe had a revised advanced directive dated Sept. 29, 2012. She emailed it to me, and when I compared it to the original, I discovered only one modification: “If I should be in an incurable or irreversible mental or physical condition with no reasonable expectation of recovery, I direct my attending physician and other medical personnel to withhold or withdraw treatment that serves only to prolong my process of dying.”

It took only one more conversation with the neurologist to know what we had to do. He confirmed that Joe had irreversible damage to the brain and that he would never recover.

Mixed with the pain of knowing what had to be done was this incredible relief of finally knowing that in withdrawing treatment we were doing what Joe wanted, and it was the right thing to do. This was Joe’s parting gift: He took the time to prepare an advanced directive that made it absolutely clear what should be done in the very circumstances I was facing.

My only role was to see that his intention be honored.

In a private room on a quiet floor at the medical center, skilled professionals removed the rigid breathing tube from his throat, and within minutes, Bishop Joseph M. Sullivan died on June 7, 2013.