Take a few minutes to read about the medical events leading up to this family conference.

Patient: Ryan is in his late teens and was admitted 3 weeks ago with severe meningococcal meningitis.

Family: Mother Sheryl and older brother Josh.

Medical Situation: Ryan was healthy until three weeks ago when he developed a fever, myalgias and a severe headache. Thinking this was the common flu, his mother gave him some acetaminophen and sent him to bed. However the next morning she found him breathing rapid and shallow and could not wake him up so she called 911. In the emergency room Ryan was quickly intubated. He was in septic shock and found to have meningococcal meningitis. Ryan has remained in the ICU and unresponsive for the entire 3 weeks despite full medical management including antibiotics and a ventriculoperitoneal (VP) shunt for hydrocephalus. A few days ago he became hemodynamically unstable when his VP shunt obstructed and he had a cardiac arrest. After 4 rounds of CPR there was eventual return of circulation and he has since stabilized. He was weaned off pressors and his acute kidney injury resolved. However, since his arrest, his neurologic exam is very concerning. His pupils are only minimally reactive, he has lost his cough, gag and corneal reflexes and he is not showing any spontaneous movement. Neurology was consulted and said that there is a small possibility that he may wake up, but a high likelihood for long term dependent disability based on testing and his exam.

Family Conference: You are meeting with Sheryl and Josh to review the information from the neurologist and disclose the recent test results. You plan to discuss whether to proceed with tracheostomy and PEG placement versus withdrawing life sustaining treatment. You have cared for Ryan since he was admitted. Sheryl has been at the bedside nearly every day and night. You are meeting with Sheryl and Josh in a private conference room near the ICU.