I worked PICU back when I was practicing in the States, and I also seemed to have fallen into that role by the time I left. My first loss was, thankfully, nothing like yours, and I think that's what allowed me to go on and do it so many times after that. He was ten years old, and had been neurologically devastated since about a year of age. They had withdrawn support the night before, and I was surprised that he was still there to be assigned to me in the morning. I walked into the room, and his mama looked up at me from her place in the chair. "You're here. He was waiting for you." As soon as she had said that, his heart rate dropped and he died. Just like that.
There was one other death that I was a part of that I will absolutely never forget. She was 16, her nails were perfectly manicured, and her mother, through her sobs, explained that she had just had them done the night of the party. The party where the brain cancer we all though she had beaten reared its ugly head, and she started to seize in front of all her friends.
I sat with her parents and her two little brothers all day. At her mama's request, I stood in the circle of family while the priest who baptized her prayed over her. When her mother pulled me out of the room and begged me to explain to the boys what was going to happen to their sister, I agreed to talk to them. "You've done that before, right? You know what to say?" I lied and told her I had, that I did, and then I went back into the room and somehow managed to tell them that sister wasn't going to come home this time.
When we pulled the tube, the doctors and RT's left quickly, and I stayed by her bedside, next to the darkened monitor, holding her mother's hand. Her father laid his head on her chest, and stayed there, motionless for what seemed like forever. Finally he lifted his head, panic in his eyes. "I can't hear anything."
I took my stethoscope and confirmed what I knew had probably happened long before. "She's gone."
When the parents left the room, a tech and I bathed her, washed and combed her hair, scrubbed the sticky residue of the pulse-ox off her perfect nails. We took out lines and clothed her in a clean gown. Even though she was 16, I made hand and footprints, one each in her favourite colours: pink and purple. When we were finished, I found her parents in the waiting room. Her mama was curled in a tight ball, refusing to come see her baby, because she didn't want to see her "like that" anymore. I explained that the tubes were gone. The wires were gone. The machines were gone. She just looked like she was sleeping.
We went back together, and then I left them all there to say good-bye. On their way out the door, the mother grabbed my arm. "You won't let her be alone, will you? You'll stay with her?" It was already after seven, but I promised. I clocked out, paged transport and sat by her bedside. When they came, I walked with her down to the morgue and made sure she was 'tucked in' before I left.
I've helped to midwife many souls from their bodies since then, but that day stays with me.