Drowning in the desert: family denial of brain death

Drowning continues to be a cause of childhood mortality that is associated with significant psychological distress to the affected families. The unexpected death due to such preventable injury causes excessive grieving responses in these situations. In the present report, we describe a case of a 3-year-old child who was a victim of drowning in a recreational pool, whose family went through severe denial phase following the establishment of brain death. Single-photon emission computed tomography brain scan showed the absence of tracer uptake within brain parenchyma, while the calvarium showed increased tracer distribution, also known as the "halo sign." She also had electrocerebral inactivity revealed by electroencephalography. We also discuss the magnitude of this family distress that led to total family avoidance of meeting with the treating team, from the time the parents were informed about the established brain death in the drowning child till the patient had cardiopulmonary arrest 2 weeks later.