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I pronounce you … dead Add to ...

Beep, beep, beep. My pager jolted me awake after only 20 minutes of sleep in the hospital call room.

"A patient just passed away. I need you to come over and pronounce him," the charge nurse said, after my third attempt to successfully dial the number on my pager display.

"Who?"

"The one in room 33, bed 1. You know, the guy with heart failure, kidney failure, DNR." She tried to jog my memory, but I had never met this particular patient. Do Not Resuscitate means they have signed a form stating they don't want to be resuscitated if their heart stops, usually because they have terminal medical issues and it would only cause further suffering.

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"I'll be there in a minute," I said.

I was only a week into my internal medicine rotation as a first-year resident, and it was the first time I'd ever been called to pronounce a patient dead. Pronouncing death, like delivering babies, is one of the tasks a doctor is expected to perform. I suppose it's a way of coming full circle with our patients - we help them come into the world and then mark when they leave it. It's also one of those things you are never actually taught in medical school, but are just expected to know when you arrive on the wards.

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I have never been afraid of dead people. I live across the street from a cemetery and I worked at the medical examiner's office as a pathology tech for a summer during premed. I assisted in autopsies and admitted the newly (and not-so-newly) dead to the morgue. This involved photographing the bodies and cataloguing all their possessions.

As I looked through the wallets of the deceased I would often find their shopping lists or receipts from their last meals and wonder if they'd had a premonition about their imminent demise. I was curious about the plans they'd made that now would never be accomplished.

I spent many weekends working alone at the ME's office to accept bodies that came in outside regular hours. "Don't you get scared, being there alone?" I was often asked. I never worried because I always knew exactly where everyone was and what they were doing. Usually, they were lying quietly in the cooler. It made me much more uncomfortable to be working alone in a store and confronted with a customer with a poor understanding of personal space.

As I walked to the nursing unit to pronounce the patient, I began to feel a fluttering of nerves in my stomach. It wasn't the thought of facing a dead person that gave me the feeling, but the anticipation of the process itself. I didn't even know what was involved in declaring someone deceased.

It's fairly easy to tell if someone is alive or dead, but there are always proper procedures to be followed, especially in the medical system. I was worried I might do it wrong. What if I made a mistake and I missed faint signs of life? Was it supposed to be solemn? What do I do? What do I say?

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It was probably the effects of sleep deprivation, after being 20 hours into a 28-hour call shift, but I had a mental image of myself standing over the patient like a minister at a wedding, intoning in a sombre voice, "I pronounce you … dead."

I knew that was ridiculous, but I confessed my inexperience to the charge nurse when I reached the unit. Fortunately, she was used to dealing with clueless interns and patiently explained everything.

"He has a Do Not Resuscitate order, so that's why we didn't call a Code Blue or anything." A Code Blue is called to resuscitate a patient who has stopped breathing or is found unresponsive. "All you have to do is confirm that he has passed away. Just listen to his heart and lungs and document that he is no longer alive. That's all you have to do. Ready?"

I nodded and we walked into the room. The patient was lying in bed, all alone. There were no family members or anyone with him. His eyes were closed, but his skin had the same waxy texture I remembered from my charges at the medical examiner's office.

I took out my stethoscope and listened to his chest. Nothing. I listened on each side for any faint sound of air entry and watched carefully for the familiar rise and fall. I felt his limp wrist for a pulse, just to be sure, and there was nothing. He was definitely dead.

I wrote a note in his chart saying that I had verified the lack of cardiac and respiratory activity and pronounced death at 2:30 a.m. That was it. The poor patient had passed away alone, with a stranger marking his passage. The event was recorded without any drama or ceremony.

I was relieved my part in the process was over, but I couldn't help but feel a bit disappointed at how anti-climactic it was. The last, most mysterious journey of this man's life was reduced to an episode of medical procedure, just one more piece of paperwork.

Dr. Andrea Skorenki lives in Edmonton.

Illustration by Sylvia Nickerson.

 

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