the Pronouncement
I assisted my intern on a "pronouncement" the other day. A death pronouncement. Whenever someone dies in the hospital the intern on call is paged, and it is their job to verify that the person is indeed dead and then officially document it in the chart.
We arrived at the room, to find a hand-written sign taped to the door. "DO NOT ENTER," it read, "Please go to nurse's station first." Obviously that was put there for the benefit of any unexpected visitors, to try to prevent the unimaginable shock of a family member walking in to find that their loved one was no longer of this world. We ignored the sign, and entered.
Now, I have been around a lot of dead people. I have observed and performed dozens of autopsies, and can honestly say that I do not find it gross or creepy to be in the presence of death. But it was an odd feeling to be in the position of having to prove death. In all my previous encounters with the departed, their death was a given. It had already been established, without question or uncertainty. Not that the death of this person in front of me wasn't certain - indeed, it was quite obvious - but it required the formality of proof.
Listening for a heart that did not beat... feeling for a pulse that was not there... watching for respirations that did not occur... shining light into eyes that were fixed and motionless. Holding my stethescope for such a long time against a startlingly silent chest. The skin was still warm. The mouth gaping. I had to gently press the eyelids closed, as they did not close on their own. Not that it mattered, really. Its funny that we desperately avoid having to see the eyes of the dead. Like somehow with closed eyes we can maintain that child-like fantasy that they are sleeping and comfortable. The eyes bring them back to earth.
It made me think about why we need a formal pronouncement by a doctor. Why did they need the 27 year-old intern, 8 months out of medical school, to call it? Why did her MD title make it official, when any nurse, or hospital worker, or person off the street could have easily come to the same conclusion? I think we have a fear in our society - a fear that is perpetuated by B horror movies and old Tales from the Crypt episodes - that it is actually possible for someone to seem dead and have an autopsy performed on them while they are in reality alive and screaming on the inside. I swear I have seen this on tv. I guess it even goes back to the poisons taken by desperate lovers in Shakespeare's day, where a potion could give all the appearance of death, enough to fool doctors and priests and forbidden boyfriends. I can gaurantee you, this is impossible. But I bet some weird stuff has happened in the past. Foul play involving inheritances and estranged wives and ilegitimate children and life insurance policies. I suppose it is good to have a system in place to legally and impartially declare death. It will be weird when I am the one to make it official. I guess that will be one thing that medical school has taught me: I know how to diagnose the absence of life.
Jack Bauer faked his own death on the final episode of Season 4 of 24.
http://en.wikipedia.org/wiki/Jack_Bauer#The_.22Death.22_of_Jack_Bauer
"Once Secret Service Agent Spaulding and CTU personnel left the scene, Bauer was administered epinephrine and revived."
And, of course, don't forget Flatliners, in which Jack/Keifer learned to induce a reversible, clinical death.
My point exactly - on TV. Not reality. And though I don't know much about Jack Bauer's death in 24, I bet that if he took something to stop his heart from beating he did not fake his own death, he induced his own death. The body can only survive so long without oxygen delivery to important tissues before end-organ failure and death ensues. The audience is fortunate that Mr. Bauer did not emerge a little mentally challenged.
Keifer must have a thing for fake death.
This guy Kevin Williams (link below) is out to prove you wrong.
http://www.near-death.com/experiences/editorial01.html
My father died in the ICU at OHSU, and luckily, I got to be with him. It is an astounding thing to watch someone die. In my book, the easier part was afterwards ... except for the eyes & mouth thing. They don't want to shut, and I was freaking out trying to keep them closed.
Have you been present while a death occured, or only been there afterwards?
Mat, I'm sorry about your dad. Its good that you could be with him.
I have never been present at the moment of someone's death. My sister was with my grandma when she died, and I think she really valued that experience. Wait! I have witnessed someone die during surgery, but that is a very different situation, ripe with its own weird intensities.
Tom - maybe people have near death experiences, maybe they don't. It is certainly possible for someone's heart to stop beating, and for them to then come back to life. This happens all the time, because your tissues can sustain a lack of oxygen for a finite period of time. My point is that when someone is cold and stiff it is obvious that they are dead. No one can come back after that. Its just funny to be in the position of diagnosing the obvious.