Time of Death

"Doctor, patient X has stopped breathing, we need to come and pronounce him."

Mmmkay, not my idea of fun. But, it comes with the territory. It is daunting when the patient's family is nearby, sobbing, hugging each other, holding the decedent's hand. Crap, keep it together, you can do this! No matter how much or how little I have been involved in the care of a patient, when the time comes to pronounce them deceased, to invade the space of mourning family members, to perform the final physical exam on a loved one, it is not easy. I do everything in my power to keep it together.

Pupils dilated and fixed. No palpable pulses. No heart sounds or breath sounds. No activity on the monitor. Cold, pale flesh. An empty vessel that used to be a living, breathing human being. A father, a husband, a grandpa. It chips away at your soul. I find myself vacillating between the stoic physician and emotional bystander. Death is a cold, cruel...

Trying to maintain composure when offering condolences is not an easy task. Deep breath, clear mind. Say "sorry for your loss" in one swift but coherent and composed breath while maintaining eye contact and offering a hand or pat on the shoulder is my approach. Then the shock comes in the form of "Thank you Doctor" or "Thank you, everyone has been wonderful here", or the silent nod with tears flowing freely down the loved ones face. Oh crap, I have to ask for the autopsy...

"I am truly sorry for your loss. I apologize but, I have to ask you if you would like to have an autopsy performed on your loved one?" We must ask this. Knowing how to ask, and when to ask can be a challenge. You want to not feel like you are imposing any further upon the family, nor interrupting their grieving process. But, it must be done. It is a mandatory part of our process for handling a death in the hospital. Pronounce, console, query, death certificate, note/discharge summary, name of funeral home, and notify the unit secretary who notifies admitting. Sometimes the Medical Examiner needs to be notified. It depends on the circumstances surrounding the patient's death. Today, this was a non-issue for me. Phew! Time to go home, hug my family, say I love them, and try to get a restful nights sleep.