The first death I "pronounced"
She was 69, and she had cancer.
She had been discharged to rehab earlier that day - Saturday1 - after being treated for pneumonia. The rehab facility realized that she was dying, and sent her back.
I met her on Saturday night. She was struggling to breathe. The ED staff had started BiPAP, but as soon as she was "stable", they admitted her to my team and sent her to the floor. As the admitting resident, I had no where else to send her. The buck stopped with me.
I spent three hours with her family that night. They were angry, and frustrated, and I absorbed it. They believed that if she made it to her chemotherapy session on Wednesday, things would get better. "She can beat this," they said. "She's a fighter." They spoke for her, because she could barely speak for herself. They were not prepared for the possibility of her death.
We made her DNR that night, and comfort-measures-only on Monday morning. She died on Tuesday.
The process of pronouncing death is a fairly simple, standardized ritual: Listen to the heart and lungs. Check reflexes. Tell the family. Call the Coroner, and the Organ Bank. But talking about it is hard. As a society, and as a profession, we don't like to talk about death. We talk about winning the fight, never giving up. In doing so, we have made denial a kind of virtue. But the truth is death doesn't care. It's a rule of the universe, like entropy. (Arguably, it is entropy.) It doesn't really matter how brave you are, or how hard you fight. Death finds you, and life ends.
I should not have been the one to discuss death with her that night. This is the consequence of our denial: we avoid discussing death as long as we can. But if you wait too long, you will not be able to discuss your wishes yourself - that job will fall to a loved one. And the one to codify your wishes will not be your trusted doctor - it'll be a fresh resident, like I was that day. I felt utterly unprepared to do so. I wish I could say it gets easier.
I still remember her name.
This piece was written several years ago.↩