Bailey S. Fitzgerald
February 1, 2019
That patient died, the text read.
A pause.
I’m pretty sure she is dead.
Three trailing dots appeared and disappeared as he hesitated over the next text.
Can you come double check?
The hospital floor was dark and silent when the intern texted me. I’d been listening to a mystery book-on-tape on my headphones, so I jumped when the phone pinged.
It was an expected death. Our patient was an elderly woman, well into her 90s, and already frail when she developed the pneumonia that lead to her admission to the hospital. The emergency room had at first sent her to the ICU. The chest x-ray showed white fog scattered throughout both of her lungs, an infection that left little usable lung. After a day of intensive treatment, she had had enough. She asked her family to let her go.
“Everyone has to die somehow,” she told the ICU doctors. I imagined them looking at one another, silently thinking “she’s not wrong”. Her daughter agreed, and aggressive treatments were discontinued. She was transferred to the regular medical floor, where my intern and I took over her care. When I met her, she was already struggling to breathe, taking quick sharp breaths at irregular intervals. “We’ll make sure you’re comfortable” I said to her, turning the knob on the wall to increase her flow of supplemental oxygen. I reviewed the plan for her care with the nurses, including medications to soothe her breathing and others to minimize pain. I doubted then she’d make it through the night.
And now, she had died. It was sad, even though it was expected. Even though this was supposed to happen. I knew the feeling was irrational. This death was what she had chosen, after all. I told my intern I was on my way. Pulling my headphones out of my ears, I wrapped them around my ipod, and tucked it carefully away in my bag before heading over. I knew there was no need to rush for our patient’s sake. She wasn’t going anywhere. But my intern sounded worried.
I arrived to find the intern hovering in the doorway, shifting from foot to foot. He kept turning his head sharply to look back into the room at the patient, as though to check she hadn’t moved.
“Have you done this before?” I asked.
“Never,” he told me, “and I really don’t want to get it wrong.”
I followed my intern from the darkened hallway into the room and paused for a moment on the threshold as my eyes adjusted. The only light in the room came from a small fluorescent fixture on the wall above the bed, whose plastic guard scooped out from the base of the bulb, directing the light up to the ceiling. Our patient reclined back as though sleeping, one hand reaching out from under the blankets to rest near the bedrail. She looked much more peaceful now than when we met, her ragged breaths replaced by stillness. Lying, as she was, directly underneath the light, the angled illumination cast disconcerting shadows down onto her face, her brow ridge creating dark circles where her eyes would be. I wanted to rush around the room flipping every switch upward until even the dark space beneath the bed was illuminated. Instead, I walked to the bedside.
My intern and I bent over the patient together, both listening hard to her chest with our stethoscopes. Was that… did I hear...? In the dark, I could almost convince myself that I had heard something, but no. It was only my own unsteady hand, shifting the head of the stethoscope against the gown. The skin on her neck was still warm, but I felt no pulse under my fingers. The night was dark, and my intern’s uncertainty was infectious. “Feel anything?” I asked the intern. He shook his head. “Right” I told him. “She’s dead.” He visibly relaxed, having gotten the correct answer. “Write down the time,” I advised. “We’ll need it for the death certificate.”
Outside her room, we split up tasks. The intern went off to check on another patient, leaving me alone in the dim hallway. He wasn’t the first intern that year who’d lacked confidence in his death exam. A friend of mine, an intern on duty in another part of the hospital overnight, called me to help him through the logistics of declaring a death. When I arrived, I found him hooking up EKG leads to his recently deceased patient to verify that the silent heart indeed had no electrical activity. It seemed silly, but I understood his impulse. Pronouncing someone dead seems so final, as though it is your declaration of a death that makes it reality. You want to be not only sure, but sure sure.
In the quiet, lonely hallway, I thought I heard a kind of soft creaking noise. A patient in the next room, I told myself firmly, probably rolling over in their sleep. I’m sure it’s nothing.
But was I sure sure?
I stood motionless in the hallway for a full minute, listening hard, but the noise did not come again. I started to walk away, but stopped before turning the corner. My tired brain had latched onto a story my friend told me once, about a patient she cared for in residency. Everyone called him Lazarus. After a code was stopped and he was declared dead, the charge nurse began disconnecting his IVs, and straightening the room. That was when he sat straight up in bed, gasping for breath. The nurse was terrified. Residency urban legend? Maybe. But in the story that patient had fooled a team of ICU attendings. Could I be more certain than they were?
Rationally, I knew that the woman was dead. In some cases, death is a clinically grey area, unexpected, or difficult to make sense of. This was not one of those cases. Unlike my intern, I had declared many patients dead before. Knowing that a person is dead doesn’t even require particular medical training. In an Agatha Christie novel, I would have simply bent down and placed my hand cursorily over the carotid for less than a second before making the dramatic declaration. But the Victorians buried loved ones in safety coffins with bells and flags in order to alert attendants in case they woke up underground. They knew that doctors could get even basic things wrong.
This is ridiculous, I thought to myself. But my heart rate picked up as I walked back down the long, empty hallway. I looked around, ensuring nobody was there to see me before I slipped back into the room to listen one more time. Just to be sure.
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