September 2, 2009

• Te moriturum saluto

  I just pronounced my first patient.

  Specifically, I pronounced him dead. shuffled off this mortal coil. An ex-human, as it were.

  The nurse rang me up, and informed me that the patient in room **** had died and I was needed to come pronounce him. I was unsure of what exactly this entailed. Was I supposed to just waltz into the room with a quick, yup, he’s dead? Was I supposed to perform some kind of extensive workup? Was the family in the room?

  As it turns out, pronouncing a patient is a lot easier than I thought it would be. In some ways it almost seemed easier than it should be. No causal observer to the room would have known he was dead. Eyes clothes, head lolled a little to the side on the pillow, trach tube in his throat, he could have just been sleeping.

  I approached cautiously (because I have seen too many zombie movies not too), and called his name, tapped his chest. Felt for a pulse, listned for breath sounds. Where once his heart had beat a self affirming rhythm of “I’m here, I’m me, I am” there was now only a quiet emptiness. The eyelids when I lifted them up were fixed, dilated, staring off into some distant horizon that only the dead or possibly highly intoxicatd can see.

  And that was it.

  No code had been called, as this patient had advance directives, (aka living wills, aka obama’s “death panels”) which specified he was do not resucitate (DNR) and do not intubate (DNI). Reading over his medical notes, the only biography most of us will ever get, he had been sick. He had seen this coming. And he had made his peace with it.

  Being the cross-cover night doc, I had never spoken to him. I knew next to nothing about him. And yet on me fell the onus of contacting the next of kin. Another first in my medical career. Thankful for the small favor of it still being early (who wants to be woken up to receive bad news?), I rang up his wife. I could hear in her voice that she already knew why I was calling.

  Not knowing any better way to break the news, I simply went with blunt…I am sorry to inform you that your husband passed away at such and such a time.

  She seemed flustered (and who wouldnt be?), kept repeating okay as if it was a mantra that really could make everything alright, and told me she would be there first thing in the morning. Long after I am gone, the one who ruined her day.

  Could I have done a better job? Probably, but I dont know how.

  After all, I still had another 10 pages to return, and the night was just beginning.

  • 2:52 am
  • 8 Comments