*Disclaimer - all identifiable characteristics have been changed*
*Trigger warning - description of examining a dead person and what happens to a body after death*
My first call. Pager? Check. Stethoscope? Check. White coat? Check. Granola bar? Check. Confidence? Well you fake it till you make it so "check"
At a gentle walk, I moved through the corridor of the obstetrical ward. My white coat trailing in the wind like sails of boats venturing through uncharted waters. The distant newborn cries echoed until I crossed into silence. I had made it to the Palliative Care ward. Ironic to have life and death in the same hallway, but in the wake of construction that's how it worked out.
I went to the nursing station, introduced myself and asked if there were any unstable patients requiring my attention. The head nurse replied, " Oh well thank goodness you are here, could you please declare a death? He's been dead for two hours now, the family is waiting for you."
I gingerly stepped into the room with the nurse and introduced myself to the family. I offered my condolences and support, and then explained the necessary steps for the declaration of death. They were offered the opportunity to stay for the exam, but they chose to leave.
There are three criteria used to declare someone dead, you must have at least two of them:
1) Pupils dilated and non reactive to light
2) No palpable central pulse (such as the carotid pulse in the neck)
3) No respiratory effort or breath sounds for 1 minute
Thank goodness I had the teaching on this the day before. We were also taught that despite meeting the criteria for death, the body can remain in many ways "alive" for hours after. From muscle twitches to sounds of digestion, these and many more processes may occur as the various parts of the body break down. Death is not instantaneous despite turning peoples' world upside down in an instant.
Alone in the room, grateful for the nurse at my side, I began to examine a man whom I had cared for for days. Whose labored breathing I helped to calm, whose grimaces of pain I helped to relieve, whose spirit in whatever sense you believe it was no longer there. I approached the patient's face and delicately opened his eyes. Criteria 1 was met. I place my hand gently along his neck, no pulse found. I listened with my stethoscope and watched for one whole minute. Criteria 3 was met.
I went out to inform the family and assist them with funeral arrangements. They expressed their gratitude for everything we had done and left a box of chocolates at the nursing station as a token of their appreciation. I carried on with my day as best as I could but I felt distracted. The events of the morning still lingered like hot coal in a christmas fireplace. I can't help but reflect on the way I see life and death now. It's not static, it's not black and white, it is just grey zones. One can be alive and not living. One can be dying but so full of life. One can be dead to those around them for decades and others can live on through those who loved them.
At the end of my shift, I walked through the same familiar hallway - the gentle wails of new life piercing through sadness of losing my first patient. As I stepped out into the afternoon sun, I sighed deeply. I made it.
*Trigger warning - description of examining a dead person and what happens to a body after death*
My first call. Pager? Check. Stethoscope? Check. White coat? Check. Granola bar? Check. Confidence? Well you fake it till you make it so "check"
At a gentle walk, I moved through the corridor of the obstetrical ward. My white coat trailing in the wind like sails of boats venturing through uncharted waters. The distant newborn cries echoed until I crossed into silence. I had made it to the Palliative Care ward. Ironic to have life and death in the same hallway, but in the wake of construction that's how it worked out.
I went to the nursing station, introduced myself and asked if there were any unstable patients requiring my attention. The head nurse replied, " Oh well thank goodness you are here, could you please declare a death? He's been dead for two hours now, the family is waiting for you."
I gingerly stepped into the room with the nurse and introduced myself to the family. I offered my condolences and support, and then explained the necessary steps for the declaration of death. They were offered the opportunity to stay for the exam, but they chose to leave.
There are three criteria used to declare someone dead, you must have at least two of them:
1) Pupils dilated and non reactive to light
2) No palpable central pulse (such as the carotid pulse in the neck)
3) No respiratory effort or breath sounds for 1 minute
Thank goodness I had the teaching on this the day before. We were also taught that despite meeting the criteria for death, the body can remain in many ways "alive" for hours after. From muscle twitches to sounds of digestion, these and many more processes may occur as the various parts of the body break down. Death is not instantaneous despite turning peoples' world upside down in an instant.
Alone in the room, grateful for the nurse at my side, I began to examine a man whom I had cared for for days. Whose labored breathing I helped to calm, whose grimaces of pain I helped to relieve, whose spirit in whatever sense you believe it was no longer there. I approached the patient's face and delicately opened his eyes. Criteria 1 was met. I place my hand gently along his neck, no pulse found. I listened with my stethoscope and watched for one whole minute. Criteria 3 was met.
I went out to inform the family and assist them with funeral arrangements. They expressed their gratitude for everything we had done and left a box of chocolates at the nursing station as a token of their appreciation. I carried on with my day as best as I could but I felt distracted. The events of the morning still lingered like hot coal in a christmas fireplace. I can't help but reflect on the way I see life and death now. It's not static, it's not black and white, it is just grey zones. One can be alive and not living. One can be dying but so full of life. One can be dead to those around them for decades and others can live on through those who loved them.
At the end of my shift, I walked through the same familiar hallway - the gentle wails of new life piercing through sadness of losing my first patient. As I stepped out into the afternoon sun, I sighed deeply. I made it.
