How to Pronounce a Patient ‘Dead’ July 1995
On my first rotation, a clerkship in Internal Medicine, we had a patient who was dying of breast cancer. It had advanced because she chose alternative medicine treatment instead of conventional therapy. It was at the end. Her family had basically dumped her off onto our service to die.
She was being massaged with oils. The morphine drip was running. Spa-type music was playing as we rounded on her in the morning.
I found it strange that there was no family present for her at any time.
In the evening, the intern was called at the bedside to pronounce her dead. He asked me to come with him so I could learn.
First you look in the eyes and shine a light. There is no reaction of the pupil. Second, you listen and feel for breath. Third, you listen and feel for heartbeat. When there are no breaths and no heartbeat, your patient is deceased. You write a note and fill out lots of paperwork. In some cases the coroner has to be notified of this death, too.
As I was learning from him, out of the corner of my eye was my patient’s spirit trying to get my attention. “Look at me! I’m happy!” was my patient, kind of in a short skirt and top, looking fabulous and jumping up and down. I looked up at her, thought—‘what if my intern finds out I am doing this?’—and quickly looked back down. I avoided eye contact with the spirit. But I felt her. She didn’t know that things like this are ‘not okay’ in medicine today.