I am not exactly sure of what prompted me to do it, but I began keepÂing a tally of all the proÂnounceÂments I have done. A pronouncement is that act in which a doctor officially declares a person to be dead. Some deaths are theatric specÂtacÂles involving beepÂing monÂiÂtors, electric shocks, and crackÂing chest carÂtiÂlage. These tend to be chaotic, gritty, and conclusive as in the TV shows, sometimes ending with a disÂtraught physician intoning, â€œTime ofÂ death. . . .â€
However, most proÂnounceÂments done in the hospital are remarkÂablyÂ simpleÂ and imperÂsonal. Because we attach so much meaning to death and have sequestered it far from the public eye, we are conditioned to believe that its act must be as spectacular and monumental as its significance. But what usuÂally hapÂpens is that the perÂson will merely expire, often with nothing more than a quiet, gaspÂing sigh.Â It is usually expected but spontaneous, with a somber but quiet family waiting aimlessly for the event to occur.Â SomeÂtimes hosÂpice arrangeÂments are made for the patient to go home to die, surÂrounded by famÂily and friends.Â SomeÂtimes a volunÂteer in the hosÂpiÂtal will keep a vigil of sorts, sitÂting in a chair while readÂing a book or watchÂingÂ TV as he or she does the job of those who have no family, waiting to fulÂfill the simple courtesy of not letting anyÂone die alone. SomeÂtimes a nurse will make the rounds and disÂcover that the patient has passed in the few brief hours in between visits. Regardless, those final moments occur at any hour and in any floor of a large hosÂpiÂtal like mine. In every case, whenÂever the death is disÂcovÂered, a page is sent to whichever resÂiÂdent is on call to stop by and make the offiÂcial proÂnounceÂment.
This means that I usuÂally know nothÂing about either the patient or the famÂily.Â I have to make an effort to remember the name and the general circumstances leading up to the death long enough to speak with the famÂily and request their perÂmisÂsion for an autopsy.Â The physical exam takes only few minutes, and it requires less than thirty minÂutes to do all the speaking and docÂuÂmentation before movÂing on to the care of other things.
My litÂtle tally is nothÂing fancy, nothÂing more than a series of hatch marks in a small bookÂlet of munÂdane medÂical inforÂmaÂtion which I then tuck into my white coat. I hardly rememÂber the patients; I can no longer recall any of their names or even what they diedÂ from.
But I rememÂber the famÂiÂlies.Â I rememÂber the surprising array of reacÂtions, ranging from jokes and laughter about the whole affair to quiet sniffles into a brother or a sisterâ€™s shoulÂder. I rememÂber the words of those left behind, which are often characterized by appreÂciÂaÂtion and a deep respect for everyÂthing that has been done for this body. I feel unworÂthy and deeply unsetÂtled because I had no part in it. . . . in fact, my sole reason for conÂtact has been that only the remains remain.
If the famÂily is parÂticÂuÂlarly effuÂsive, I will write a litÂtle note of it in the chart: â€œNo pulse, no audiÂble heart beat, no spontaneous respirations; no corneal, pupilÂlary, or gag reflexes. FamÂily expresses deep appreÂciÂaÂtion for all staff.â€Â And every sinÂgle time, I am tempted to write, â€œKyrie eleiÂson,â€ an ancient litany that has become a habit to recite whenÂever I am othÂerÂwise speechÂless with sorÂrow.Â But knowing that not all the patientâ€™s famÂily memÂbers would appreÂciÂate such an addenÂdum, I say it to myself, scratch out a litÂtle tick in my bookÂlet, and moveÂ on.
To â€œproÂnounceâ€ means to state, often with a degree of finalÂity and cerÂtainty.Â But to me, it has also meant to describe and therein impart an element of meanÂing. ProÂnounceÂments are ritÂuals of annoÂtaÂtion and are sufÂfused with meanÂing preÂcisely because they are rouÂtine withÂout being munÂdane. In the heavÂily secÂuÂlarÂized professions of medicine and academia, we write and state all sorts of things, sometimes searching for the abstract and exotic, while at others struggling to attach meaning to the mundane. I am grateful that some of my closÂest times of intiÂmacy with GodÂ are moments like these, when the two come together very visibly in the procession of the physical into the ethereal, the ephemeral into the eternal.
MakÂing a note of it is the least that I canÂ do.
But someÂone may ask, â€œHow are the dead raised? With what kind of body will they come?â€ How foolÂish! What you sow does not come to life unless it dies. When you sow, you do not plant the body that will be, but just a seed, perÂhaps of wheat or of someÂthing else. But God gives it a body as he has deterÂmined, and to each kind of seed he gives its ownÂ bodyâ€¦
So will it be with the resÂurÂrecÂtion of the dead. The body that is sown is perÂishÂable, it is raised imperÂishÂable;Â it is sown in disÂhonor, it is raised in glory; it is sown in weakÂness, it is raised in power; it is sown a natÂural body, it is raised a spirÂiÂtualÂ body.
I declare to you, brothÂers, that flesh and blood canÂnot inherit the kingÂdom of God, nor does the perÂishÂable inherit the imperÂishÂable. LisÂten, I tell you a mysÂtery: We will not all sleep, but we will all be changed â€” in a flash, in the twinÂkling of an eye, at the last trumÂpet. For the trumÂpet will sound, the dead will be raised imperÂishÂable, and we will be changed. For the perÂishÂable must clothe itself with the imperÂishÂable, and the morÂtal with immortality.
About the author:
David graduated from Princeton University with a degree in Electrical Engineering and received his medical degree from Rutgers - Robert Wood Johnson Medical School with a Masters in Public Health concentrated in health systems and policy. He completed a dual residency in Internal Medicine and Pediatrics at Christiana Care Health System in Delaware. He continues to work in Delaware as a dual Med-Peds hospitalist. Faith-wise, he is decidÂedly Christian, and regarding everything else he will gladly talk your ear off about health policy, the inner city, gadgets, and why Disneyâ€™s Frozen is actually a terrible movie.