I am not exactly sure of what prompted me to do it, but I began keeping a tally of all the pronouncements I have done. A pronouncement is that act in which a doctor officially declares a person to be dead. Some deaths are theatric spectacles involving beeping monitors, electric shocks, and cracking chest cartilage. These tend to be chaotic, gritty, and conclusive as in the TV shows, sometimes ending with a distraught physician intoning, “Time of death. . . .”
However, most pronouncements done in the hospital are remarkably simple and impersonal. 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 usually happens is that the person will merely expire, often with nothing more than a quiet, gasping sigh. It is usually expected but spontaneous, with a somber but quiet family waiting aimlessly for the event to occur. Sometimes hospice arrangements are made for the patient to go home to die, surrounded by family and friends. Sometimes a volunteer in the hospital will keep a vigil of sorts, sitting in a chair while reading a book or watching TV as he or she does the job of those who have no family, waiting to fulfill the simple courtesy of not letting anyone die alone. Sometimes a nurse will make the rounds and discover 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 hospital like mine. In every case, whenever the death is discovered, a page is sent to whichever resident is on call to stop by and make the official pronouncement.
This means that I usually know nothing about either the patient or the family. 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 family and request their permission for an autopsy. The physical exam takes only few minutes, and it requires less than thirty minutes to do all the speaking and documentation before moving on to the care of other things.
My little tally is nothing fancy, nothing more than a series of hatch marks in a small booklet of mundane medical information which I then tuck into my white coat. I hardly remember the patients; I can no longer recall any of their names or even what they died from.
But I remember the families. I remember the surprising array of reactions, ranging from jokes and laughter about the whole affair to quiet sniffles into a brother or a sister’s shoulder. I remember the words of those left behind, which are often characterized by appreciation and a deep respect for everything that has been done for this body. I feel unworthy and deeply unsettled because I had no part in it. . . . in fact, my sole reason for contact has been that only the remains remain.
If the family is particularly effusive, I will write a little note of it in the chart: “No pulse, no audible heart beat, no spontaneous respirations; no corneal, pupillary, or gag reflexes. Family expresses deep appreciation for all staff.” And every single time, I am tempted to write, “Kyrie eleison,” an ancient litany that has become a habit to recite whenever I am otherwise speechless with sorrow. But knowing that not all the patient’s family members would appreciate such an addendum, I say it to myself, scratch out a little tick in my booklet, and move on.
To “pronounce” means to state, often with a degree of finality and certainty. But to me, it has also meant to describe and therein impart an element of meaning. Pronouncements are rituals of annotation and are suffused with meaning precisely because they are routine without being mundane. In the heavily secularized 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 closest times of intimacy with God 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.
Making a note of it is the least that I can do.
But someone may ask, “How are the dead raised? With what kind of body will they come?” How foolish! 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, perhaps of wheat or of something else. But God gives it a body as he has determined, and to each kind of seed he gives its own body…
So will it be with the resurrection of the dead. The body that is sown is perishable, it is raised imperishable; it is sown in dishonor, it is raised in glory; it is sown in weakness, it is raised in power; it is sown a natural body, it is raised a spiritual body.
I declare to you, brothers, that flesh and blood cannot inherit the kingdom of God, nor does the perishable inherit the imperishable. Listen, I tell you a mystery: We will not all sleep, but we will all be changed — in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed. For the perishable must clothe itself with the imperishable, and the mortal with immortality.
[This post was edited from its original form, found here.]
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 decidedly Christian, and regarding everything else he will gladly talk your ear off about health policy, the inner city, gadgets, and why Disney’s Frozen is actually a terrible movie.
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