Sunday, July 6, 2008

Last Word

I was moonlighting last night, and I got a call from one of the nurses to pronounce a patient at 6:30 this morning. Doctors don't have to be the one to pronounce patients as dead, but nurses for some reason think we have the ultimate power.

Or perhaps it makes them uneasy.

So, I got out of bed and walked up the stairs. I went into the room where the patient -- an elderly woman who had survived 10 years after a liver transplant (no small feat) -- lie dead in her bed.

There's an eerie sort of air in the room of a dead patient. I don't know how to explain it. Perhaps it's because you know going in that the person is dead. Maybe it's the void of life you can sense. Whatever it is, it's unmistakable.

I went through the formalities of listening to her heart ("absent heart tones") and her lungs ("no breath sounds"). I also checked for corneal reflexes ("corneal reflexes absent"). I then called her primary doctor to tell him the not-so-surprising news. The patient was DNAR -- Do Not Attempt Resuscitation. That means no heroic measures, no intubation, no chest compressions and cracking of ribs.

The primary physician said he would call the family, since he had a relationship with them. I wrote my note in the chart and went back to bed. My note will be the last written word in her medical history. "The patient was pronounced dead at 6:30a on 7/6/08." No hoopla. No fanfare. Just a simple testament to the ultimate change in condition. I hope to leave this world as peacefully.

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