Pronouncing Death

Some may find it strange that I talk to my patients who have already died. "I am going to place my stethoscope on your chest now," and, "I am going to open your eyes and shine a bright light in." This is all a part of what is called the "death exam," the final physical exam that a doctor conducts after a patient has died in order to officially pronounce death. A cloud of fear and anxiety would fill the room when I first conducted this exam -- an encounter between the dead patient and I -- this lifeless, breathless body before me; questions would swirl in my mind: How am I supposed to act? Where do I place my hands? Is it normal for the body to still be warm? Now, I view it as an honor and privilege to have this final moment with my patient. The moment is gentle and calm -- a moment which lingers between the world of the living that that of the dead; when the body is still warm, yet the heart has stopped, and the breath has ceased.

As I conduct the final exam, I reflect on the life of my patient -- this person that I have had the pleasure to connect with over the past days and weeks. I recall our conversations that offered me glimpses into their life -- a dynamic life outside of the walls of this hospital -- their hobbies, profession, and relationships. I recall moments of laughter shared with loved ones and nursing staff, moments of quiet tears shed, moments when my patient connected with their loved ones as a father, a mother, a brother, a grandparent, a friend. During my last exam, I look at the scars on their body, the tattoos, the jewelry, the chipped finger nail polish, and I wonder about the stories and moments behind these now artifacts -- stories in which my patient is the main character, stories which, woven together, make up who they are and what they are. These are stories that transcend the medical diagnosis that they carry, the objective exam findings that they have, and the invasive procedures that they had done.

For those in the medical profession, it is often easier to see patients as a collection of illnesses and aliments that need to be treated. The lady in room 52 with chronic abdominal pain; Mr. C in room 58 with pancreatic cancer; the 67-year-old female coming in with heart failure. Synthesizing patients into a single sentence, a "one liner," allow medical professionals to easily identify and communicate about these patients. However, by doing so, I deconstruct my patients and their stories, allowing the objectification of a dynamic person, creating a distance between the individual and the illness that is undergoing the medical treatments, diagnostic tests, and physical exam. By reducing my patient to one brief sentence, I strip the humanity out of my medical practice.

The medical anthropologist Arthur Kleinman writes of the East Asian belief that we are not born fully human but, rather, only become human in our interactions with others. As my patient and I interact for the last time, as I talk to them for the last time, as I observe loved ones say goodbye for the last time, I am able to see beyond the breathing tube, the IV lines, the bruises, and the jaundiced skin. I am able to see the collection of stories that my patient embodies -- an adventure novel of youth, a romance story between two lovers, a family saga, and tragedy with illness. I realize that as doctors, we try to preserve the body, and as friends and families, we try to preserve the story. I reflect on these stories and feel honored -- honored to have had the chance to be apart of my patient's story, as a short sentence, as a footnote, in the last chapter of their rich and intricate life.

On days when my patients die, I go home, I light incense. I light incense in their memory. As the aroma of incense fills the room, I offer prayers of peace and soothing respite for the family and friends left behind, as they continue on, writing their own stories. As the smoke of the incense ascend up into the heavens, I give gratitude to my patient who has not only taught me about medical illness and treatment, but has allowed me, through our connection and interactions, to become more fully human.