Death certificate

Today had to pronounce a patient dead. Quite an experience. This was a 47 year old african american male with a past medical history significant for hypertension and cardiovascular disease who had suffered a cardiac arrest. His heart had stopped for unknown reasons, he was resuscitated by EMS personnel, and brought to the hospital where he was started on Arctic protocol. This is a relatively new medical advance whereby we cool the blood of patients with recent cardiac arrest, bringing down their overall body temperature, with the intention of trying to save brain. In some patients it works, in this patient it did not. He likely had just suffered to much of an anoxic (no oxygen) brain injury from his arrest. So after rewarming him from the Arctic protocol, he was found by Neurologists to be brain dead. Still he remained on a ventilator, and we were keeping him "alive" with machines and fluids. Once we confirmed his brain death then the tough decision had to be made to take him off the ventilator. We discussed the medical course and the plan at length with his family. It was quite tough for them. This man was still relatively young, I think it was quite hard for them to let go, even with the knowledge that he was essentially already dead.

So with about a dozen family members around, we prepared to withdraw the ventilator support. We kept only IV fluids and medications to prevent him from having seizures or pain. Then we removed the breathing tube, and this young patient slipped away quietly into the day. Without the ventilator his brain did not tell the muscles of his diaphragm to keep breathing. He took no more breaths, so slowly his heart ran out of oxygen and it too stopped beating. I watched this process on the telemonitor, while trying simultaneously to be there in a caring way for the family. They cried, in fact they sobbed quite loudly. The emotion in the room was palpable. But in this scene I still had to do my job. I confirmed that he had in fact passed away, by feeling for pulses, examining his pupils for any response, and listening for any breathing.

He had passed away, and after consoling the family some more, I went to fill out the required paperwork, including the death certificate. Felt kind of weird, to have experienced as a 3rd year medical student the joy of helping to deliver babies. Now I had completed the other bookend, and had officially declared the end of life. Being a doctor really does mean being a part of the whole life process from beginning to end.