Today I filled in the death certificate of another physician. I can’t decide whether I feel honoured, or horrified, or… both. Honoured to have provided medical care to another doctor; horrified to be the one that has the “final” word. Certifying a colleague dead somehow more chilling than the average death assessment.
My last rotation provided ample opportunity at the art of pronouncing death. The charting of which reaches my hand with all too certain familiarity, and (perhaps appropriate?) brevity: “Pupils fixed, dilated; no HR/RR x 1 min. Family notified. Death certificate complete.” The. end.
My mind is spinning with the idea of certifying death. Why do we do it? Is it for the dignity of the deceased? Providing closure to loved ones? A sick desire of western culture to exert some measure of control over even the most uncontrollable: our own inevitable, yet inconceivable, mortality?
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During my recent trip to Pakistan, I was blessed with the opportunity to provide care to internally displaced people (“IDP’s”) from the floods. The privilege of having one’s own death confirmed and certified became apparent. Many died silently. Their absence only noted hours –sometimes days– afterwards. Profound, protracted, pain experienced by family members at the lack of closure.
The experience gave me a deep longing for our over-monitored Western settings: well-resourced to the point of providing excellent “dead-care”. Locate a missing body. Identify the anatomical cause of its demise. Restore cosmesis to an acceptable level for public presentation.
To what end, though? Certainly the body receives no benefit to sporting post-mortem mascara. And, as scientific as autopsy may sound, the final cause of death is almost always the same: respiratory or cardiac failure secondary to infinite combinations of antecedent precipitants.
If we are honest with ourselves, these acts are largely carried out in the name of those left behind. As impossible as it may be to untwine emotional attachment to the deceased; somehow, a professional confirmation of why the body has ‘timed-out’ provides a stepping stone for moving forward. A psychological aid in the face of a universal life event that evades even our most concerted efforts to stall or contrive their circumstances.
As much as I can’t influence the nature and timing of my own death, one request:
To whatever young physician has the task of certifying my death, should these “death forms” still be in vogue in my (hopefully) old age. In the line that says “Reason for Death” you have my full permission, against coroner’s specifications, to write something altogether outlandish:
“total lifetime limit on CO2 emissions reached”
“felt gracious towards others awaiting her hospital bed”
“brain fatigued secondary to futile question-asking…”
Happy Halloween to the living. And to those we have left behind, our love.