The first time I pronounced someone dead

It’s easy to get lost in the hospital. I’m only an intern, and already I know it like the hallways of my old high school, every doorway, and doorknob. But overnight, as I float between the floors and the units, answering pages, I quickly lose track of where I am, what time it is, what day it is.

I am vaguely aware that I’m on the fifth floor, the top floor of the hospital, when the nurse approaches me.

“Doctor, the patient in bed 32.”

I don’t look up. In front of an incandescent screen, I am just finishing a postoperative note on a young man who had a routine gallbladder surgery. It is the middle of the night: that strange, confusing hour that is neither today nor tomorrow, when the zeroes line up in military time on the computerized nursing charts, and outside, dark night becomes dark morning. Inside, the fluorescent bulbs keep burning their bizarre, timeless energy, reflecting off the cold linoleum floor.

This is the witching hour, the time of night when, if I have a moment to think, maybe even to close my eyes, I will ask myself cruel questions: What am I doing here? What am I doing in this sterilized hell? I am tired, bitter from too much work and no sunlight for days on end, nearly delirious. Half a mile away, my family sleeps in a cool, quiet house, a night breeze blowing the blinds gently against the window frame:tap, tap.

“Doctor?”

“Mm-hmm?”

“The patient in bed 32.”

“Sorry? What about her?” My fingers keep up their rapid clicking.

“She died.”

I stop. There is a reason I’ve been hanging around up here tonight.

The patient in bed 32 is a seventy-one-year-old woman with an aggressive bladder cancer and advanced dementia. She was transferred here from the ICU earlier today, after her family members signed a do-not-resuscitate form. At the start of my shift, hours ago, I looked her over and decided to call her daughter, Clarissa, to ask her to return to the hospital.

“It could be tonight,” I told her.

Now I turn away from my glowing screen and hurry down the hall. I find Clarissa standing at her mother’s bedside, weeping quietly. She is a forty-ish, heavy, puffy-eyed woman wearing a navy blue tracksuit and sneakers. She wears her brown hair in ringlets around her face, pinned back at the temples with ladybug bobby pins, like a little girl. Her husband, a sinewy man on crutches with a speckle of grey in his beard, hovers quietly in the background. The room is dark. On the TV, a gospel choir is singing.

The patient lies still in the bed, looking much as she did when I saw her several hours ago: waxy lips parted, thin gray hair combed back neatly from her face. Leaning down to place my stethoscope on her chest, I see the details of her body up close–the hairs scattered on her upper lip and chin, the pores on the fleshy tip of her nose, the sticky tears still glistening in the corners of her eyes.

On the other side of the stethoscope: pronounced stillness, roaring silence, a sound I’ve never actually heard before. Although I’m already feeling seasoned and jaded by three months of residency, this is, in fact, the first time I’ve pronounced someone dead.

I part the eyelids one at a time and shine my light into the glassy, blank eyes, glimpsing for a moment the depths of the ocean caught in that tiny beam.

When I let go, the eyelids stay half-open, and in an awkward, clichéd gesture, I tug them back down with my fingertips, hoping they won’t pop open again like the eyes of some plastic doll.

Rising, I reach for Clarissa’s hand and say, “I’m sorry.” Then, remembering what I am here to do, I add firmly, “She’s died.”

Nodding and biting her lip, Clarissa whispers (a bit melodramatically, it seems to me), “One thirty-one.”

The time of death.

We are silent for a moment. I hold onto her hand. Then, abruptly, she says, “I need help taking her ring off.” Eyes squeezed tight, face crumpling: “I don’t want to be the one to pull it off her finger.”

I think I see her husband roll his eyes and shift his weight on his crutches.

In my bravest voice, I offer, “Would you like me to take it off for you?”

She nods, eyes still closed, head bowed.

I pull the covers back and gently lift the thin hand, still warm and alive-feeling. The fingers are curled tightly as though they’ve been clutching something. I grab onto the fingertips. Now that I’ve volunteered, it’ll be a pretty morbid picture if I can’t manage to pull off the ring. I resolve not to be timid. But the fingers are pliable in mine, and I loosen the fist easily. The hand is empty. The ring is a thin gold band with a blue stone. With a firm, slow pull, it slides over the knuckle, scraping along with it a thin layer of something slightly wet — dried skin cells maybe, sweat, lotion.

I hold the ring out to Clarissa, who takes it and clasps it to her chest.

“Thank you,” she whispers. “Thank you for calling me when you did.”

Papers to sign, notes to write. Disposition: Expired. I go to the stairwell and head up, my footsteps echoing off the cement walls. I reach the next floor and turn to the doorway — stopping short, startled.

A locked door: “LEVEL 6 — ROOF.”

Of course. I was already on the top floor of the hospital. There is nothing else here.

Disconcerted, tired, I turn and hurry back down the stairs. The night goes on.

Chrisse Henneberg is a family medicine resident.

This piece was originally published in Pulse — voices from the heart of medicine

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