First Encounter with Death

Is it taboo to talk about death and dying? Nobody seems to take an interest. You could almost hear the unspoke thoughts in the silence: 'He's fading' 'We can't offer anything else' 'It is awful, watching someone (die on us)'

It is awful, indeed.

I struggle with my guilty feelings. Sometimes it seems easier to think about someone dying, an endpoint, closure, rather than to think or witness them suffering in prolonged disability. All or nothing, no grey areas in between. My world is solid again.

The first time I saw death outside of the anatomy class, it was with the a senior doctor than I, though younger in years than I. His proper English upbringing gives a palpable air around him.

Today he was teaching me about death. We had been called to certify a man who has passed away due to his fulminant cancerous state. We went into his single room. It was quiet - no distracting machines beeping at irregular intervals. No accessory lines, probes, blood pressure cuffs that restrain his body to the physicality of the room. There were no wailing or distressed relatives. There were no get-well cards or flowers from the gift shop. There was just him, an empty husk of a man lying beneath the thin sheets that no longer gave him warmth, but only serve to offer a fleeting modesty.

The colour of his skin was a bright yellow, as if someone had painted food colouring on him, except it had a sickly tinge, beyond his obvious jaundice. His skin appeared waxy and taut, stretched tight over the normally animated eyes, nostrils and cheekbones. His mouth was shrunken, yet fixated in that ominous 'O' sign.

'They nearly always look like this,' my mentor said, in his usual detached tone, so that his emotions were not betrayed. 'Do you know what to look for?' He asked. I gave him an anxious glance and started to utter a few words that floated to me from fragments of my clinical experience, almost six years past. Without hesitating, he started to teach me systematically a way to fulfil the legal requirement of death certification.

Artificially, the first step was to call out the person's name. Then checking a response to pain. I rub my knuckles over the patch of tightly stretched skin on the centre of the chest that no longer shifted air. 'It's easier when they've had a bit of time,' my mentor said, encouraging my efforts.

I pry open the plasticine lids and shine the ungraceful Energiser torch at his pupils. No movement can be seen in the laxity of those eye balls. I made a mental note to myself to buy a penlight so that no person at the end of their life should have their dignity lessened by their signs of life being checked by a big red ungainly torch.

I place my fingers over the major arteries of the neck. I feel nothing apart from the fine tremor of my own fingers and the weak rapid pulse contained within it. I place my stethoscope over the area of his heart, and contrary to what I hear 99.9% of the other times it is used, I heard an emptiness. Not completely devoid of sound, but a hollowness, as if the rustling of the sheets and the brush of the stethoscope were transmitted inside the empty cavity of his chest. A loneliness of sound.

We listen to this loneliness for a few minutes together, then silently lift our stethoscopes off his body, readjusting it into the comfortable nooks on our shoulders. There is no dramatic flare as we walk out of the room and nod gravely at the nurse so that she may begin the preparations down to the morgue. We find the medical chart and write down those fateful words:

"ATSP (asked to see patient) re: signs of life
No response to voice or painful stimuli. Pupils fixed and dilated, unreactive to light. No breath sounds or heart sounds heard. I pronounce xxx deceased as of time/date. May him rest in peace."