Hemorrhage

Last night, I pronounced someone dead for the first time.

I've been around death before. It is unavoidably intertwined with this profession. From the early medical school days in anatomy lab when you draw the scalpel across the cadaver's unblemished skin, to that moment as a medical student when you happen to wonder whatever happened to Mr. X you chatted with about chess before he was upgraded to the ICU, and the notification pops up informing you that the patient whose chart you are trying to access is deceased.

Processing each of these moments is like peeling back another petal, another step closer to the pistil, the seed, the essential core at the heart of some greater meaning that your human mind cannot grasp. That unsettling feeling, that this person existed like you or I, with these same trivial concerns and menial thoughts, is now a thing. A corpse.

This patient that I had to pronounce dead, just two weeks ago he was sitting upright in bed after being recently extubated. My senior had been surprised. "Who put glasses on him?" He'd asked for them after he stirred from the remnants of sedation. He was less than a decade older than me. I remember thinking to myself one day as I drove home, thinking of all those countless young men who passed through the MICU having ravaged their bodies with the consequences of alcohol addiction, how little we cherish the one and only body we are given, until it is too late.

"Here are the basics for the death exam," my senior said to me as we put on gloves. The grieving family members had just been escorted from the room for this procedure. The image of his sister, carrying away a large brown bag of his possessions, was branded into my skull. "Feel the skin for warmth, pulses. Check for response to verbal, tactile, noxious stimuli. Listen for absence of heart and lung sounds. Then test the cranial nerves--pupils, corneal, doll's eye."

Have you ever felt the temperature of a body whose life has just begun to fade? It is cold, yet just perceptibly warm enough for the unnerving thought to strike you that at one point in time, this heat was an embrace at a party, a handshake at a job interview, a jacket cast off after a wintry night out, a solid presence in the dark rising and falling with each breath under the covers of the night.

I called out his first name. I shook his shoulder. I inflicted pain.

His heart no longer beat, but the machine was still breathing for him. As the nurses moved to turn off the ventilator, I looked at his face. Dark red crusting in the nares, the mouth, and blood stains all over the sheets. He had bled everywhere at the end. I brought the light to his eyes, still open, with unmoving pupils like gaping holes.

My senior handed me a makeshift instrument to test the corneal reflex. I couldn't look away from those unseeing eyes. I brought the tip of the instrument gently down onto an open eye. Not a single twitch or movement. Just the same eerie, empty untrained gaze. I repeated it again to convince myself it had happened.

By the time we finished the doll's eye maneuver, the ventilator had been turned off. As I moved my stethoscope from point to point, I heard nothing inside that unnaturally still chest.

Time of death. 5:28 am.