certifying death.

i picked up the phone and sleepily punched in the numbers from the "Contact Info" tab on her electronic medical record. I paused for a moment and gulped. Heartburn. I felt the acid burn as it slid down my throat. Finally, the phone rang with an eery crackling in the background. A crackling that you can't help but notice at 3:30 in the morning. No matter how many times i do this, it never gets easier. "Hello..." A sleep-infused voice answered the line on the other end. It's always best to be direct and straight to the point. "Is this Mr. Peterson?" No matter how you broach it, an unfamiliar voice in the darkness that appears to know you, is always unsettling. "Yes... Who is this? What time is it?!?".

At this point I always, always, always apologize. It's the start of an apology that stretches beyond this chance telephone call and into the night. It stretches into the days following this tragedy, and sometimes longer than that. "I'm sorry to disturb you... this is Dr. Patel from the Hope Valley Emergency Department. Again, I'm sorry to wake you, but I'm calling about your mother, Mrs. Peterson". I usually offer a long pause and wait for a response. I hear "Oh my God! Is she okay? What happened?" Here the is always an instinctive pause. I steady myself and launch into a set narrative. "She was brought into the ER by paramedics. She had called 911 after complaining of indigestion that wouldn't go away. By the time they arrived with her, we were already set up to try and stabilize her. She had already lost consciousness." A cry or a wail usually interrupts me, but I typically press on. "When she arrived, we immediately began CPR and tried to get her heart to beat again. A breathing tube was placed to take the stress of breathing off her body and to get 100% oxygen to her. We used every medication we could to stimulate her heart. But..."

"Is she okay? How is she??!@?"

"She's passed..."

I let the words sink into the space between us. I again offer my apologies and assure the family that she felt no pain. I ask them to carefully drive to the ED so that we can talk in person and they can spend time with their loved one. I offer to call her primary care provider. I again ask them to drive carefully. When they arrive, it begins anew. More family arrives. I tell my story to a series of faces that have already stopped listening. I begin the tale again. I offer condolences. I try to explain... But the reality is that we almost never know. In the morning I will scrawl my signature into a death certificate. Proclaiming the time that another life was extinguished...

Death is always unexpected. And never welcome. And in its wake, families are left with a gaping wound in their lives. The grief, the shock, the despair. A hopelessness sets in as all of the words left unsaid come to mind. It's exhaustive to witness. I seize the moment and ask families to be strong. To use each other. To cry as a family and to support each other. I've always considered it a deep privilege to be with families as they begin this grieving process. To be the one to deliver this news, to inflict this pain, and then to try and desperately begin to heal these wounds...

Sometimes, the way we dignify the passing of a life seems more human than all that we do to try and save it...