Death: He sees it, but will never understand

The first time I saw a dead body I was groping around in the dark in 125 feet of water looking for a drowning victim. A few members of my diving club had volunteered to help the grieving family find her: Collectively, we had enough brashness coupled with the insouciance of ignorance to go looking for this poor soul after the sheriff's divers said it was too dangerous at that depth. That's testosterone at work for you.

We fanned out across the muddy bottom, holding onto a guide rope. We had agreed upon a code: one tug, we're through looking (someone's out of air or freaked out); two tugs, we've got meat.

Meat. That's the word our ad hoc leader used. In less than 24 hours, a woman goes from the prime of life, someone's mother, lover, friend, to a hunk of meat on the bottom of Lake Washington, crawdad food.

About 15 minutes into the dive, I felt a couple of tugs and looked to my left to see a couple of my fellow divers guiding her body up through the depths, her hair streaming out behind her like Medusa's and silhouetted against the backdrop of a diver's light.

Back on the surface, in the warmth of an August afternoon, she didn't look so bad. A little pale and blue around the lips, but other than that, she just appeared to be asleep. Gathered round, warming up, we watched the aid crew strap her lifeless body to the gurney and haul her away. She looked so peaceful.

Years later, I was inundated with dead bodies, cadavers as they were called in anatomy lab. There were perhaps 30 of them, all laid out under sheets on stainless steel laboratory gurneys, injected with formalin and sporting manila tags on their big toes with pertinent information such as age, sex and cause of death.

I spent way too much time in that lab. Some people spent even more, and a few really intrepid ones (budding pathologists, I suspect) even ordered in pizza while they quizzed one another late into the evening. There was no grief associated with these dead bodies. They were specimens, not people, and they served their purpose.

Throughout my years in training, I would come across other dead bodies -- often, I was there as they crossed over from being "patient" to "body." It was never pleasant. I still find myself wondering what that 8-year-old would be doing today if the bullet fired from a passing car in a fit of road rage hadn't found its way into her heart. A few centimeters one way or the other and she'd still be somewhere.

When I was a resident, there was an interesting ritual that I was asked to perform on the newly dead: pronouncing death. At any time of the day, but more commonly in the middle of the night, 15 minutes after flopping onto my lumpy cot in the call room, my pager would go off and I would be asked to trundle on up to the wing where the newly departed was lying.

I never quite understood the urgency of these requests. Why couldn't the pronouncement at least be held until the espresso stand opened at 5:00 a.m.?

The nurse would hand me the chart and tell me that the patient just died. I would enter the room and do a perfunctory exam that always made me feel a little silly. Look in their eyes: pupils fixed and stable. Palpate the carotids: no pulse. Listen for breath sounds and heartbeat: none there. The sternal rub: This is where you grind your knuckle into the dead person's sternum in an effort to elicit a pain response, which is what invariably happens in people who aren't dead.

Finally, the shake and shout:

"Mrs. Goldman! Mrs. Goldman! Can you hear me?"

No response. Yes, she's dead.

This pronouncing of death was especially odd in that the nurses and everyone else knew that the patient was dead. Never once did I ever have to come out and say, "You've got it wrong there, Sally, she's not dead, just resting."

There was another unsavory ritual that occasionally would take place on the newly dead, once again usually in the middle of the night, this time to avoid prying eyes. A bunch of residents would furtively gather around a former patient to practice a procedure they needed to learn, such as intubation. They'd draw the curtains to block the view and one by one insert the endotracheal tube into the airways, even going so far as to post a lookout.

Even in my day it was a rare occurrence, and hopefully it's even rarer now. I never felt comfortable participating in this violation. I cannot see that my final act of well-wishing should be inexpertly cramming a tube down a poor dead guy's throat. "Bon Voyage! Go meet your maker! And here, take this tube with you. Too bad if it's in your esophagus. You won't need it anyway!"

Perhaps the reason that I don't like death is that I don't understand it. It's a time of transition and, despite my belief in the afterlife, I have no clue what happens next -- and that unnerves me. Religious people will talk of a better life, heaven, just waiting for them after their earthly sojourn. Others speak of brightness and light, images garnered from interviews with people who have "died" on the operating table and come back. I suspect these experiences have more to do with the anesthetic and cardiac drugs that have been pumped into them than with any objective reality of a new world of light.

Some would say that it is a holy time. We stand at a frontier and watch as the patient departs on a journey, we know not where.

Others simply believe that death is the end of the road. I recall a beer commercial about that. You only go around once so you have to grab all the gusto you can. I can't recall the brand of beer, but I do remember their version of gusto: bikini-clad women on a sailing ship outnumbering the guys 4 to 1.

In any event, death is the great unknown. And I have never gotten used to the sight of it, from that first corpse on the bottom of the lake to every encounter ever since.

In some respects, I would like to be inured to its pain, to have it become routine. But then I come to my senses and think that that is exactly what I don't want to happen. I have had colleagues who have done just that. Their tenderness has been hidden inside a protective cocoon. I suppose that they adopt this approach in order to allow themselves to continue to do their jobs efficiently without becoming entangled in the messiness of death. Yes, it works to keep the pain of death at bay, but at what cost? That's what I want to know. I can't help believing that the day I stop feeling is the day I lose the soul of being a physician.

And I can't have that.


Dudley is a Seattle physician.

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