Two Deaths

It’s two in the morning and I have to go pronounce you dead. I have never met you before, so I cycle through my stack of paper sign-out sheets until I find yours, which contains a few details about your medical history and a handwritten, asterisked note: *may die overnight. My white coat hangs on the back of my chair, sagging under the weight of the stuff in its pockets – papers, handbooks, granola bars – so I slip it on (suit up, kid!), chug whatever water is left in my Styrofoam cup, and start down a long, beige hallway toward the ward. I have pronounced a person dead once before, months ago, in a different hospital; I took care of her for almost three weeks before she started vomiting blood and was promptly moved to the ICU. Am I dying? she had asked me, desperate, her face stained with blood behind the oxygen mask – she was only forty-six – and I had not known what to say, so I gripped her arm and said something canned, like We’re doing everything we can. Several days later, she drifted away in the golden haze of renal failure, surrounded by friends and family in one of those rooms with a shattering, panoramic view of San Francisco. When I arrived at her bedside, I was startled to see her white lips and sallow cheeks, her utter stillness. Her family knew she was dead, so my little routine – listening for a breath here, feeling for a pulse there, announcing the time – was but a formality, and afterward, our team debriefed and reflected. But now, I stand alone in the middle of the night at the 5A nursing station asking, Does anyone have to come with me? and when the charge nurse replies, simply, No, there is nothing else to do but swivel on my heel and go to you. The door to your room is closed, so I press it open – it is heavy – and find darkness. Suddenly I feel afraid, like a child at night who doesn’t want to enter her closet, so I switch on the light and the room instantly reveals itself: the folding chair poised against the wall, the side table where someone left behind a few saline bullets and a stack of four-by-fours, and directly opposite me, the bed and your body. I sit down and look at you. You are a thin man, black, with a gray beard. The blanket is pulled all the way up to your chin. Well, this is awkward, I think, half expecting you to sit up and roar SURPRISE! but you do not, so I lift the blanket and place my stethoscope on your chest, which is still warm. Listening, I consider how grand it is that we, who dwell in a freezing void, are capable of generating heat: that glorious, thermodynamic signature of cellular metabolism. I conclude that you are dead (of course), announce the time of death to no one in particular, and then add, May God be with you, which surprises me, since I am an atheist. I go back to the nursing station where the death packet is waiting. I fill it out, sign my name, and tell the nurse, It's done.

This post was written by Emily Silverman, MD. Along with Glitter and Progress, it won second prize for Best Essay in the 2016 LitQuake Writing Contest.