Rituals of Annotation
I am not exactly sure of what prompted me to do it, but I began keeping a tally of all the pronouncements I have done. I never really knew this before, but pronouncements are done in a remarkably simple and impersonal way. Most patients who die in the hospital do not go with a bang but with a whimper. While some situations involve spectacular theatrics involving beeping monitors, charged paddles, and the cracking of cartilage from chest compressions, most patients die with a quiet, gasping sigh. I am still not sure which is more unnerving, but the former is what we typically imagine or see on TV during a pronouncement: a sweaty and distraught doctor ripping off latex gloves in frustration and listlessly intoning, “Time of death…”
What usually happens, however, is that the person will expectedly but spontaneously expire. Death is typically spotted from a fair distance and in most cases the family is cognizant of this. Sometimes hospice arrangements are made and the patient goes home to die surrounded by family and friends. Sometimes a volunteer in the hospital will keep a death vigil of sorts, sitting in a chair while reading a book or watching TV to pass the time as they wait to fulfill a promise “not to let anyone die alone.” Sometimes a nurse will make the rounds and discover that the patient is simply dead. It happens at all hours and in most floors of the hospital. Regardless, whenever the death is discovered a page is put out to whichever resident is on call to come by and make the official pronouncement, even though everyone already knows the truth.
This means that I usually know nothing about the patient or the family. I have to make an effort to commit the name and overall disposition of the patient to heart long enough to speak with the family and request their permission to grant or deny an autopsy. It typically takes thirty seconds to do the examination and less than thirty minutes to speak to everyone and document everything I need to before moving on to other things.
My little tally is nothing fancy, nothing more than a series of hatch marks in a small booklet of mundane medical information tucked into my white coat. So far, there have been five marks in two weeks. I can hardly remember the patients at all, much less their names or even what they died from.
But I remember the families. I remember the different reactions of different people, some joking and laughing about the whole affair, some quietly sniffling in a brother or a sister’s shoulder. I remember their words, which are often filled with appreciation and deep respect for everything that has been done for this house of memories. And I feel unworthy and deeply unsettled because I had no part in it… in fact, I never knew the patient, because the only reason I came into contact with him or her at all was because there was only an it left.
If the family was particularly effusive, I will write a little note of it in the chart: “No pulse, no audible heart beat; no corneal, pupillary, or gag reflexes. Family expresses deep appreciation for all staff.” And every single time, I am tempted to then write, “Kyrie eleison,” as has become my habit to say whenever I am otherwise speechless with sorrow. But not all the patient’s family members might appreciate that sort of addendum, so I say it to myself, place a little tick in my booklet, and move on.
To “pronounce” means to state, often with a degree of finality and certainty. But to me, it has also meant to describe and therein impart an element of meaning. Pronouncements have become a ritual of annotation, one that is suffused with meaning precisely because it is routine without being mundane. Small wonder that the closest I have come to intimacy with God in this heavily secularized profession have been in moments like these, where that which is ephemeral proceeds into the eternal.
Making a note of it is the least that I can do.
But someone may ask, “How are the dead raised? With what kind of body will they come?” How foolish! What you sow does not come to life unless it dies. When you sow, you do not plant the body that will be, but just a seed, perhaps of wheat or of something else. But God gives it a body as he has determined, and to each kind of seed he gives its own body…
So will it be with the resurrection of the dead. The body that is sown is perishable, it is raised imperishable; it is sown in dishonor, it is raised in glory; it is sown in weakness, it is raised in power; it is sown a natural body, it is raised a spiritual body.
I declare to you, brothers, that flesh and blood cannot inherit the kingdom of God, nor does the perishable inherit the imperishable. Listen, I tell you a mystery: We will not all sleep, but we will all be changed— in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed. For the perishable must clothe itself with the imperishable, and the mortal with immortality.
– 1 Corinthians 15
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