PRONOUNCE | Rose Berman
The first corpse I ever touched was a cadaver, cold and waxy from the morgue.
The second was still warm.
12:26 a.m.
Hollow dings of telemetry alarms echo off the tiles, and a nurse comes to get me. She says: Room Eleven has passed. She points at the red line on the telemetry screen representing the patient’s blood pressure; it’s perfectly flat.
I don’t understand what she’s asking at first. She stares at me, and a few slow seconds later I realize she wants me to pronounce the patient.
Pronounce. It’s a strange word. It’s not pronounce the patient dead, just pronounce the patient. No dead—never dead. But what else would I pronounce the patient, anyway? “Now husband and wife?”
Pronounce means something different to me; it reminds me of the years I’ve spent perfecting my French pronunciation, performing the sounds on and in and en in front of a mirror until my mouth learned the shapes. Pronouncing is good—in fact, it’s one of my favorite things to do. I often pace around the apartment reading French writers Saint-Exupéry, Cocteau and Apollinaire aloud, pronouncing them. In my fantasies, a French person will one day be surprised I’m not a native speaker. They will say: you pronounce everything perfectly!
But on this night in the ICU, I go to pronounce somebody rather than something. I bring my stethoscope to listen to a silent heart.
Pausing outside the room, I ask the nurse: is family in there?
No, she says. They thought he wouldn’t want them to see.
I’m glad. I won’t have to pronounce in front of sobbing family members. Even though it means the patient died alone.
The light is on in the room, the curtain pulled across the glass door. How will I be sure he’s dead? There was an article in the paper recently: a man was pronounced, only to wake up on the operating table just before the surgeons began to remove his organs for donation. What if I’m responsible for something like that? What if this patient really is alive? Or worse—what if I’m not sure, and I pronounce him anyway?
12:28 a.m.
Behind the curtain the patient is lying in bed, eyes wide open, unmistakably dead.
It isn’t just his open eyes—it’s something about his skin, pale and yellow, and his sunken cheeks. I never realized how different the dead look from the living; in stories, it’s often said that the dead look like they’re just sleeping. But no one could think this man was sleeping.
I am alone with a dead body. The thought frightens me. But—it’s only a body. I look at the patient’s frozen face and think in a flash, to comfort myself: this is just what you left behind.
I don’t know where he went, just that he isn’t here anymore. Saint-Exupéry, through the mouth of the Little Prince, expressed his certainty that his own body was nothing but a shell, nothing but a husk. Une écorce.
I’m convinced of this, too.
12:29 a.m.
I listen to his chest for a long time; I might hear something. His body is still warm. It’s strange to touch someone’s body without talking to them or asking how they feel. But I do this for bodies with someone inside, not for husks. Not for shells.
I listen for another minute. No, the sound is just my fingers on the back of the stethoscope—isn’t it?
I look at my watch: it’s 12:33 a.m. I pronounce silently. I know that even if there were someone in the room, I wouldn’t have to say “time of death, 12:33 AM” aloud—that, apparently, is just for TV. I say it in my head anyway, because it’s the only example I have of pronouncing. It makes it feel real.
Although he really died ten minutes ago, his official documents will say 12:33 a.m. I, an October intern, have the bizarre power to decide the exact minute of a man’s death. When his family remembers him a year from now, ten years from now, they will remember: 12:33 a.m.
12:34 a.m.
I go back to my desk to review the resident handbook page about death. First on the checklist is to call the family. This morning the patient “went CMO”—“comfort measures only”—after his family decided on a palliative extubation to let him die without suffering. They know they’re going to get this call. But I still have to tell them—I still have to say it. The handbook advises me to say the word “dead” or “died” in order to avoid confusion; I practice it in my head. Your father has died. Your father is dead.
In high school, a classmate of mine died after a bike accident. She was hit by a car in a crosswalk, and for five days we were in limbo, waiting to see if she would wake up. My best friend Ashley flew up to Massachusetts on that summer day—August 10, 2009—to spend a few days with my family by the ocean. When we met her at the airport she burst into tears, folded her arms around me, and said into my ear: Codi died.
Codi died. Only now do I realize that Codi was in the ICU, that she probably “went CMO” when the doctors determined she would never recover. That someone was there to pronounce her. I was sixteen then, like Codi, with no inkling of what had happened. I now remember Ashley’s words with the crispness of an adrenaline-fueled memory: Codi died.
Whatever I say on the phone to this patient’s family will be forever remembered. This call will be one of the worst they’ll ever receive. They won’t remember my name, but they’ll remember my tone and the words I choose. I feel like I’m intruding at a tipping point in their lives, somehow powerful enough to determine the shape of one of their lasting memories.
1:04 a.m.
The death note is just a template; I type “.imdeathnote” and it appears fully formed. The only part I have to fill in is “the patient will be remembered for ***.” I’m moved by the fact that this sentence is part of the death note at all, but I also don’t know what to write in place of the three asterisks. I’ve only known the patient since my shift began four hours ago. What will he be remembered for? On the phone, I didn’t even think to ask.
In the end, I type the only thing I know: the patient will be remembered for the love he had for his family. I feel like I’ve done him a disservice; perhaps those three asterisks should be replaced with “his prizewinning scholarship on the English Civil War” or “his exemplary work with disadvantaged children” or “all the afternoons he spent teaching his son to fly an airplane.”
I’ll never know. But in the hospital record, he will always be remembered for the love he had for his family.
Next time, I tell myself, I’ll be sure to ask. Next time I’ll know. Next time, the écorce in the bed will be more than just a shell.
Rose Berman is an internal medicine resident at Beth Israel Deaconess Medical Center in Boston. She received her undergraduate degree in history from the University of Chicago and her medical degree from Harvard Medical School. A humanities lover at heart, she still has a fondness for World War I memorials and the scent of archives. Her interests include narrative medicine, palliative care and quality improvement.