The first time I verified a death, I didn’t even know I was supposed to do that. I don’t know if I didn’t expect it to be such a significant part of my job or if I thought I would have to be ‘more senior’. Either way it seems utterly ridiculous now.
My first job was on a gerontology ward, so it really wasn’t long until the issue presented itself. I approached the registrar to tell him that I had no idea how to do that sort of thing. I was embarrassed, but he was kind and duly showed me the steps.
When the next time came around, I entered the side room alone and shut the door. I remember being a bit put-off that this patient was still warm and that when I placed my stethoscope to her chest I could hear those hollow noises that rumble inside the thorax of somebody who is dead.
The more I stared at that patient, the more I was convinced she was going to open her eyes. I could picture it; her eyes snapping open, her hand grabbing mine. I let my imagination construct this entire situation and I couldn’t stop it. There was such a sense of unease and urgency; I did the job and hurried out.
The feeling reminds me of my first childhood home. There were holes between the steps on the stairs and when I had to go upstairs in the dark I would convince myself there was a hand about to spring from one of those holes and grab me around my ankles. It wasn’t real, I knew it wasn’t, but I let myself believe it and I ran so fast up those stairs.
I come from a family where death and dying wasn’t even a taboo; we wake our relatives in their homes and the coffin was always open. When my grandmother died, she was laid out on her own bed. I remember being eleven years old and sitting beside her on that bed with my cousin, chatting away and rearranging her rosary beads around her fingers.
Dead bodies just weren’t an unknown thing for me and so I really was surprised by how I felt those first few times. I still can’t explain it.
Of course, I didn’t tell anybody; I got on with the job and it went away. Verification of death is something that doesn’t faze me in the slightest now.
That’s not to say there isn’t solemnity associated with every death, there just isn’t fear. Very occasionally even now I will still feel something ‘extra’ though that surprises me. Once I found myself unexpectedly shedding angry tears as I verified the death of a man who had been knocked off his motorbike by a pheasant; I think it was that his end just seemed so absurd.
Now, when there are students on the ward, I try and take them with me to verify deaths. I hope they will feel more comfortable on that day when they shut the door and it is just them and a body. Perhaps it will always just be an inevitable rite of passage or perhaps it was just me who felt like that, after all I never asked anybody else.
By the Secret Doctor
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The picture accompanying this article may show a patient with a right proximal femoral fracture but she should not be described as dead. Although the mortality of this injury is high it is inappropriate to use this picture, which may be of an elderly lady with a shortened externally rotated right leg as a result of fracture, to make a point.
You're not alone doc. I had no idea my first time and had the fear more than once when verifying. It is that awesome responsibility conferred upon us at qualification to be the definers of life and death. that responsibility further compounded by the terrible fear of getting it wrong. I think it is indeed a universal rite of passage for every doctor and the first time you are on your own to do it will never be easy.
The first patient I certified still had their morphine pump attached. It went off when I was listening for chest sounds, and gave me such a fright. The patient was in their 30's, and looked like they were asleep. I thought I was being silly, and never spoke to anyone about my unease. It looks like im not alone, which is always a good thing to find out. Thanks
Thanks for describing. You are not alone in this right of passage and it is important to junior doctors currently that we describe these feelings. Its part of the transition to becoming a professional and its the stresses like these that cause challenges for Foundation Doctors. ( GMC Are Medical Students prepared for Practice ) As FPD I see a lot of Reflections in eportfolio about similar situations. I urge trainers to acknowledge the importance of this transition and to make the space to discuss these stresses with our future colleagues.
as a medical students we were doing our phlebotomy duties, my colleagure went to find a patient then came back to me saying she thought they might be dead but didn't know. We both went to see the patient and realised neither of us had a clue what to do to tell.... so we went to get Sister, who wasn't at all surprised that the patient had died.
Dear Anonymous - re 'inappropriate photo' - is this a serious comment?!
With respect to whether or not the lady should be 'described as dead' - she hasn't been described as anything. Unless you've read a different article. Of course there is an implication that she is dead because it has been used as an image in a blog about death. If you want to be so surprisingly pedantic, we can say that in fact, you don't even know that this patient is a she. Perhaps this is a male in a pair of slippers typically worn by a female. Secondly her right leg is not shortened, it is just externally rotated. Perhaps her right leg fell that way when she did of a stroke or a heart attack. Perhaps she did have a fractured neck of femur and she did die, which would as you point out, not be a given but a possibility and if this is a dead patient with a fractured neck of femur then the photo would not claim to be representative of the prognosis of fractured neck of femurs generally.
Perhaps she isn't even trying to play a dead patient. Perhaps she is just asleep on a trolly and if this is the case then I would also like to say that I am not attempting to imply that sleeping causes death either.
Or perhaps this is just a photo stock image of a model posing for a photo on a trolly.
The Secret Doctor
For several years at our Trust we have included death confirmation as a Mock OSCE station (using a SIM) for final year students and as an educational supervisor of FY1s have endouraged the trainees to use their first Death confirmation as a reflective note for themselves and their e-portfolio, I would encourage both in all Trusts and in final year undergraduate teaching .