I was a medical student when I first saw someone die.
A middle-aged woman lay in the intensive-care unit surrounded by machinery that recorded her heartbeat, measured her blood pressure and pumped air into her lungs. Tubes protruding from every orifice drained urine, stool and secretions. Catheters dripped sugar and salt solutions and medicines into her veins. She was stout with curly graying hair and yellow skin, and she was absolutely motionless except for the mechanically enabled rise and fall of her chest.
Like nervous, curious puppies, we students crowded around her bed as the doctor to whom we were assigned solemnly explained that this woman was “dead,” and he was about to document that fact for the medical record.
He called her name. No response. He scratched the bottom of her foot. No response. When he turned off the ventilator, the hissing stopped. In the dead silence, no one breathed.
After an endless couple of minutes, the doctor restarted the ventilator, and the woman’s chest resumed its rise and fall. The final step was conducted by a neurologist who did tests to confirm the absence of electrical activity in her brain. Only after this final proof was she formally pronounced dead.
As I walked out of that room, my mind churned with the bizarre dichotomy I’d just witnessed.
Intellectually, I knew when I entered her room that the woman was dead. But the movement of her chest, the tracings of her heart and the warmth and color of her skin made her seem every bit as alive as any anesthetized patient lying on an operating table. When the doctor turned off that ventilator, I shuddered. The formal death pronouncement was an anticlimax.
A death pronouncement – the responsibility of a doctor or coroner – is a judgment based on a belief in irrevocability. Within my lifetime, the criteria that define irrevocable death have changed.
For centuries, death was said to occur at the moment the heart stopped. That, people believed, was when the essence of a person – the soul, the chi, the Ka or whatever name you give to that which animates the collection of chemical compounds that makes up a human body – fled.
In 1968, a committee of the Harvard Medical School proposed to define death by the death of the brain – the criterion applied to the woman whose death I witnessed as a medical student – rather than by the stopping of the heart.
Brain death is the best definition we currently have. But who knows what the future holds? Medical science has learned to restart hearts. Will we ever learn to restart a brain?
Speaking of brain death, Dr. Mehmet Oz, host of television series “The Dr. Oz Show” said: “There’s no question that the heart without the brain is of no value. But life and death is not a binary system. It’s a continuum. It makes sense for many reasons to draw the line at brain death, but that doesn’t mean it’s really a line.”
firstname.lastname@example.org. Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland.