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Only five minutes earlier I'd been asleep, when the nurse stirred me awake, asking me to pronounce Mr. Fitzgerald dead. I had never done this before. Not as an intern. A hundred questions ran through my mind at once. Was I supposed to pretend I knew the patient? Was I supposed to give the family words of reassurance, tell them that he had fought hard, that he was finally relieved of his pain? Maybe I wasn't supposed to say anything at all. I was at a complete loss.

The stairwell echoed with my footsteps as I found the former patient's page. Seventy-nine years old, pneumonia, do not resuscitate. It was all the information I had. Not much to go on, but then neither was my past experience with this sort of matter. In medical school, we were taught how to preserve life, not what to do if we failed.

Certainly, I had learned a thousand physical ways to tell if a person is dead. The skin becomes blue, then white. The limbs begin to stiffen -- a process commonly known as rigor mortis. There would be no pulse in the wrists or carotids, the iris would dilate and breathing would stop. The patient would show no response to pain, and no reflexes could be elicited. An electroencephalogram -- the charting of electrical activity in the brain -- would show a straight line, as would an EKG.

The list went on and on. But what was I supposed to do? What actions should I perform? There is a formal checklist for everything in medicine -- even for this -- but as I walked up those stairs, I could not remember one for the life of me. Or for Mr. Fitzgerald.

I began to sweat a little, and not only because my pale, undernourished body was laboring up its third flight of stairs at 2:43 in the morning. There were going to be people in that room who had not only just lost a loved one, but who needed closure for what was most likely a long period of waiting and suffering. What they did not need was to have me clumsily poking at random around their lost relative's body, mocking their pain with my inexperience. And even worse was that I'd be the only one in the room who never knew Mr. Fitzgerald at all.

A chill wind enveloped me as I climbed past a window, abnormal for an autumn San Diego night. I wondered if Mr. Fitzgerald's grandchildren thought it grew cold every time someone died.

In medical school, you learn a lot of science. While humanistic qualities are certainly desired by med schools, they are still not considered as valuable as, say, the memorization of all 27 ion pumps in the nephron of the kidney. So while I knew every single thing that constituted the physical state of death, emotionally I knew about as much as any grandchild.

I reached the top of the stairs and came onto the former Mr. Fitzgerald's ward. The sense of death, I thought, permeated the floor. I was not prepared for this.

Next page | Listening for her breath