Unit 7  Section 2Exercise 3 The moment of death
Clinical correlate #2: Death Pronouncement/The death certificate
Nurses, families, and occasionally doctors are present at the moment of death. Here are some glimpses into what that moment entails. Jim Crace’s Being Dead, is a novel that begins with the murder of a couple, and moves forwards to their bodies’ progressive decomposition and backwards to the lives they led. Read the excerpt, as well as the resident’s story about a strange encounter with death.
Jim Crace Being Dead
Celice began to hyperventilate, a quall of sips and gasps and stuttered clames. Her heart and lungs were frenzy-feeding on the short supplu of blood, until quite suddenly, they failed. They had abandoned her, too devastated to survive. Her chest muscles had fogtten how to rise and fall. Her reflexes were lost. She could not cough or even swallow back the blood. The brain-cell membrane pumps shut down. Celice had lost control for once. She's gone beyond the help of medicine and miracles. No breath, no memory.
There were still battles to be fought but these would be post mortem, the soundless, inert wars of chemicals contesting for her trenches and her bastions amid the debris of exploded cells. Calcium and water usurped the place of blood and oxygen so that her defunct brain, alonst at once, began to sell and tear its conpoies, spilling all its saps and liquors, all its stored immersions of passion, memory and will, on to her scarf, her jacket and the grass. Less than a minute. She was fortunate."
Joseph had been insensible at first. He was concussed. His grey matter could etabolize only half the glucose that it needed. But he was still functioning. His kidneys still processed and cleaned his cells. His stomach still digested what was left of the magno and the cheese brioche he's eaten for his breakfast, and the humiliating sandwich that he'd had for lunch, twenty minutes earlier. His blood supplied his tissues with their nutrients and sent its white corpuscles to construct their canopies of scars across his wounds. His bone marrow continued to add new cells to the trillions that had already passed their dark, unknowing time as part of him. His pupils dilated in the sunlight. His bladder processed all his waste, although he was inontinetn already. He still breathed the heavy, salty air of summer in the dunes. Occasionally he movered his leg or extended a finger....half a meter to his side, he saw his wife....Joseph tried to squeak her name, His arm was heavy and numb, dislocated at the shoulder. The air seemed too thick to penetrate with anything as soft as flesh. Yet somehow, fortified by his self-pity, Joseph found the will and the adrenaline to reach across towards his wife. he wanted to apologize...At what point had the life--curmudgeonly, distracted, timid and thick-skulled--gone out of him? Joseph's heart was squirming like an angler's worm, refusing to be reconclied to the awaiting deep, but weakening with every beat...They say that hearing is the last of our proficiencies to die, that corpses hear the rustling of bed sheets being pulled across their faces, the early weeping and the window being closed, the footsteps on the wooden stairs, the ruffian departing, the doctor's scratchy pen...The final sound Joseph hear was his own bark. His face was grey-white, sheenless, dulled. He was still swating and his penis was erect, not filled with blood and passion but stiffened by the paraoxysms of his muscles. Cruel fate. His limbs and face still twitched, a reflec to the body's acidity. His larynx was conculsed. The sound he made was not a rattle of a whoop, but more like the call of foxes, or else a gull,or else the unresponding kick-start of a motorbike. Within a moment of the bark--and the few retreting cub squeaks that followed it--Joseph stared up at the day with flat, toneless eyes. Again, no breath, no memory.
From Being Dead, Picador, Farrar, Strauss and Giroux, New York
Rodriguez is dead
In the hospital where I trained, we admitted many AIDS patients who were dying. On various night shifts, I took care of a little man called Rodriguez, but I did not much enjoy it. He complained that one of the doctors I revered had 'let wind' in his presence, and ever since then I thought him cantankerous and ungrateful, as though doctors weren't also allowed to be human. Rodriguez whined his way ever deeper into his illness and solitude. In the context of the many other patients I had and my own hard life of service, Rodriguez remained on the periphery of my consciousness. But one night, as I slept in my hospital bed, I distinctly heard someone calling out to me: "Rodriguez is dead, Rodriguez is dead!" the voice said as I woke to an empty room. A few seconds later, the telephone rang. A bored nurse yawned: "Could you come to the floor and pronounce Rodriguez? He just died." I never understood why such an intense, intuitive, I would almost have to say telepathic experience, wound its way from Rodriguez to me. Perhaps in order to leave the hospital, his soul had to pass through my room, and its wing touched me as I slept. Or perhaps there is a universal element to dying that touches us, whether there is an emotional attachment or not.
Study Questions
1. What is your reaction to Jim Crace’s paragraphs? (as previously mentioned, there is a great deal more description of the progressively decomposing bodies in subsequent chapters of the novel). What purpose might such details serve, given that they are in a novel? Is there a boundary-crossing here? Should such descriptions remain private, purveyed only by pathologists? Or it is a good thing to expose dying in this way?
2. What is Crace's style like? What purpose does the style serve? In these pages, is Crace a poet/Writer? Or a scientist? Refer to Last days, Unit 1, and reflect on the role of the artist-as-observer as compared with the physician-as-observer.
3. What does pronouncing someone dead involve? Click on the clinical correlate below
4. What message do you extract from the passage on the death of Rodriguez?
Recommended reading: Sherman Nuland, How we die: Reflections on Life’s Final Chapter. Dr. Nuland has an interestin (though painful to read) chapter on the death of a murdered child, reflecting on what the last moments entail.
Clinical correlate 2: Death Pronouncement/The death certificate
http://www.mywhatever.com/cifwriter/library/eperc/fastfact/ff04.html
http://www.aahpm.org/cgi-bin/wkcgi/view?status=A%20&search=177&id=313&offset=0&limit=25 (Informing significant others of a patient’s death)
Swain GR et al Death certificates: Let’s get it right http://www.aafp.org/afp/20050215/editorials.html
Nowels D Completing and signing the death certificate
http://www.aafp.org/afp/20041101/curbside.html |
