The Dead Book

I LIKE TO TAKE MY TIME when I pronounce someone dead. The bare-minimum requirement is one minute with a stethoscope pressed to someone’s chest, listening for a sound that is not there; with my fingers bearing down on the side of someone’s neck, feeling for an absent pulse; with a flashlight beamed into someone’s fixed and dilated pupils, waiting for the constriction that will not come. If I’m in a hurry, I can do all of these in sixty seconds, but when I have the time, I like to take a minute with each task. 

I talk to the patients I’m about to pronounce, even though they’re dead. “Mrs. Jones,” I might say, “I’m just going to listen to your heart,” before I touch the plastic stethoscope to her chest. Because I don’t provide direct nursing care to patients anymore, I don’t carry my own stethoscope. When I pronounce someone dead, I use one of the disposable stethoscopes designed for listening to the chests of patients with infectious illnesses. They are made of flimsy red plastic the color of cartoon blood, and I feel a little cheap when I use one to pronounce Mrs. Jones, as if I have shown up at a dinner party in a ripped tube top. But I make sure to treat Mrs. Jones’s body with the same respect that I would afford a living, breathing patient. I always imagine her soul sitting in the corner of the hospital room in one of our beige visitor chairs, invisible to the eye but listening with her large, warty ears. 

Until I pronounce her, Mrs. Jones is not officially dead. Even though she’s stopped breathing and her heart is silent, legally she’s still alive. Sometimes I have other tasks to do, and it takes me a while to get to Mrs. Jones’s room. My thinking is that Mrs. Jones, whether her soul is sitting in the corner or not, doesn’t really care whether I pronounce her dead at 4:07 or 4:53. I like to believe that time doesn’t matter much to dead people. 

It does matter to the living, though. If Mrs. Jones’s husband or children are sitting at the bedside, that will make me hurry. The dead are dead, but the bereaved want closure. Invariably the family will ask me for the time of death, as if the information makes it more real for them.

It’s traditionally a doctor’s duty to pronounce patients. In the hospital where I work, only a few nurses have been given the pronouncing wand — mainly the nurse supervisors, like me, who oversee the hospital’s day-to-day functions and happen to be available twenty-four hours a day, seven days a week. We can pronounce only under specific conditions, however: First, the patient’s doctor has to order it. This can be done after the fact — and often is, especially if the patient dies in the middle of the night. Even during the day it’s kinder to the family not to make them wait for the doctor, who is often reluctant to desert his living patients in order to rush to a dead person’s bedside. Second, I cannot pronounce a patient who is a coroner’s case; this includes victims of violence — even if the wounds are self-inflicted — and anyone who was admitted less than twenty-four hours prior to death. And third, I cannot pronounce a patient who was on a ventilator at the time of death, although I can and often do pronounce patients who’ve died just a few moments after we’ve withdrawn the ventilator. 

But if there’s no tube running into the patient’s lungs, and the coroner has no need to confirm the cause of death, and no doctor wants to do the pronouncing (and, really, why would they — they’re busy enough with the living), then I am called to pronounce the patient dead.

Pronouncing patients is only a small part of my work. Like the doctors, I spend most of my time with people who are still breathing and whose hearts keep something at least approximating regular time. Part of my job is also to figure out how to squeeze more patients into our already crowded hospital. Hospital rooms are becoming scarcer nowadays, and this can add a scavenger aspect to the news that a patient has died. When Mrs. Jones dies, she makes room for Mrs. Smith, who’s been waiting five hours for an empty bed to become available. I can’t help but feel a little grateful that Mrs. Jones has finally passed. It was inevitable, and now Mrs. Smith will get the benefit of Mrs. Jones’s already-cooling bed. 

ALL BASEMENTS ARE CREEPY places, even those without a morgue. The hospital where I work stores its bodies in the basement, where pipes painted the same pinkish beige color as the low ceiling run the length of the halls. There are many twists and turns, and the hallways all seem to lead to nowhere or to end in locked doors.  

Built in the 1930s, the windowless morgue has tiles the exact putrid green color of those seen in all tv and movie morgues. The rest of the hospital has been updated with laminated wood flooring and neutral color schemes, but the morgue remains untouched by a decorator’s hand. At the center of the space is the autopsy table, with its sloping steel presence and its great drain. Above it is a faucet with an enormous sprayer head attached to a flexible steel hose, like the ones used to wash dishes in a commercial kitchen. I try not to think about what happens on that table, but, of course, the more I shun the thought, the more my mind conjures it.

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