Monday, January 17, 2005

Pronouncing Death - Part 2

In the comments section of the previous post, I got very insightful feedback from Hospice Guy (HG). As HG and I conversed about in the prior post's comments, nurses may not legally pronounce death in most (if not all) states. On numerous occasions, I have pronounced the death (unofficially, of course, as I may not do so legally) at say 9pm. The doctor on call is seeing a patient in the Emergency Department or in the ICU and is not available to come to the floor and officially pronounce. S/he finally comes to the floor by 10:30pm (or later) and pronounces the death officially. For the records, this patient died at 10:30pm and the family are not notified until the doctor makes this official pronouncement. If the family was not present at the time of death, the family may want to come visit before the patient's body is transported to the morgue, in which case, by the time the family arrives, the patient may be undergoing rigor mortis. Absurd? I think so.

I love feedback that gets me thinking. As a result of Hospice Guy's comments, I decided to investigate further, what is included in a doctor's pronouncement of death that may be different from what the nurse does? In my process of investigation, I came across this site.

And what do you know? They agree that a thorough neuro exam is not necessary to pronounce death. Even if it were, nurses are certainly capable of conducting a neuro exam, as we do so on a regular basis with living patients.

About a month or two ago, the wife of a patient who'd died fainted in my arms when I told her that her husband had passed. While the wife was still on the floor and her sister was sobbing at the bedside, the doctor came in and conducted a very thorough neurological exam on the deceased. The nurses who had run into the room to help me with the unconscious wife were horrified. (I was too busy keeping the wife's head from hitting the ground to notice the doctor). Because first of all, the doctor did not need to spend a full ten minutes checking pain and corneal reflexes (the patient was undoubtedly dead) and could have instead helped us with the patient's wife who was still alive and breathing and unconscious on the floor.

When the family is at the bedside, we (nurses) are expected to inform the family of the patient's death (though it is usually pretty obvious to the family when it happens - though not always). And yet, we are not permitted to call the family to inform them of the death when they are not present. Even if I have worked with the same family for weeks and we have established a strong rapport, it is instead the duty of the doctor (even if s/he has never met the patient nor the family - as is the case with the on-call doctors at night).

There is a lot about the medical system that I find absurd.

Wow. I had a whole different agenda for today's post. But it was nice to get thrown off track. That is what I love most about blogging - comments that get me thinking and doing research to find answers to questions I hadn't even thought to ask myself. Thanks to Hospice Guy and to each of you who comment. Each and every comment means a lot to me. You all keep me going with this work. Thank you.

No comments: