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My first time

Stephen G. MooreStephen G. Moore

It was my turn, apparently, according to some unwritten rule that governed this type of thing.  I was working in the ER as a 4th-year medical student extern, and someone had died somewhere in the hospital. It was the job of the medical student extern to go and pronounce the patient dead.  Odd that no one had mentioned this particular assignment to me before, but off I went, to find the patient, and to do my job.

Two thoughts played in my head as I wandered the halls of the cavernous old hospital, trying to find the patient’s room. This first thought was the awareness that I had been born in that hospital almost 25 years earlier. The second thought, and perhaps more important to the story, was the realization that I had no idea what it meant to pronounce someone dead. Somehow, I had made it through most of the four year medical school curriculum, without ever participating in a single discussion about what defines clinical death. I had been involved in the care of patients who had “RHC’d” (respiration has ceased) before, but always as part of a team, where we hurried on to the next patient, leaving others to manage the aftermath. This was my first time to be responsible for declaring a person dead. The best option I could come up with at that time was to think about a living patient, and simply subtract the clinical indicators about a living patient’s well being, such as blood pressure, pulse, respiratory status, and reflexes.

After arriving at the patient’s room, and speaking briefly with the nurse and reviewing the chart, the clinical facts started to become clear. The patient was a 42-year-old man, with end stage lung cancer, due to tobacco addiction. His passing had not been unexpected. I entered the quiet room alone, pausing to survey the extremely emaciated and far older looking than 42-year-old body on the gurney in front of me. His tobacco stained fingers told the story of his compelling addiction. I went through the motions of looking for signs of life—there were none. This man was dead.

I did my job and completed the required paperwork, but the impression of a 42-year-old man dying from lung cancer, due to a preventable cause, stayed with me. Later, as I would make career choices, my understanding of what my job was as a physician, started to evolve. It was not enough to be involved, after the fact, by simply trying to mitigate the impact of disease.  It was far more effective to prevent the condition from ever occurring.

Steve Moore, MD, MPH '93, is the Owner and CEO, CarDon & Associates



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