| The Funny Bone |
Dead Reckoning En route, I ducked into the hospital library, where a young lady said she had nothing listed on this matter, but the information I needed was probably on file in the superintendent’s office under “Lex Mortem Dictu.” I headed straight to that office, where I found only an old man who acted as messenger boy for the first assistant; he had worked there for many years but couldn’t remember just exactly how to pronounce a man dead. Perhaps, he suggested, I should ask another intern or a nurse; someone, he was sure, would be happy to enlighten me. Unfortunately I met no one on my way to Ward K. When I finally arrived I found a huddle of frowning nurses with their arms folded tightly across their chests. They had been waiting almost an hour for me, they said, and they could not move the body until a doctor had officially pronounced the man dead. Furthermore they needed the bed for another patient. They were clearly in no mood to answer my questions about the proper procedure, so I reluctantly made my way through the unfriendly cluster to the middle of the ward, where a bed was screened. I entered the enclosure to find it crowded with nurses and orderlies. When I reached the head of the bed I slowly pulled down the sheet, exposing an emaciated man. He was unquestionably dead because the nurses had been waiting for nearly an hour, but was that sufficient evidence? Had the usual tests of death been made? What were these tests and who had made them? I somehow had to conceal my inexperience. I fumbled for the man’s pulse; his skin was ice cold but I thought I could just detect a faint yet rapid pulse until I realized that I was gripping his wrist so tightly that the pulsation was mine. I took out my stethoscope and listened intently to his chest, but I could hear no sounds. I then opened his eyelids and noted that the pupils were unequally dilated. By this time I could sense considerable rustling among the nurses and orderlies. I overheard tense whispers about hurrying it up and getting the job done already. I continued to examine the man, though, desperately hoping that someone would finally give me a clue about the next step. But I could gather nothing constructive from the undertones. So I finally straightened up, looked significantly at the head nurse, and declared that she was correct: the man had undoubtedly expired. She snorted and exclaimed loudly, so everyone in the ward could hear, “Just go ahead and pronounce the man dead and stop all this nonsense!” I began to feel weak. The thought occurred to me that the repeated use of the word “pronounce” must bear some special significance; it must mean that something must be said in a particular way, with some particular legal phraseology. I dimly recalled seeing a play in which a character had died and the attending doctor had made a public statement. I tried desperately to recall what he had said, and then suddenly remembered a few words that seemed to cover the situation. With all the dignity I could summon, I intoned the following statement: “By virtue of the authority vested in me by the Commonwealth of Massachusetts and in accordance with the rules and regulations of the Health Department of the City of Boston, I, Dr. Hyman, a duly authorized intern of the Boston City Hospital, do hereby and hereon officially pronounce this man dead, and in witness thereof I hereby and in the presence of these witnesses set my hand and signature.” When I finished, a stunned silence seemed to settle over the onlookers. The head nurse in particular looked shocked, and I was no little alarmed at her pallor when I asked for the certificate to be signed. After a moment’s hesitation, she retrieved a slip of paper from her desk. I quickly initialed it and then strode out of the ward. At the door I turned and saw everyone still frozen in an oppressive hush. On my way back to the main wards I again felt weak as I wondered how much of the ceremony I had fouled up; I had obviously done something quite contrary to the usual procedure. A grumbling yet jocular throng had turned deeply solemn upon my pronouncement. The more I reviewed the situation the more worried I became. I resolved to ask the first house officer I met how I could extricate myself from this mess. It was getting late and although I had no appetite I went to the dining room hoping to run into my senior attending. But only a few interns were there and the waitress had begun to scold me for coming in so late when the telephone rang. “If you’re the new intern and your name is Dr. Hyman, you’d better get up to the superintendent’s office right away,” she said. “But have a cup of coffee first, because you’re going to need it.” I gulped down the hot brew and bounded upstairs. If the front office was calling me, I was definitely in trouble because I had heard that only a few complaints ever reached the stage where the superintendent was called in. If this was happening on my first day at the hospital, my future was dim indeed. It was with a heavy heart that I entered the office. The superintendent was pacing up and down and seemed to be arguing with several of his assistants. When I opened the glass door, they all looked rather savagely at me. I felt queasy. The first assistant wasted no time in yelling, “What the hell have you been doing in Ward K this afternoon? You’ve turned the whole hospital upside down. Couldn’t you pronounce a man dead without raising all this rumpus?” Then the superintendent, a kindly man, interrupted and said, “Now young man, will you please tell us exactly what went on in Ward K?” So I explained the situation, prefacing my remarks by saying that I was not familiar with the Lex Mortem Dictu in use at the hospital, so I had substituted Section 110 of the 1905 Code. Everyone stared at me, and then the superintendent said, “Please tell me the exact statement that you made.” I repeated my earlier pronouncement word for word, with as much dignity as I could muster. Again a stunned silence fell. Finally the superintendent turned to the first assistant and said, “Charlie, first thing in the morning run down to City Hall and get a copy of that Section 110 of the 1905 Code. It’s about time we did this thing right; I’ve been here damn near 26 years and it’s the first time I’ve ever heard the proper way of pronouncing a man dead.” Then he said to me, “All right, young man, you did the right thing. Just forget about the rough way we were handling you. Goodbye and thank you very much.” I returned to the wards in an even gloomier mood than before I had been summoned; I cursed myself for citing the 1905 Code. Why hadn’t I had the courage to confess my ignorance? I was in a worse mess now. When they looked up that code there would be nothing in Section 110—if there even was such a section—that had anything to do with pronouncing someone dead. I found the house officers’ quarters and stumbled into bed. The next morning, I was relieved when my department chief smiled as I told him about my predicament. He had heard all about it from the front office. “Chief,” I said, “I didn’t want to confess this to anybody, but I honestly don’t know how to pronounce someone dead. There was nothing in the notes you gave me yesterday. Tell me, how does one do that?” The chief looked at me for a long time. Finally he said, “My boy, you have asked a question that every physician who has ever been present at the death of a patient has pondered. I know of no hospital with a specific ritual for pronouncing a man dead. By word of mouth, one intern conveys the traditional method of the institution to another and eventually the pronouncement of death may become just a nod of the head. Yesterday you inadvertently stirred up a problem with no special solution. It was lucky that you remembered that Section 110 of the 1905 Code. But for now the front office has a hot potato in its hands, and I advise you to keep away from that part of the hospital.” He then led the way into the operating room, and we said nothing further about the matter. Pending a continued search for Section 110 of the 1905 Code, the superintendent issued a memorandum about the procedure to be followed in pronouncing a patient dead. It stated that henceforth house officers should conduct themselves with decorum and confine their remarks to a simple statement, the text of which had been carefully typed into the body of the memorandum. Reading it, I was astonished to find my speech replicated verbatim, my own feeble recreation of words a stage actor had uttered so many years before. Albert Hyman, Class of 1918, was a cardiologist whose interest in cardiac resuscitation led him to witness numerous patient deaths early in his career. In the 1930s, together with his engineer brother, he invented and patented the “artificial pacemaker.” Operated by a hand crank and a spring motor that turned a magnet to apply electricity, the device was a breakthrough, though it was not widely accepted by the medical community at the time. This article appeared in the Autumn 2004 issue of the Harvard Medical Alumni Bulletin. Photo: Spike Mafford/Photodisc/Getty Images |
The telephone rang, and the nurse who answered it said I had better get over to Ward K and pronounce a man dead right away or there would be hell to pay. They had been looking for me all afternoon and where the devil was I? I knew nothing about pronouncing anyone dead, so I started out with much misgiving. 
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