Not quite a year ago, I penned some thoughts on being in the ICU, and what it was like to walk with death.  This article is the natural evolution of that.

"Dr. Jones, what was the time of death?"

There is no need to look at the clock.  I already did.  And at that moment, I firmly fixed in my mind that hour and minute.  I know what time she died.  I was there.  In fact, I was the one who told the nurse to turn off her levophed, vasopressin, and dopamine (the medications that were keeping her blood pressure up and her heart beating).  I was the one who asked the respiratory therapist to remove the breathing tube.  I asked the nurse to turn off the monitors in the room, so the family didn't have to watch their mother flatline, or see the alarms reporting that she wasn't breathing.

And then, after it all was over, I was the one to place my hand on her chest, to closely listen to the lack of breathing, the lack of heart beat, and then pronounce her as dead.

I ask the family if they desire an autopsy, and if they know of funeral home arrangements.  Mostly, I just try to stay out of their way.  They don't need me.  The know I already did everything I could.  I had to tell them we couldn't save her life.  They seem confident that we did our best.  I hope they know it is true.  And in the end, I hope they take comfort in the knowledge that our final efforts were focused on comfort, on relieving suffering, on allowing her to leave this earthly realm without physical pain. 

It is the least I can do, and often the most I can do.