I saw my first patient pronounced dead today. He probably came into the ER dead already, so I might not have witnessed him die. But I did get a very unsteady feeling as I heard the resident who'd been giving orders say the words, "Time of death: 2:31 PM." The resident was impressively poised and calm as he shouted tasks to the group of students, interns, and nurses (the attending was in the room but remaining hands-off). But even he was visibly shaken as he had to pronounce a human being dead, and, as I stuck around to listen, call the coroner.
Earlier in the day, the patient's son had taken him out from his residence for a hamburger. It turned out that the patient was on a puree-only diet, and the hamburger directly precipitated his death.
"Wow," one of the nurses commented, "that son is sure gonna feel guilty."
Or, I wondered, did he know exactly what he was doing? Did he and his father talk about the emptiness of a life of institutions and puree? Did they decide a hamburger would be the perfect way to go?
Doctors don't get to know the answers to these questions.