THE WALRUS (CANADA) – I CAN’T RECALL a time as a paramedic when I pronounced someone dead without complete confidence.
Back then, it was a relatively easy decision to make. The Ministry of Health in Ontario, where I served on ambulances and helicopters for a decade, had a list of things that qualified someone as being “obviously dead.”
It’s the type of list paramedic trainees have to recite for exams, and I knew it colloquially as Policy 4.4.
“We’d say they were circling the drain”
Policy 4.4 included things that didn’t really need to be spelled out, like decapitation, rigor mortis, gross charring of a burned body, and obvious decay, which is a far more common thing for a paramedic to find than you might think.
In some memorable cases, I knew I was about to pronounce a person dead as soon as I stepped off the elevator.
The stench coming from their apartment was unmistakable, and the superintendent of the building always knew just as well as I did what we would find on the other side of the occupant’s door.
When death was clear, my work was done. There were no lights and sirens, no hustle, no TV-drama moments.
With a look at my watch and a nod to my team, a life was determined to be over. Out came the shrouding white bedsheet (actually, they were halfway between salmon pink and faded orange), and I would head out of the room to shatter the life of a stranger.
“I’m sorry to tell you this . . . ”
But sometimes death was less clear. There would be no obvious criteria—the look of death had yet to set in—and my mind would race to determine what I could do to pull a person back from the cliff’s edge.
Those were the times adrenalin junkies like me trained for—it was like being a pilot in a simulator when engines fail. We had a term for patients like this: we’d say they were circling the drain …
Adapted from Death Interrupted: How Modern Medicine Is Complicating the Way We Die © 2022 Blair Bigham. Published by House of Anansi Press as part of The Walrus Books series.