22 October 2008

The Undertaker

I had a patient die recently; it was someone with an obvious MI who came in in full arrest and despite much ado did not make it. He did not have a physician, and so a few days later, I was called by the funeral home to see if I would be willing to sign the death certificate. Now, in my training I was taught that as an ER doc, we should pretty much never sign death certificates: that was more properly for the patient's treating physician, who could more accurately reflect the cause of and contributing factors to the death. In most cases, all we know as the ER doc that is the patient came in dead and stayed dead, so it's not really appropriate for us to do it.

But this was an uncommon case, in that there was no PCP and that I did know the cause of death. I could have turfed it to the medical examiner, but that would have caused a lot of hassle and delay in the funeral. So I agreed. They said they would bring the papers by the ER on my next shift for me.

So the next day, I had forgotten about it until the triage nurse came and got me, obviously creeped out. "There's this guy, says he's here to see you about some papers, but he's kinda strange and I didn't know..."
"Oh yeah, the death cert. No problem, send him back."
"Are you sure? He's a little..." She trailed off, at a loss for words.
"Yeah, I was expecting him."
"Oookay. Your funeral," she slyly smiled as she went back to the front.

My eyes nearly fell out of my head when I saw the guy. It was amazing. If you asked Tim Burton to create a claymation caricature of what a mortician should look like, he would have made this person. He was tall and thin, and very very pale. The whiteness of his skin was set off by the black three-piece suit he was wearing (of course) underneath a full-length black trenchcoat (of course). On top of his head there was a black silk hat which looked like a cross between a fedora and a stovepipe hat. His hair was long and black, and he wore a very full black goatee underneath an elaborate waxed handlebar mustache. His manner was very grave (of course) and unfailingly polite. He could have stepped right out of the Victorian era, except that he was wearing a wristwatch.

"Boy, you've really got the look going on there, don't you?" I offered, as I filled out the forms.
He shrugged, "Goes with the job."
"Does it ever."

He politely filed the papers away in the black leather satchel (of course) he carried at his side, and quietly left. I can only assume the he climbed onto a waiting horse-drawn glass-sided hearse and rode away.

I love my job.


  1. This is what came to my mind as you described him:
    Because I could not stop for Death –
    He kindly stopped for me –
    The Carriage held but just Ourselves –
    And Immortality.

    We slowly drove – He knew no haste
    And I had put away
    My labor and my leisure too,
    For His Civility –

    We passed the School, where Children strove
    At Recess – in the Ring –
    We passed the Fields of Gazing Grain –
    We passed the Setting Sun –

    Or rather – He passed us –
    The Dews drew quivering and chill –
    For only Gossamer, my Gown –
    My Tippet – only Tulle –

    We paused before a House that seemed
    A Swelling of the Ground –
    The Roof was scarcely visible –
    The Cornice – in the Ground –

    Since then – 'tis Centuries – and yet
    Feels shorter than the Day
    I first surmised the Horses' Heads
    Were toward Eternity –

    Emily Dickinson

  2. Man I wish I could have seen this guy.

  3. Really? We sign electronic death certificates in the ED all the time here in New York.

  4. I am very impressed with your writing and this blog! It's nice to finally find a more liberal medical blog out there.

  5. Glad I WASN'T there.
    I'd have stared rather rudely.


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