Intern Year: My first death pronouncement.

Sleep inertia: it's that feeling of haze and sluggishness that lasts for up to thirty minutes after being awoken from sleep.

It's exactly what I feel during my first week of intern year, one night at 3:00 AM on the phone with my senior resident.

"Hello?" I try not to sound too groggy.

"Have you ever done a death pronouncement before?" My senior resident also sounds very sleepy.

"No..."

"Well we're going to do one. Meet me on the third floor."

In the hospital, when someone dies, a doctor needs to examine the patient, make sure they have indeed passed away, then pronounce the death and call the family and the patient's primary doctor. A very emotionally grueling role, one that can be made even more agonizing if the room is filled with sobbing/yelling/crying family members.

For better or for worse, this patient is alone. She was already on hospice, meaning it was already decided by her and her family that her care would focus primarily on comfort, rather than curing or treating her illness. It was only a matter of time.

When my senior resident and I reach the room, she is laying in bed, her eyes closed and mouth wide open. My senior nods at me, encouraging me to start the exam. He had coached me on our way to her room, First you have to check her responsiveness. Say her name, touch her arm. Next, listen to her heart and lungs. You shouldn't hear anything. Check her pulse. You shouldn't feel anything. Open her eyes and check her pupils. And that's it. Write a note, then start making calls.

It was eerie. In medical school, they teach you to listen for heart beats, listen for breath sounds. With all our work with cadavers in anatomy class, it never really prepared me for the silence I hear when I place my stethoscope on this woman's chest. My senior helps me by opening her eyes so I can check her pupils. I have never been one who advocates that Oh, the soul is in the eyes, but as I stare into the blackness of her pupils with my penlight, I see nothing but emptiness staring back.

I did not know this woman, but there is still something gut wrenching about having to declare her "Deceased". As though if I didn't put it into writing, it could somehow be reversed. I sign my note.

My senior, who thankfully took the duty of making the phone calls to her family and doctor, mouths something to me as he is dialing. "Don't forget the paperwork."

I feel zombie-like as I take the sheet of paper from the nurse, and again reiterate the details. Time of death: 0300.

As I check boxes, I wonder how this experience could be different if it had happened during the day. Maybe under the cloak of night, death seems a twinge more macabre. I finish signing my name. No, I decide, it probably makes no difference.

I go back to my call room. Lie in the bed with the hospital sheets and hospital blankets, the same sheets and blankets that cover the patients' beds. They used to smell sterile. Now they smell a little like death. I fall asleep anyway.

Two hours later, when I wake up, I am a little less groggy. And, what do you know, my sheets smell sterile again.