Somebody sign the death certificate, already!

I'm still pissed off about something.

Consequently, I still feel the need to get this off my chest, even though I've said from the very beginning that this blog was never meant to be primarily about me or my life, but rather about science, medicine, and skepticism. Despite that intent, sometimes things happen that I have a hard time not venting about, and it's not always possible not to inject a bit of my own personal life into my writing. Also, after all the bad things that happened during my recent trip home, I'm having a hard time getting back to my usual topics. Yes, I'm aware that there's a blogger out there who took the time over the holiday week to write a two-part attack on something I wrote. Yes, I had briefly considered answering his attack. Unfortunately (or perhaps fortunately, depending upon your point of view), my heart just isn't into getting into a blog pissing match at the moment. (And, yes, I know I haven't always been above enthusiastically engaging in such activities occasionally in the past.) Unfortunately, this is festering, and, now that I think about it, it is relevant to the usual topics of this blog, given that it has to do with medicine. So I'm going to write about it.

Please indulge me for one more day. I promise to get back to my usual topics soon, and I haven't forgotten about the plans I had made for this blog's second year.

Here's what pissed me off last week. As I mentioned a few days ago, my uncle died last week after having suffered a massive heart attack the Thursday night before Christmas. It happened at around 2 AM last Wednesday. The doctor on duty declared him dead--and then left for India without signing the death certificate. I don't necessarily blame her for that. Most likely she was covering that night and was scheduled to leave the next morning. It's not at all uncommon for it to take several hours to type up a death certificate to be signed, although many times as a resident I filled out the death certificate myself when I happened to have to declare a patient dead. No, what happened next is what irritated the hell out of me. Perhaps it is the fact that the funeral is tomorrow and I won't be able to attend that brought this to a head today.

They couldn't find any other doctor to sign the death certificate. And without the death certificate the funeral home director couldn't legally take the body from the hospital morgue. The body couldn't legally be cremated according to my uncle's stated wish. The body had to stay in a refrigerated cubicle in the morgue. To add to the indignity, my uncle's family was charged $75 a day for storage and refrigeration of the body! It still makes my blood do a slow boil to picture my uncle's body left there for any longer than was absolutely necessary. All I can envision is his body on a slab in a cold, dark refrigerator, collecting frost.

And if I, as just his nephew, thought about such things, imagine what his wife and daughter were thinking about.

This went on for almost three days. Any hope of having the funeral before the end of the year (while most of the family from out of state--including me--was still around) dissipated. During this difficult time after my uncle's death, his wife and daughter had to deal with this additional problem and try to find out who could sign the death certificate in the absence of the doctor who declared the patient dead. I understand that it's a legal document. In fact, I've even balked at signing a death certificate for one of my partner's patients once before, but that was only because I knew he was in town and not on vacation. If he had been on vacation or out of town, I would have simply asked for the chart to verify the cause of death and then signed the certificate. That's all it should have taken: For one of the doctor's partners (or the attending physician if, as I suspect but don't know, the doctor in question was a resident or a house doctor) to do that. There is no excuse for this doctor's absence to have delayed the signing of the death certificate for more than a few hours at most, holidays or no holidays.

No excuse at all.

Yet, for over two days, my cousin was given what seemed to all of us to be the runaround. She made multiple phone calls, and finally appealed to my mother to get a couple of relatives on her side of the family involved, one of whom happens to be an attending at the very same hospital where my uncle died (but was unfortunately in Florida at the time) and the other of whom is a surgical assistant there. She was given the number of hospital administration, and I hope she gave them hell. The sad thing is, it should never have been necessary for anyone to give anyone hell just to get the death certificate signed!

The lesson of this incident is that little things we doctors do, without even thinking about it, can, without our knowing it or necessarily appreciating it, cause enormous distress in patients or their families. Should I ever be faced with the prospect of having to sign a death certificate for one of my partners when he is unavailable, I won't balk. I'll ask for the chart to verify the cause of death (a death certificate is a legal document, after all, and it's foolish to sign it without some minimal verification), but I won't balk the way I did a couple of years ago.

I'll remember this incident when it comes to other things I do that affect patients. I also hope that my fellow physicians who may read this will consider what I've said and think about how even the seemingly smallest things they do can impact the lives of their patients and/or their families.