The first time that I pronounced someone dead was a very mild experience. I was an intern, and one of our patients was under comfort care measures only, and was due to expire sometime that night. I was on the floor to sign some orders, and one of the nurses grabbed me. "You need to pronounce Mr. S in 422."
I had no idea how to pronounce someone dead. Was there a procedure? Did I need to do an exam? How sure did I have to be? I wasn't going to take any chances. I felt for breath and for pulse. I did painful stimuli. I listened for heartbeat and respiration. I even printed a telemetry strip. He'd expired before the nurses could unhook his leads.
When I looked at the strip, I went back into the room. There was activity on the strip. There were occasional ventricular contractions. I needed to be sure. The nurse was a little impatient. She had a look at the strip too.
"Oh fuck, I forgot the magnet!" She ran out of the room and came back quickly with a round magnet and placed it on his chest. There was no more activity. Mr. S's pacemaker was off now.
I saved the telemetry strip from Mr. S and look at it every now and then. It helps to remind me of the amazing technological achievement in medicine, and that despite all of this achievement, sometimes a person has to say that enough is enough.