How Can You Tell From The Dead Moving Body to The Live One?

• When I was just entering my upper-class years in medical school, I found myself working on one of those very long, crowded wards they had at Bellevue Hospital in those days. One afternoon I finished my assignment early, and hoping to learn something, I went over to where the intern and resident were examining a patient behind some movable curtains. They were talking quietly and reading in the patient’s chart. I looked at the patient from the foot of the bed. The patient was breathing very slowly, four times a minute. Finally, I whispered to the intern, “This guy looks really sick to me.”
• The intern and resident looked at me with some interest. “He’s been dead for the last ten minutes,” one of them told me.
• So I learned that the human body continues to move every once in a while after death.
• Medical school offered no courses specifically on how to tell the living from the dead.  An important issue, one would think. They assumed that you were going to pick that up along the way on your own time. I, for one, had always thought that if there was someone lying there who might be dead, you gave him a big pinch, and if he sat up, that meant he wasn’t dead.  But it turns out, that determination is not so simple. That final breath you see in the movies when someone has a few last words to say then flops his head over to one side and closes his eyes need not in real life be a sign of real, no kidding, death. 
• My next brush with the more or less dead occurred when I was an intern. Of course, I knew more then. In fact, no one knows as much about everything as a medical intern, especially when he is talking to medical students.  I was standing in the Emergency Room of St. Vincent’s Hospital watching a team of specialists trying to revive a dead person. Someone had called “code blue,” over the hospital loudspeaker. That meant that this particular team of experts should hurry to wherever they were called to rescue a patient who was on the verge of dying. In my experience, it was always called after the patient had already died. There followed a complicated farrago of medical instruments being inserted here and there into the body, which was pounded on now and then. This was unseemly, I thought. When you’re dead, you’re dead; and the dead should be allowed to rest in peace.
• I was pontificating to this effect to the medical students who had gathered around me when the dead body in question sat up, propelling me to the other side of the room.
• He was still dead, of course. The medical team had been applying electric paddles to his chest in order to shock his heart back into action; and in a last try, they had turned the controller up too high. The current had penetrated to his spinal cord with this spectacular effect. I may have been correct in my analysis of the situation, but I had definitely lost my cool in front of the medical students.
• I subsequently heard about a patient who had been revived by even more heroic measures. The team had cut open his chest and massaged his heart directly. They were wheeling him quickly to the operating room when he suddenly said, “Get your Goddamn hand out of my chest,” before falling back down dead all over again.
• Of course, there are some patients who are, indeed, turned back from death’s door at the last minute by these emergency efforts. Their number is small, and death is not usually forestalled for any considerable length of time, but it does happen; and that is why so much is invested in this effort. More about this below.
• As an intern I went on “dead rounds” from time to time at one of the flop houses that still served the homeless on the Bowery, which was nearby. We were charged with declaring their dead, dead. The proprietors did not like to inconvenience the doctors too much, so they saved up their dead residents before calling us so we had to make fewer trips. Often it was a matter of days before they had collected enough dead people to make it worth our while. By that time the smell of the entire building was very unpleasant.
• 
  
• 
• 
  
• 
  
• 
  
•  The smell of putrefying bodies has been described elsewhere, and I have nothing to add. Besides, my ability to smell things is limited and mymemory for smells even more limited; but the smell was bad.

• Under those circumstances, I had no trouble determining from across the room that death had taken place. Putrefaction is not subtle. Anyone could tell. But no one is officially dead until a doctor declares him dead. It is one of those powers reserved to doctors by law that makes the practice of medicine so prestigious. I explained this to my wife who complained some about the way I smelled when I arrived home.
• Every once in a while there is reported in the press a person who has been declared dead by a physician but who wakes up discommoded on a slab in the morgue. These relatively rare incidents make more of an impression than they should on some of my phobic patients. Claustrophobic individuals are afraid of being trapped in various places: stuck elevators, airplanes, traffic jams on bridges, and so on. The idea of having been incorrectly diagnosed as dead is very scary to them; and for that reason many arrange to be cremated. Evidently, the idea of being burned alive is less distressing than being buried alive.
• As everyone knows, there is still another in-between state where it is not clear exactly how dead a particular person may be. These are those individuals who for any of a number of reasons have become comatose. They can continue for years not able to breathe, or eat, or move any part of their body, but who continue to live with these things being done for them by others. An entire medical literature has grown up about how to determine whether or not such a person is “brain dead,” or in a reversible coma, or just plain dead. These situations are understandably very painful for the family. I was upset recently by simply hearing of such a case.
• My patient was a young woman who was in an elevator with her father when he had a heart attack. An ambulance was called and the emergency medical personnel who came to the scene applied desperate measures to save the man. Despite the stories I mention above, there are understandable reasons for trying at these dire moments to save the person’s life. It is possible that that the man or woman will be returned to life; but, more commonly, he, or she, is left in a coma which, sometimes, does not resolve in weeks or months, or, on occasion, years.
• Cases of this sort occasionally are reported on in the media. Usually, one member of the family is prepared to “pull the plug,” that is, refrain from artificially feeding or breathing for the patient. In other words, allow him to finish dying. Other members of the family notice some ambiguity in the patient’s response which encourages them to think the person they love is still hiding somewhere in that otherwise inert body. Because the loss of that loved person is so terrible—and also for religious reasons—they hesitate to give up hope once and for all.
• In the case of the young woman’s father, he was saved—in a matter of speaking—but suffered massive brain damage. It was plain he could never recover—or, at least, never recover with his mental faculties intact. And yet, he could be kept alive on a ventilator. And that is what happened.
• Every day for the next six months my patient and her mother came to the hospital to watch their comatose relative as he was turned from side to side and gasped and coughed from time to time. Although he moved reflexively, he never showed any sign of waking up. And yet they continued to come every day. The idea of letting him die was impossible to contemplate.
• In this case it was obvious the comatose man was not suffering. He was too impaired neurologically to experience anything. It was only his family who suffered. About six months later the man developed pneumonia and finally died.
• I know that there are those who argue about the sanctity of life and about our fate being in God’s hand—although in these situations, it seems to me to be in the family’s hands. They say we never have the right to let the person die if it is in our power, somehow, to allow him or her some semblance of life. I cannot see the matter from that perspective. I imagine myself lying there in a coma, dead for all practical purposes, and alive only to make those I love suffer. If I thought there was a small chance I could wake up in the future, as happens sometimes, I would not wish to take that chance. I did not exist for the previous thirteen or so billion years of the existence of the universe and I will not exist during the trillions of years during which the universe finally unravels after I die. It does not matter if I die a few years prematurely. What matters is whether I can live usefully or not and whether or not I can help those I love or hinder them.
• Recently, physicians have discovered that there may be evidence of some consciousness in these people who are immobilized and otherwise removed from us. That is not an argument for keeping them alive! It is an argument for hastening their death. Imagine how terrible it would be to be trapped conscious but unable to perceive anything or move in any way. It is that ultimate fantasy experienced by my claustrophobic patients. It would be worse than being buried alive because it could go on indefinitely.
• So, I have an opinion about how to tell the living from the dead: when you’re lying there and not moving, but you’re gone forever, you’re dead. There. That was simple, wasn’t it?
• 
  
• (c) Fredric Neuman. Follow Dr. Neuman's blog atfredricneumanmd.com/blog or ask advice at fredricneumanmd.com/blog-ask-dr-neuman-advice-column/
•      .psychologytoday.com