Ashes and Dust.

One of the last reports I transcribed last night was a “death summary.” The patient (whyinhell are they called “patients,” anyway?) was elderly, though not particularly old at 81, had a fairly nondescript past medical history, wasn’t taking the customary 28 medications and supplements that most people her age (and much younger) seem to consume every day, had several family members in attendance for her grand, albeit unexpected, finale. She had just caught a pneumonia a couple of weeks ago, was apparently recovering from that, but then developed a pulmonary embolism from having been flat on her back in a hospital for a few days.

Nothing about her “story,” as I heard it, dictated in slow, measured tones by a doctor who seemed genuinely to care about the lady and her family, was particularly noteworthy, I suppose. As I do with all death summaries, though, I was as careful as I could be to get every dictated detail accurately--death, after all, is not the same thing as a sore throat or a fractured tibia. A death summary is the permanent “permanent record,” so you want to get it as right as you can. Yes, yes, I know--it’s just the final few hours or even moments of a real person’s life, does not begin to capture what the person was, who s/he was, how much s/he might have mattered to the grandkids or the coworkers or even in her role as “crazy cat lady” in some flyover Midwestern neighborhood. Still, it was her last moments, and deserved to be recorded accurately and, more importantly, with respect.

So I made sure the “i’s” got dotted and the “t’s” got crossed and all the commas got put in the right place. It was the least I could do.

Having been in this business for a while, I’ve transcribed a lot of death summaries. The one I remember forever is the first one I ever transcribed, concerning a 4-year-old boy who one day started walking funny--”my little crooked man,” his mother called him. His name was Drew (I even remember his last name, but won’t repeat it here--it’s a privacy thing, you know?). The doctor dictating the report was the general pediatric section chief I worked for, and who had hosted just hours earlier a retirement party for another doctor in our section.

It was late January, snowed a ton that day. I had fortunately just put new all-weather tires on the car, so had little trouble making it over to section chief’s house, where I shoveled snow off her sidewalk and front porch, helped greet people (including another of our pediatricians, who was about 8 months pregnant and took a fall, stumbling over the curb). Good night, at least to that point and even to the end of the party.

Monday morning I came in to find a micro-cassette on my desk, awaiting transcription. I plugged it in, then listened to my boss relate the story of Drew and his final moments, which came to pass about two hours after the retirement party ended. “His eyes rolled back in his head,” my boss dictated--and the 4-year-old was gone.

Two years after that, not long before said boss was getting ready to move to Minnesota, I was at my desk one morning and got a call from an inpatient floor, about one of our longstanding patients with a longstanding “idiopathic pulmonary hemosiderosis.” The patient, a girl named Pam who was born on Valentine’s Day 1972 and who doggedly worked towards a degree in allied health professions even while lugging around an oxygen tank, had been admitted a day or two earlier. “Pam’s gone,” the caller told me. And for the first time in four years of working with her, I tracked my boss down in a patient room and interrupted her examination of a patient. “It’s Pam,” she said, the instant I poked my head in the door.

On Monday, just a couple of days later, I was transcribing Pam’s death summary.

Ashes to ashes, dust to dust is all fine and everything, when the ashes and ashes or the dust and dust have at least a little something--you know, a “life”--separating them.

(And how I got off on this particular tangent, I will never know.)