Respiration has ceased.
The shift chaplain carries a pager which buzzes, often. Sometimes it displays a phrase, like “Medical Activate” or “Trauma Activate” and a room number. We get there as fast as we can. Sometimes it’s a phone number and a name. We call and identify ourselves and we hear that a patient needs a notary or a prayer or a visit.
Sometimes it’s just a phone number. We call and identify ourselves. And the person on the other end says, “I have an RHC.”
RHC. Respiration Has Ceased. It’s our hospital’s way of saying that a patient has died.
I’m not sure why we use the letters. It could be because death has been defined differently across time.
- When brain function ceases.
- When the heartbeat stops.
- When breathing stops.
It could be because there are so many ways that we could describe dying. Passed. Graduated into eternity. Kicked the bucket. Gave up the ghost. Crossed over. Fell asleep.
To avoid all confusion and denial, we use three letters. RHC. Breaths have stopped. Heartbeats have stopped. Two staff members have listened and agreed.
There are other times, of course, that we talk about an RHC. In a miscarriage, for example, there were no breaths. And that hurts as much because it is as much a death. But for us, most often, there was breath and there isn’t now.
In our hospital, if a person dies, a chaplain comes. Not to pray, though we do sometimes. Not to provide comfort, though we do often. We come to make sure that information is gathered and calls are made so that the person will be treated with timely respect. We can go for a day or two without an RHC. Other times, we can have four in five hours.
I started to write that I’m learning a lot about death. But I’m not sure that I am. I’m learning a lot about the ways that people are in the first minutes and hours after a death.
For staff, checklists are remarkably valuable as a way to live the moments after an RHC. RNs work their way down a list of calls and questions. The checklist allows the mind to be occupied as a hedge against the emotions. Because sometimes they are in tears. For every nurse, someone is their first death.
I can’t make any predictions about families and their reactions to an RHC. I walked into one room and people were laughing and talking about his chocolate chip cookies. I walk into another and a son is sitting silently, all alone with his now-silent dad. I walk into another room and people are sobbing, mostly silently.
And I start to talk:
- I tell them that I’m sorry.
- I tell them that the hole in their heart will stop bleeding all the time but it will never go away.
- I tell them that they can stay as long as they would like and that there is no right length.
- I tell them that when they are ready, I have some paperwork, but that I will come back.
- I tell them that people will try to say the right thing and won’t.
- I tell them that each of them will grieve differently and that each of them knew the deceased person differently.
Not all at once do I tell them these things. I stand quietly for a long time if I need to. Although we all face death, this is the only time they have faced this death, this particular loss in their heart. And I want to give them time.
The paperwork I mentioned is the “Release of Body” form. For the funeral home to pick up the body, the next of kin needs to indicate which funeral home. And we are the ones that have that conversation with the family or the POA.
I’m telling you this because we’re not good at talking about death and dying. That unwillingness means that many families are adrift when I first walk in the room. It means that sometimes a person refused to talk with family about funeral arrangements, even when death was close.
I’ve been reading Being Mortal: Medicine and What Matters in the End. Atul Gawande says that we need to talk about death a little more, and depend less on medicine averting it.
Because it comes. Medical treatment or no. And if we learn to talk about it before we need to, we’ll be better prepared when we have no choice.
Because R will C. And someone like me will ask about arrangements.
- Atul Gawande. Being Mortal: Medicine and What Matters in the End. New York: Metropolitan Books, 2014. ↵