According to Webster’s Dictionary, death is the permanent cessation of all vital functions. In my book death happens when I am no longer able to keep the patient alive or when we should not be keeping the patient alive. In the later case, keeping the patient alive is unethical, unreasonable and has no future benefit for the person. This is probably a simplified view of what happens in the Intensive Care Unit, but it’s true.

For every patient that dies in the ICU I get a death certificate that has to be filled out. Along with the patient’s name, DOB, SSN I have to document the cause of death.

Coming up with the real or leading cause of death sometimes gets complicated. Most patients die from cardiorespiratory arrest – the heart stops and the patient is no longer breathing. Some patients are declared brain dead when the primary insult causes cessation of brain function. Since all patients die when their heart stops, it’s what led to this arrest that should be considered the cause of death.

In many cases it’s fairly easy. For example the patient might die from an overwhelming lung injury caused by pneumonia. The patient might become brain dead after a severe head injury etc.

In some cases, things happen so quickly that you never have a chance to figure it out. If the patients presents with a low blood pressure and arrests on your door step, there could be multiple conditions leading to this. With the declining rate of autopsies you might not have the benefit of the postmortem exam to “satisfy your curiosity”.

In some cases the sequence of events could be so complex that coming up with ultimate cause of death becomes tricky. For example, the patient with a cancer was given chemotherapy reducing his blood counts. Having no white cells to fight the infection the patient developed overwhelming sepsis and renal failure. Low blood pressure and tachycardia increased metabolic demand on the patient’s heart leading to the heart attack. The patient goes into a cardiac arrest and suffers anoxic brain injury; the family decides to withdraw care based on a poor prognosis.

Even thought the patient died from anoxic brain injury, the ultimate culprit of his death was cancer triggering the cascade of unfortunate events.

Documenting the correct cause of death is important not only for the statistical purposes but important for the family of the patient as well. Knowing what their loved one ultimately died from might provide closure and peace.