Documentation

Our society places an inordinate importance on official documentation of all kinds. Want to travel? You need a passport. What's being taught in schools? Show me the standardized test scores.

Of course, not everything boils down to what can be seen on a piece of paper.

My father's death certificate actually tells you very little about his death.

My dad was a private trap shooting coach. One day, he left as normal to go to the gun club, about 20 minutes away. My mom was working in the garden, as she did every day. Dad came out to let her know he was headed to the gun club. "OK. See you later," Mom said. It was all very ordinary.

At the gun club, it was also very ordinary. He watched his students, chatted with friends. His students say that he suddenly put his hand to his temple and said, "Oh!" Then he collapsed. Someone called 911. One of his students, Heather, acted quickly and tirelessly, giving him CPR until emergency crews arrived. She managed to get his heart started again, but he needed artificial respiration.

At the hospital, they continued to try to revive him, but he'd had a massive stroke. He was pronounced brain dead.

They had him in the ICU, hooked up to a variety of machines, by the time someone phoned my mother.

She knew, all four of the children knew, all our relatives, most of his friends, even casual acquaintances knew that his biggest fear in life was being incapacitated and kept alive by machines. He'd told us all, over and over, never to let that happen.

He'd never put it in writing, though. Luckily, his doctors left the decisions up to my mom. Luckily, we all agreed – Dad had actually died at the gun club. He was already gone. He was 78 years old.

None of the children lived in the same town as my parents at the time. I was the closest, and it would take 3 ½ hours for me to drive there. Some of us, children and spouses, needed to arrange time off from work. The earliest we could all get to Mom was the next day. Mom decided that we needed each other, and should all be in town before they unplugged the machines. She asked the hospital to wait until the next day, to let us all see him if we wanted to. Then, they'd unhook all the machines.

Everyone who wanted to be was let into the ICU, one and two at a time, cousins, aunts, uncles, children and grandchildren. My children were 21 months and 8 months old. For me, seeing him was like seeing a familiar house that no one lives in anymore. He wasn't there.  I wasn't at the hospital when they unhooked him and officially pronounced him dead.

His death certificate lists his place of death as the hospital, of course. It lists his cause of death, rather inexplicably, as cardiac arrest.

I know doctors who are scornful of cardiac arrest as a cause of death, or a diagnosis of any kind. "It's like saying that someone died from abdominal pain. It's a symptom, not a cause." It's apparently a catch-all fall back to say, "Well, yup, obviously the heart stopped." Even more inexplicably, on Dad's death certificate in the spaces left for other medical conditions, those that were present but not officially the cause of death, the spaces are blank. There's no mention of the stroke that left him brain dead. I have no idea why, but I've wondered more than once if the person who filled out the necessary paperwork was actually familiar with my dad.

When I'm asked about my family history on medical forms, I list stroke as my dad's cause of death. Some day, someone may look at the records and assume that I had it wrong, but I think it's important that my doctors know what actually happened.

My mother died at home, in her own bed, which is an inestimably great thing for her. It meant, though, that the authorities probably had to work a bit harder to document her passing.

The morning that she died, I called the police department's non-emergency number and asked, "What do I do now?" Did I call an ambulance? The coroner? Was there a procedure? What is it? I didn't know.

"We're sending an officer over," she said.

We sat and waited, my middle daughter and I. The house already felt different. Two officers showed up in minutes, arriving in separate cars and conferring for a moment outside before they came up to the door. I wondered if they were steeling themselves for a scene inside; there wasn't going to be one, but they didn't know that.

They were very sweet, but they also had to follow procedure. They couldn't just take our word for who she was. They wanted my mom's ID, but when I said it would be in the pocket of the pants she'd worn the day before, they said they'd get it themselves. They wouldn't let either of us back into Mom's room. I thought that was silly – if we wanted to stage things, we would have already done so.

They closed the door while they checked Mom. "What are they looking for?" Terry wondered.

"Needle marks, bruises, signs of malnutrition," I told her. I knew they were also looking for things like bed sores, urine soaked sheets or clothes, signs of suffocation, wounds – any sign that she had been neglected or a victim of violence – but Terry was upset enough. I wasn't going to say that out loud.

"Oh. They won't find anything like that," Terry said.

"I know, but they don't know that yet. They don't know us from Adam."

They came out and informed us of what we already knew, that it looked as if she had passed away peacefully in her sleep. They phoned the coroner, and made small talk while we waited.

"Was she on any prescription medication?" No. "Any history of heart disease?" No. "Any history of high blood pressure?" No. "Any history of stroke?" No. "Under a doctor's care?" No. She hadn't seen a doctor in 20 years.

After several more of these questions, one officer asked, "How old was she again?"

"83."

"Ma'am," he said, "that's amazing."

"I know! She's amazing."

I predicted that the official cause of death would again be listed as cardiac arrest. It took them almost a month – long after the body had been cremated – to issue a death certificate.

The cause of death is listed as "arteriosclerotic cardiovascular disease."

Well. Really? The space for "interval between onset and death" is blank, because she was never diagnosed with cardiovascular disease or arteriosclerosis. The certificate also indicates that there was no autopsy. Without an autopsy, how do they know what her circulatory system looked like? I'm willing to guess that they took a blood test; maybe it said that she had high cholesterol. Still, it seems a pretty big leap to get from there to deadly cardiovascular disease, and I have no idea whether they did any tests at all.

There are, again, no secondary causes. The form has 3 spaces for, "Conditions if any which gave rise to immediate cause stating the underlying cause last," and one for "Other significant conditions," but all that's listed is the official cause. Since she did not die under supervision by medical personnel, there is no certifying physician. The coroner's office filled out the part that says, "On the basis of examination and/or investigation, in my opinion, death occurred at the time, place and date stated." The official time, of course, is the time the coroner arrived at Mom's house. Even though she was dead for hours before that, she was not officially dead until Someone in Authority was able to Certify it.

In generations past, "old age" was a perfectly acceptable cause of death. History and literature are full of people who are described as dying from old age. Now, though, we find that unsatisfactory and vague. We can't possibly say that advanced age alone is fatal – we want an explanation, darn it. Why is old age fatal?

There are few other ways to explain using 36 letters to say, basically, "cardiac arrest," which basically means, "Yeah, s/he's dead, alright." Using a dart board or Magic 8 Ball also explains it, but not much better.

My teenage son said, "Isn't cardiovascular disease preventable?" He was annoyed that his grandmother's death might possibly have been something she could have postponed longer. (I miss her so much; we all do.) I had to point out, though, that they were just making a best guess. Without an autopsy, no one knows what her arteries, her heart or anything else looks like. More importantly, everyone who has cardiovascular disease wishes that they could live a normal, medication free life and then pass away peacefully in their sleep, at the age of 83. That's pretty much everyone's best case scenario, sick or not.

In fact, knowing that both my parents died painlessly, at places they loved, gives me great hope that I can prevail upon the Almighty for the same for myself. Let me have an ordinary day and pass away quickly, without warning. Ordinary days are what a life is built of.

I won't ever put "old age" as a cause of death on my medical forms when I'm asked how my mother died - but I'll think it.