The Delicacy of Declaring Life and Death

The practice of medicine is undoubtedly one of the most noble and complex professions. Over the years, doctors passionately, vocationally, and wholeheartedly work to protect and promote life. They witness miracles, astounding recoveries, and moments that reinforce their belief that every effort has been worth it. Thus, one of the most challenging and sensitive diagnoses for a doctor is to declare a person dead.

This difficulty lies in two main aspects. The first is emotional. Over the years, doctors build their careers on the foundation of saving lives. Each recovering patient, each returning smile, stands as a testament to the value of their work. So, facing the end of that life, that moment when there's nothing left to do, is undeniably one of the greatest challenges to the medical soul.

The second aspect is technical and scientific. Contrary to what many might think, determining death is not straightforward. It's not simply looking and seeing immobility. It's about searching for very specific signs which, at times, can be so subtle they go unnoticed. The absence of pulses in vital areas, the lack of response to intense stimuli, the permanent dilation of pupils in light, and of course, the prolonged absence of breathing are just some of the indicators evaluated.

Then, there are the post-mortem stages that the body goes through after life ceases. It starts with palidez mortis, where the skin fades due to lack of circulation. Then, algor mortis sets in, gradually cooling the body. Rigor mortis follows, stiffening and contracting the muscles, and finally livor mortis, where accumulated blood stains the skin, resembling a bruise.

But, and here's the most beautiful and challenging part: life is much more than the absence of these signs. Life is joy, experience, learning. And living with quality is not just a medical act; it's a human act. It's everyone's responsibility. It ensures that every day, every moment, is filled with meaning, love, and purpose.

In conclusion, while the end of life presents its challenges and complexities, the true essence of medicine, and of humanity, lies in celebrating and protecting the miracle of being alive.

According to the prologue of the editions of the human physiology book by Arthur Guyton:

"The mere existence of life, that vital spark that keeps us standing, is almost beyond our conscious control. When hunger strikes, we instinctively seek food. If fear engulfs us, our first reaction is to seek protection. Feeling cold drives us to seek warmth, while other innate drives push us towards social interaction and reproduction. Essentially, every human being functions as an automaton, driven by automatic mechanisms. However, what sets us apart is our ability to be aware, to feel and recognize this automatic functioning, allowing us to adapt to changing circumstances that would otherwise be insurmountable for life.

It's vital to trust health professionals, our primary care doctors. These individuals have acquired deep knowledge and have been nourished by vast human wisdom. They are exceptional beings, trained to discern what is beneficial from what is optimal.

So, if you ever find yourself watching a doctor who, with serenity, attends to someone convulsing on the ground and, amidst that, asks questions that seem trivial to you, rest assured he's doing the right thing. Based on his extensive training and experience, he knows exactly what he's doing. And although he might not have the moment to explain his actions to those present, he acts meticulously following every step his training taught him. I say this based on my own experiences.

According to popular sayings, always ingeniously phrased: "The stomach alerts us when it's empty, but the brain doesn't do it in the same way."

This reflection allows us to understand that we can nourish our brains without falling into mental saturation, nor experiencing that feeling of heaviness or fullness we feel in the stomach."