The autopsy should have been a piece of cake. My patient had a history of widely metastatic cancer, which was pretty straightforward as far as causes of death go. Entering the various body cavities, my colleague and I found what we anticipated: Nearly every organ was riddled with tumors. But after we had completed the work, I realized that I knew why the patient had died, but not why he’d died that day. We found no evidence of a heart attack or blood clot or ruptured bowel. Nothing to explain his sudden demise. Yes, he had advanced cancer—but he’d been living with that cancer the day before he died, and over many weeks and months preceding. I asked my colleague what he thought. Perhaps there had been some subtle change in the patient’s blood chemistry, or in his heart’s electrical signaling, that we simply couldn’t see? “I guess the patient just up and died,” he said.
I’m a hospital pathologist; my profession is one of many trying to explain the end of life. In that role, I have learned time and again that even the most thorough medical exams leave behind uncertainty. Take the current spate of heat-related fatalities brought on by a summer of record-breaking temperatures. Residents of Phoenix endured a month of consecutive 110-degree days. People have been literally sizzling on sidewalks. And news organizations are taking note of what is said to be a growing body count: 39 heat deaths in Maricopa County, Arizona; 10 in Laredo, Texas. But the precision of these figures is illusory. Cause of death cannot be measured as exactly as the temperature, and what qualifies as “heat-related” will always be a judgment call: Some people die from heat; others just up and die when it happens to be hot.