I remember the first time as a physician I was asked to pronounce a person dead. My first job as a freshly graduated medical student was as an intern in the emergency ward of a large city/county hospital. So as a rookie ER doc I was told to legally declare the person in Room 12 dead.

In the sanctuary of medical school that I had just left a few days before, I didn't remember a course on being dead. Of course we learned the structure of the human body in the first-semester anatomy class, and that cadaver was dead. And there had been deaths of patients in the wards that I had cared for along with the team of residents and the professors of medicine or surgery. But this was different. Then I was just a student, now I was a doctor of medicine; my diploma said so.

The person was an elderly female brought to the emergency room by her family. There was no lengthy medical history. It was just a body that didn't move or react. It didn't seem to breathe, and the circulation was poor to say the least. I wasn't instructed in any protocol, so I just looked at her for a long while. She was clothed in a white dress with small blue flowers. There was no jewelry and no shoes. I discovered that if you stare long enough at a dead body it will seem to breathe with the chest appearing to move ever so slightly. Or so it seemed to a pretty frightened intern.

I proceeded to pull out my stethoscope and listen for a heartbeat and then moved to hear any air exchange in the lungs. Then, too, it was easy to wonder if there was just a faint wisp of air or a single lub-dub of a heart contracting one last time. There was neither. Then I attempted to look for any light reflex in the eyes. They were fixed, and no one looked back. There was a time I even wondered if I was supposed to yell at her or shake her to see if she would respond, but I didn't. I wasn't sure what else to do.

The family had discovered her dead, so I just had to make it official. I, not the family or the police or the ambulance driver, but I, the doctor, had the honor, privilege, the job to make it legal. With my act she was not going to officially walk, eat, sing, pay taxes or breathe again in this life. I did it.

I have seen dying since. I have signed death certificates since. But I wonder from time to time if there are others walking around seemingly breathing who are really dead. There is still the chest movement signifying breathing, but there seems to be little life. That doesn't mean doing nothing is the sign of death. Sitting in the sun with the warmth on your face appears death-like, but it is savoring the sun. However, it is when a person doesn't feel alive that I worry they have already expired while the heart beats on.

There are circumstances when a person may not feel alive. Being alone and lonely is one. Being depressed and emotionally cut off from self and others is a near-death experience, and with suicide the "near" goes away. Ignoring the world around us and its incredible wonder is a form of death. The eyes of the dead don't see a sunrise, notice a blooming flower or the beauty of a child's smile. So if we are too busy to look, what does that say about our living? Enjoying the moment and others is a sure sign of life. If we don't, then we are not much better than a corpse. There is a line between being dead and officially dead. Don't make me pronounce you.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at jgcramermd@yahoo.com.