Death Certificates and Heart Failure

county-clerk-300x225Death certificates are some of the worst reading material you’ll ever own.

But they are necessary for the “business” after a loved one’s death. I suggest purchasing a number of certificates, with extras stashed in a file instead of requesting a few more and then a few more.

On a practical note, the mortuary handling the death will most likely create and complete the death certificate. Official copies can be obtained from a county clerk’s office*.

Insurance companies, banks, and similar institutions requiring proof of death will often want the legal certificate issued with the county’s seal. However, when handling my parents’ estate, the companies that requested an official certificate versus those that didn’t even want a copy of a copy were never predictable.

You will scrutinize the certificate, confirming the facts are accurate about your beloved: date and place of birth, full name, his or her “usual occupation,” location of the grave, and what is

The cause of death . . .

Will death’s cause surprise you? My father’s certificate proved unsettling. According to the one-page document printed on sturdy paper, Dad died from the mundane . . . “Heart Failure.”

There was more. The “underlying cause” was Sinus Bradycardia. Huh? Soon, I was scouring the web for definitions. Thank you Mayo Clinic website . . .

Bradycardia is caused by something that disrupts the normal electrical impulses controlling the rate of your heart’s pumping action. Many things can cause or contribute to problems with your heart’s electrical system, including heart tissue damage related to aging, damage to heart tissues from heart disease or heart attack . . .

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In a recent patient care meeting at the hospice where I work I scanned the list of our patients. Several had the same terminal illness: atherosclerosis. Back to Mayo . . .

Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow.

As with my father, the patients were elderly, ranging from late eighties to well into their nineties. And also like Dad, this tongue-twisting name may become an “underlying cause” on their official death certificates.

Heart failure appears in many forms.


From my father’s death certificate.

But I don’t think Dad died of “heart failure.” Yes, his heart ceased beating. And yes, the underlying cause of sinus bradycardia involved disruption “of the normal electrical impulses controlling the rate of your heart’s pumping action.” On Dad’s certificate, there is also a box with the category of “other significant conditions contributing to the death.” It contains one word that, as far as I’m concerned, was the cause of his death: dementia.

You see, I’m only a son that believes—because love guides my judgments—my father’s “heart” could never fail. It was dementia that slowly killed him, crushed his spirit, and became a disease causing dis-ease in the family. Please, put dementia first. Referring to dementia as an “underlying cause” is too damn polite.

On death certificates, I wish the deceased could be categorized as dying from “old age” or “natural causes.” Isn’t that what really happens for those in the eighth and ninth (and more) decades of life? A heart is a muscle, and all those arteries supplying the body’s vital pump eventually clog. With age, it’s inevitable. The body’s electrical impulses slow or become erratic. With age, it’s inevitable.

But how can I—a loving son and a guy that cries at sad movies—only see Dad’s heart as a muscle?

I’ve known friends and hospice patients that died of broken hearts. Didn’t they? After decades of marriage, a soulmate dies (oh let’s say the official cause of death was COPD). Weeks or months later the other spouse dies, with his or her death certificate identifying sinus bradycardia—or another nasty noun—as the so-called official reason.

The certificate’s facts aren’t lying, but they sure seem inadequate. Instead, often enough, wasn’t a broken heart the more honest cause?

There are many ways and lists for how humans die. Recently the Center for Disease Control published a map of the United States showing which cause of death occurred most frequently in which state. It’s fascinating . . . and literally morbid. When patients enter hospice care, a disease “label” is always linked to her or his name. For people like me, ignorant of medicalese, causes like evil cancer or despicable AIDS are “easy” to understand. But there are pages of arcane words that cause me to hunt across the web or to ask a friendly nurse colleague for help.

When reading about those with sinus bradycardia or atherosclerosis in a hospice meeting, I now know what they mean. And though still struggling to properly pronounce them, I’m sure they will eventually appear on death certificates somewhere underneath “heart failure.”

But even more I believe, for the caregiver and the hospice patient, for the family member and the beloved with a terminal illness, for the ones grieving the ones who have died, every heart will fail because they are all broken.

Death certificates are recorded facts, but they rarely reflect our deepest hurts and truths.


*Here is the webpage with instructions about death certificates from where I reside: Fresno County, in California. An easy web search or a few phone calls to your city or county clerk will provide similar information. Or ask the hospice that has been helping you.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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