Despite advanced neurotechnology, there's one very human step in the diagnosis of death in the ICU.

Diagnosing brain death entails three rigorous criteria, all of which must be met without question.

The exact moment of death is often arbitrary, but extremely meaningful to loved ones.

The longest ten minutes of my life are those I spend in perfect stillness and silence in the final throes of the brain death examination.

A young woman had been admitted after a highway crash, extricated after a long two hours from twisted metal that had crushed the car roof and doors. Her pupils were fixed and dilated when she arrived. She had been intubated in the field by EMS, lips and face blue, not able to breathe on her own. We cared for her bruised body gently, but her only life-threatening injury was bleeding and swelling in her brain, compressing her brainstem—our seat of life.

We tested her neurological function repeatedly for two days, for any sign of brainstem function—for any sign of life.

We found none. It was my job to carefully take her through the rigorous criteria we would need to pronounce her brain dead, while her........

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