Chapter – 9
THE MOMENT OF DEATH
He took one immensely long,
Gurgling breath, and died.
– Sherwin Nuland Becomes a Doctor.1953.
The physiological changes that occur at the time of death are usually straightforward to the doctors: the heart stops pumping blood and cells of the body no longer receive oxygen or nutrients, so they begin to die. What worries most people is not as much the moment the heart stops as the prospect of knowing when their own death is imminent. “It is not the moment that matters, but the moment before the moment,” says Dr. Nuland.
Physically, that fleeting moment is characterized by the appearance of physical struggle, although the dying person is not aware of the struggle. Without oxygen, cells die and organs die. The body’s ultimate response to the lack of oxygen is visible in what is called the “agonal moment,” immediately before the clinical death, (heart stoppage) occurs. The declining oxygen content in the blood may cause muscle spasm. Normal breathing may be replaced by gasps. A brief convulsion may wrack the body. Then it’s over. Some people go from relatively delirium state to sleepy to lethargic to obtunded to semi comatose to comatose and then death.
By the time the agonal moment arrives, even a person who has anticipating death for months is not likely to be aware of the quick struggle. Whether a person is at this moment aware of anything is unknown. The cause of death corresponds to the consciousness of death. Some people who die suddenly in accidents no doubt have no idea that their last conscious moment is their last. Those who experience a more prolonged death may indeed be aware of the moment is upon them.
Near Death Experience
A near-death experience (NDE) refers to personal experiences associated with impending death, encompassing multiple possible sensations including detachment from the body, feeling of total serenity, security, warmth, the experience of absolute dissolution, and presence of light. These phenomena are usually reported after an individual has been pronounced clinically dead or has been close to death. With the recent improvement in cardiac resuscitation (CPR) techniques, the number of reported NDE has increased.
Characteristics of NDE
The traits of a classic NDE are as follows:
- A sense of being dead.
- A sense of peace, well-being and painlessness. Positive emotions. A sense of removal from the world.
- An out-of-body experience. A perception of one’s body from an outside position. Sometimes observing doctors and nurses performing resuscitation.
- A “funnel experience.” A sense of moving up, or through, a passage way or tunnel or staircase.
- A rapid movement toward and or sudden immersion in a powerful light.
- An intense feeling of un-conditional love.
- Receiving knowledge about one’s life and the nature of the universe.
- A sense of going across a bridge where the dead relatives are calling.
Harvesting of Organs for Transplant
As soon after the moment of death as possible, any organs (cornea, heart, lungs, kidneys etc.) destined for transplantation must be removed. The removal of organs for transplant is like routine surgical operation, known as “harvesting”. The removal implies all the abundance and nourishment of a literal harvest, for it offers the recipient life.
Surgeons carry out the procedure in a sterile operating room in which the donor is hooked to life-support machines to keep the heart beating. Because of the life-support system, the organs continue to receive oxygen through the blood. The sequence of the operation depends on the number of organs the deceased is donating. When multiple organs are being removed successive teams of surgeons from appropriate specialty, move in and harvest the organs separately.
At times, the recipient of the organ waits, prepped for surgery, in a nearby operating room. More often however, the organ must be packed up and transported as quickly as possible to the recipient hospital. The need for speedy transport means that most donated organs go to waiting recipients who live nearby. How long an organ remains viable for transplant depends on the organ.
A heart-lung combination must reach the recipient in four to five hours, while in kidney transplants the interval may extend as long as 48 to 72 hours. A heart alone may be transplanted six to eight hours later and lungs alone up to 12 hours later.
Tissue donation is equally important but less urgent process. A tissue may be removed after the physicians turn off the life-support system and kept for much longer before being transplanted. These include corneas, bones, skin, veins and heart valves.
Death, Disposal and Contagion
Any tissues of the dead that will not be transplanted from a corpse into a living recipient must be disposed of in some manner. Such disposal and the manner in which it is carried out depend on cultural tradition. Although many cultures and religions view dead bodies as unclean, today’s dead posing no threat to the health of the living except in highly unusual circumstances like Ebola.
Although investigations have shown that some germs do survive in the body for sometimes after death, the chances that a person who has normal contact with the dead might be infected is extremely low. Corpses of those had been infected with deadly viruses like – Ebola, and HIV, pose no particular risk if handled with adequate protection – gloves, masks, and rigorous cleaning.
The Sequel to Death
Depending on the manner of its disposal and, if applicable, on how much time elapses between death and cremation or embalming, a dead body undergoes a number of distinct changes. Those that take place soon after birth are readily detectable by sight or with simple instruments. The dust-to-dust process that we call decomposition are initially invisible to the naked eye, but soon become very evident indeed. The first three signs that life has fled (beyond cessation of heart beat and breathing) are changes in body temperature, color and rigidity.
Algor Mortis (Temperature of Death)
Body temperature drops in a phenomenon called algor mortis or temperature of death. How quickly the body cools depends on how warm the living body was at death. Body temperature drops about one degree (Farenheight or 5/9C) per hour until it reaches that of the air surrounding it. For example, if a person died with a normal body temperature of 98.6F, the dead body would have a temperature of 96.6F two hours later. In case of abnormal circumstances – like drowning death in freezing water, or high fever before death, the medical examiner cannot accurately determine the exact time of death as the cadavor’s temperature is variable.
Liver Mortis (Color of Death)
Blood has two major components – red blood cells and plasma. When the heart stops, the mixing up of the red blood cells and plasma stops. As a result the red blood cells settle to the lowest part of the body, such as the back if the corpse is lying on its back. The process is called liver mortis or color of death. The rest of the skin grows correspondingly pale as the red blood cells sink. After about two hours, the settling becomes visible; the skin becomes reddish where the red cells are concentrated. Eight hours after death, the red cells break down and the color becomes permanent. The resulting reddish-purpose discoloration is known by morticians as postmortem stain.
Rigor Mortis (Rigidity of Death)
The word rigor mortis means the rigidity of death. Immediately after death, the body relaxes completely. The face loses expression as muscle stop controlling the skin, which then sags. In normal circumstances, rigor (stiffness) begins to set in about two hours after death, sooner in a cold environment. Rigor mortis occurs first in the face, then moves to the trunk, limbs and internal organs. The stiffness peaks after twelve hours before the body gradually become limp again as rigor fades, then vanishes entirely within 24 to 48 hours, depending on temperature and other variables. The cause of rigor mortis is uncertain. It may be the result of the coagulation of muscle protein or metabolic processes that continuous in some cells after death.
Decomposition
At cellular level, autolysis (cell self-destruction) breaks the body down, if the body is not treated by chemicals of embalming. Embalming is the preservation of the corpse from decay by using spices and chemicals. The cells receive no nutrients after the heart stops beating and begin to die. They die in increment. Packs of destructive acids break loose within the cell and finish it off.
The first visible sign of rotting (putrefaction) appears two or three days after death. The gas produced by the intestinal bacteria, which contains sulphur, accounts for the rotten smell. The gas also gives a bloated appearance to the body. Most internal organs rupture and eventually liquefy within two to four weeks (depending on the environment). What essentially remains of a dead body is a skeleton with skin. In high altitude of cold and dry environment the dead body can be preserved for several hundred years.
Autopsy
Autopsy or postmortem, is the dissection of the dead body to find the cause and manner of death. Whether performed shortly after death or after decomposition has progressed-the autopsy is the most important tool for determining when, why and how a person died. It can also yield information that can save other lives. Observations made during autopsy have in some cases have saved thousands of lives or helped to characterize a new disease. Doctors and medical examiners learn a lot from autopsy.
The first systemic dissections of the human body to determine the cause of death began in University of Bologna, Italy, around the beginning of the 14th century. Since then it has been a teaching tool for the medical students and doctors. Even though many family members are unwilling to give consent for an autopsy, in many instances, autopsy can provide a measure of comfort to families by providing them the exact cause of the death of their loved one. Many times the diagnosis written on the death certificate immediately after death is not necessarily correct. Many times people die in mysterious circumstances without being outwardly being sick. There can also be discrepancies between the medical findings before death and autopsy findings. Hence, an autopsy is essential when the nature and modality of the death is uncertain.
These days pathologists doing the autopsy are quite sensitive to cosmetic issue. They do their best to preserve the outer appearance of the dead bodies. A limited autopsy excludes the head but includes the rest of the body. In a selective autopsy, the pathologist examines only the relevant areas. Medico legal autopsies are mandatory when death occurs under unexplained, suspicious or criminal circumstances.
Conclusion
There is a passage in the Buddhist sutra on mindfulness called the Nine Cemetery Contemplations. Apprentice monks are instructed to meditate on a series of decomposing bodies in the burial ground, starting with a body “swollen and blue and festering,” progressing to one being eaten by …. Different kinds of worms, and moving on to the skeleton. The monks are told to keep meditating until they were calm and a smile appeared on their faces. The idea is to come to peace with the transient nature of our bodily existence, to overcome the revulsion and fear.
You are dust, and to dust you shall return.
– Book of Genesis, (Bible) 800 B.C