Putting the science in fiction - Dan Koboldt, Chuck Wendig 2018
The many faces of death
Research labs, hospitals, and really bad ways to die
By Bianca Nogrady
There’s a great scene in the 1987 film Outrageous Fortune, which starred Bette Midler and Shelley Long, where Long’s character is asked to perform a death scene in her acting class.
Her character, desperate to please the acting coach, delivers the most overblown Baroque impression that drags on and on with its flourishes, gasps, and gestures until finally, mercifully, she “dies.” She gets utterly roasted by the coach, but gets her revenge later in the film (SPOILER ALERT!) when, to save her life, she must convince him that he has succeeded in shooting her.
That death performance is a little different. There are no flourishes, no dramatic gestures. Just bang, and she’s down.
Thanks to Hollywood, our ideas of what death looks like are pretty skewed from the reality, either to serene closing-of-the-eyes or a Tarantino-style blood-soaked blaze of glory.
The truth is generally a long way from either of these. Watching a life end is like watching a life begin. Sometimes it’s a calm, peaceful, even beautiful experience. Sometimes it’s a horrible bloody mess. Mostly, it’s a bit of both.
The expected
There’s no such thing as a “typical” death, but there are events often reported by those who work in hospitals, hospice care, or other environments.
Cheyne-Stokes respiration is a characteristic breathing pattern that often heralds death, although it is also encountered when sleeping at very high altitudes (which can lead to some unintended alarm on the part of the sleeper’s companions!). The person’s breathing gets deeper—and sometimes faster—but then gets shallower and shallower until it appears to stop altogether … and then it resumes.
The aptly named “death rattle” is an unpleasant sound that does not necessarily imply the dying person is in discomfort. It can be a rasping, rattling, gurgling, moaning sound that is thought to be the result of saliva in the throat. Generally not a lot can be done about it.
Death often comes as one long, last exhalation, but one thing that many people report is a very sudden change in the skin appearance of the person who’s died. As the circulation stops, the skin very quickly—in a matter of a minute or two—takes on a waxy appearance as blood stops moving through the skin.
The unexpected
There are few things more shocking than having someone who has exhaled their final breath suddenly take a choking gasp, sometimes a minute or two after they have apparently died.
Agonal gasps, as they’re called, sound a lot worse than they actually are (at least for the person who has died). They’re considerably less pleasant for the people sitting by the bedside who have begun to mourn. It doesn’t mean the dead have returned to life—agonal gasps are thought to be a final reflex as the brain seeks one last burst of oxygen, but they are also a clear sign that death has occurred.
An equally surprising but much more welcome event that can occur just before death is called terminal lucidity, or “lightening up.” Many tell stories of people with dementia, Alzheimer’s disease, or brain tumors: In the final minutes of life, whatever fog has clouded their minds seems to lift. For a brief, shining moment, they are themselves again. They might acknowledge a loved one they have not recognized for years or crack a joke that gives a glimpse of the person they once were.
However, this moment is all too brief and usually only happens within minutes of death. We still don’t understand why or how it happens, but for those who experience it, it is a huge gift when they need it most.
Something similar is pre-terminal agitation, where a person who might have been bedridden and barely conscious suddenly finds the strength to get out of bed, walk, dance, or even run.
Perhaps the strangest explainable phenomenon around death is the Lazarus reflex, which is very occasionally seen in brain-dead individuals in the minutes after they are taken off artificial ventilation. They might lift their arms up in the air and let them drop crossed over their chest. It’s thought to be a very basic, primal reflex, but no amount of explanation could reduce the shock of seeing it.
The unexplainable
“There are more things in Heaven and Earth, Horatio, than are dreamt of in your philosophy.” So said Hamlet to Horatio upon encountering the ghost of Hamlet’s father.
As someone coming from a background of science, there were many things I encountered while researching death that seriously challenged my ability to explain. It is possible that all the following phenomena can be attributed to oxygen-deprived brains, happenstance, coincidence, or just a desperate search for meaning. Whether that is the only explanation becomes a matter of faith, not science.
Deathbed visitations are one such phenomenon. People sitting with the dying person often report that person having animated, excited conversations with an unseen person in the room who has long since died (usually a spouse, parent, or friend).
Whether these can be explained by science or not is a moot point: For the person experiencing them, they are as real as anything else around them. Interestingly, the type of visitor seems influenced by culture. In the West, the visitor tends to be a loved one. In countries such as India, it’s more likely to be a deity.
These visitations often have a positive effect on the person who is dying, resulting in a change of attitude and language toward a sense of journeying onward. It’s usually a source of comfort to the dying person, and to those around them.
There are many stories of pets and animals behaving strangely around the moment of death: dogs howling at a distance when their owner dies, birds flocking to the windowsill. Cats in particular have been associated with death. Oscar the cat achieved global fame when a report about his ability to pick which nursing home resident was going to die next was published in The New England Journal of Medicine.
Other unexplained phenomena reported at the moment of death include strange lights surrounding someone, clocks stopping (recall the song “My Grandfather’s Clock” by Henry Clay Work—“But it stopped short—never to go again—when the old man died”), and familiar machinery breaking down at a person’s workplace.
Death is an extraordinarily varied moment and from the perspective of a writer, there is much that can be explored through it.