• Death is not what it used to be
  • The boundary between life and death has become blurred by new medical treatments,

    Recently, I found myself discussing what makes for a great literary death with my fellow judges of the 2011 Wellcome Trust book prize for medicine in literature, ahead of a debate we’re having at Waterstone’s next month. The contenders ranged from the last moments of Harry “Rabbit” Angstrom in John Updike’s Rabbit at Rest to the mawkish demise of Little Nell at the conclusion of Dickens’s The Old Curiosity Shop, which reduced the Victorians to sobs and Oscar Wilde to tears of laughter.

    As we tried to separate the ludicrous from the lachrymose, I used an example from non-fiction to show how the reality of death can be more intriguing than anything in a novel. You won’t find an everyday deathbed scene in The Perfect Storm, Sebastian Junger’s account of the disappearance of a swordfish boat off Nova Scotia in 1991. We will never know exactly how the men died – so to recreate their plight, Junger turned to people who had been through similar experiences and survived.

    At the end of the chapter in which the fate of the six men on board is sealed, the details of death by drowning are so specific, and so dispassionately drawn, that they feel chillingly true, from the collapse of alveoli in the lungs to the erratic beat of an oxygen-starved heart and the winding down of the metabolism. Junger writes: “The body could be likened to a crew that resorts to increasingly desperate measures to keep their vessel afloat. Eventually, the last wire has shorted out, the last bit of decking has settled under the water.”

    Dig a little deeper, and you will find that, just as a watertight definition of life remains elusive, the moment that it ends is equally hard to pin down. One upon a time, you would be pronounced dead if your heart appeared to stop beating. This accounts for many famous examples of people coming “back from the dead”, waking up in coffins and crying out in morgues.

    Vivisepulture – being buried alive – is one of the most widespread and ancient of human fears, which is perhaps why an increasing number of people ask to be buried with their mobile phones, just in case. In July, a 50-year-old South African man woke up inside a mortuary one weekend and screamed to be let out – scaring away the attendants, who thought he was a ghost. His family had presumed he was dead when they could not wake him, and rather than ask a doctor, had packed him off to the morgue. Concerned by such cases, a local council in Turkey has built a morgue with a warning system, and refrigerator doors that can be opened from the inside.

    Yet death, more broadly, is not what it used to be. In a recent New Scientist, we report on the case of a 55-year-old man, pronounced brain-dead after a cardiac arrest, who was minutes away from becoming an organ donor when he began to cough and show signs of life.

    In his case, the boundary between life and death was blurred by cold. Increasingly, doctors treat heart attacks by inducing therapeutic hypothermia, cooling the body to about 33C to minimise the damage to tissues and brain cells caused by oxygen deprivation, and boost the patient’s chances of survival. Yet such cooling also interferes with the brainstem reflexes used to assess brain death – whether the pupils respond to light – and the level in the blood of an enzyme, neuron-specific enolase, that seeps from dying nerve cells.

    Adrian Owen, of the University of Western Ontario, Canada, has used brain scanners to investigate the twilight states of consciousness that lie between life and death. He says there has been much discussion about whether doctors need new rules to weigh up the chances of recovery from comas, after hypothermia has been used.

    Ethical, moral and religious concerns are also gnawing away at the discussion of how and by whom death should be determined, and contributing to unease about what a patient experiences in a coma or vegetative state. “It is only five years since we discovered that you could use brain scanners to show that some people who appear to be vegetative are not vegetative at all,” says Owen. “Who knows – 10 years from now, we may be using similar technology to decide who’s dead and who isn’t. There may be some surprises…”

  • Share

Appreciations [?]