May 24, 2021 • 23 mins
It’s time to talk. It is never too late for a rigorous conversation about death activism, the guillotine and the ferocity of human love — unless, of course, you are dead already.
It is time to meet the death doulas who can help you through this, and learn why a “good death” might not be a good thing, and why it might be time to sit down with a pen and a pad and do a little thinking about your own exit.
Deeply Human is a BBC World Service and American Public Media coproduction with iHeartMedia.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
If we were at a party and everybody had two beers,
and then I asked, what do you do for a living? Like,
what do you actually say? In social setting? It depends
how quickly I need to leave. If I need to
leave soon, I'll usually say I teach sociology, which isn't
(00:28):
really true, but I know it's really boring sounding, so
then everyone's like, okay, bye. However, if it looks like
I've got some time and I know the person will
want to talk to me, I'll say I'm Director of
the Center for Death and Society and I do research
on death, dying, and the dead body, and interdisciplinary studies
(00:49):
around everything to do with death and dying. That is
Dr John Troyer, who lectures at the University of Bath
in England and is the m v P of Every party.
I am ess a host of Deeply Human and Deeply
Human is the podcast you're listening to, And a podcast
is like a balsamic reduction of pure knowledge drizzled in
(01:12):
through your ears to season your brain. Today's episode is
about dying and why you shouldn't put off talking about
it until you're dead. So part your hair down the
middle and your best Wednesday Adams and stretch out for
rigorous conversation about death, activism, the guillotine, and the ferocity
of human love. Love of mine, someday will die, but
(01:38):
I'll be close behind. I'll follow you into the dark.
You're blinding line. Okay, So back to the party scene.
How does John introduce himself when he's off the clock
in that scenario where you give him a long, interesting answer?
Do you know what they're going to say next? Yeah?
(01:59):
Usually this is actually almost always the way it happens.
They'll say, oh God, wow, Okay, I have to ask
you this question, and then it just goes into about
thirty minutes to an hour or a couple of hours
of just relentless questioning about everything and anyone's ever wanted
to know about death and dying, which is normal. I
expect that because people are genuinely interested in it, like
(02:19):
it is a constant and if you can say anything
about humans as a species, and this might strike some
listeners is a bit grim, but I think it's completely accurate.
Is that if there's anything we're good at, it's dying,
that eventually it's going to happen. I met John a
bunch of years ago before he'd moved to England and
before he was a death rock star. We met in
(02:42):
our twenties, both of us competing in the slam poetry
scene in Minneapolis. He seemed funny and weird and smart,
an assessment that still holds. And my delivery of a
rhyming poem about metaphysics at one of our competitions must
have passed mustard because he invited me to sit in
on the defense of a PhD dissertation, and that seemed
(03:02):
like a terribly adult way to spend an afternoon. So
I went, and I was mesmerized listening to John talk
about the science and culture of death. How the first
embomed bodies were carted around the US like sideshow attractions,
how people used to pose for pictures with their recently
deceased relatives, and unless you look really closely at the photos,
(03:24):
it's tough to tell who's warm and who's dead. Death,
as it turns out, runs in John's family. So my
dad was a funeral director for many years, owned a
couple of funeral homes, worked at other couple of funeral homes,
and you know, I just grew up watching him organized,
run and do funerals. But He also taught cosmetology, so
(03:45):
he taught the makeup classes. Apparently he was a very
good at matching skin tone. His students would tell me,
it's like Dan really good at the makeup, and I
was like, well, it's good to know. For the record,
John didn't want to follow in his dad's footsteps, and yes, dude,
he has seen the HBO series six ft Under. John's
(04:08):
interest was more intellectual. He wanted to investigate how technology
affects the way that society treats death and dead bodies.
For example, these days, we're living further apart from our families,
which means that we're dying further apart. Two and so
embalming services are in steady demand because by injecting a
body with preservatives, we get a shelf stable corpse that
(04:30):
allows the family time to gather. Because of this embalming technology,
the dead body in your imagination might look sort of
like a living person who's asleep, But before the Civil War,
dead bodies looked really different than living bodies. They start
to decompose, they turned black. Okay, quick extra credit fact.
(04:50):
Abraham Lincoln played a really big part in popularizing embombing
after his assassination. His body was taken across the country
in a special train car for public viewing, and it
was embombed more than once along the way. New technologies
can shape the way that we handle are dead, and
new political ideas can change the way that we die.
(05:14):
For example, California becomes a first state to pass in
what's called the Natural Death Act, and the Natural Death
Act states you have a right to refuse treatment and
to die naturally. And we think about that today is
almost being given, But it wasn't. It wasn't. There had
to be a law that was created and then passed
along you could tell people both medically and ethically, but
(05:37):
also philosophically and politically. And again I think the political
side of this is very important. You have a right
to die by refusing treatment if you no longer want it.
And why is that political? Well, because it was a
statement of autonomy. I will die as I choose. And
there's a longer history here of a break than from
religious tradition because of course, for many centuries you did
not die the way you chose. You died the way
(05:59):
God chose. Is well, if you say I die the
way I choose, that means then that the state or
whatever governing powers in place, no one will tell me
how I can die. In the nineteen seventies, universities in
the US and the UK taught sociology of death, courses
and activists fought to change our approach to death with
(06:21):
conversations about assisted suicide, end of life, rights and dignity
and death, and the living Will was invented, a document
that expresses a person's wishes for healthcare when they're no
longer able to make those decisions. I thought that all
these shifts in thinking and practice were designed to provide
(06:42):
people with a good death. John not so much. There's
been lots of conversations around this idea of a good death.
I've never been big on that terminology because then it
suggests there's a bad death. And I'm not saying you
can't create qualitative judgments around these things, because I think
we can talk about preferred ways of dying. But I
(07:03):
think ultimately what we're talking about in terms of death is,
you know, death is a phenomena you're, regardless of goodness
or badness, is going to happen. But I'm see I'm confused.
I mean, in some ways it feels like, oh, I
don't know, like why shy from normative terms, because if
I were to compare two ways of shark attack versus
(07:25):
in the arms of my beloved, like one of those
deaths is clearly sort of lousy and one is like
why better? Right now, I understand that the concern you
can come up with, and this is something that it's
been discussed that because once you start to create expectations
around dying, people can start to feel like they're doing
it wrong. And that's always been one of my big
(07:46):
concerns with a lot of the discussions around death and
dying in all different kinds of facets society, which has
been going on out for like the last twenty years.
It's never not been a hot topic as it were.
But I think that what happened is families, and usually
families more than the dying, but sometimes the dying they
can feel like they're doing it wrong. That fear that
(08:13):
I'm somehow messing up at this basic biological function is
one you might have also heard. In relation to childbirth,
Moms can face a lot of pressures about how and
where to deliver at home, at the hospital, in a
birthing center, with or without pain meds in a tub
of water, preferably on a weekday. A lot of parents
hire birth doulas to help with their pregnancy and delivery.
(08:36):
Doulas aren't part of the medical team, but there are
a source of support and encouragement and they've got a
lot of experience helping tykes into the world. There are
also death doulas who help people to leave the world.
I die with people. I say die with them because
I feel like with every person I die with, I'm
(08:56):
a little closer to understanding what death is. And that's
just the last breath. There's nothing more magical about it.
Denise Love has worked as a death duela for twenty
eight years. She's also helped set up hospices and worked
as a registered nurse, and part of her motivation in
life is to help people talk about death, to be
less afraid of the whole conversation. I think the fear
(09:19):
is just too great. I could talk about it, you
might drop dead. It's just terrified to use the word.
Even most people don't ever use the word. In their eyes.
We pass away or somebody's ill, we avoid the language
of death. Denise has spent a lot of time working
in the developing world with people in Nepal, Myanmar, Cambodia,
(09:39):
and Thailand, which is where she was when I spoke
with her. The death's Denise has witnessed and the developing
world look really different than those she's been a part
of in Western societies. Whatever this thing we're telling everybody
is to fight, that's a lot of nonsense. There's nothing
to fight. Surrendering to death means a comfortable death. That's
my theory behind it. To die people often have to
(10:02):
fight with their loved ones to die, absolutely, So come on, dad,
you can do it. Fight it. You're going to be
seventy six tomorrow, or you know. A young pregnant woman
kept saying to her husband, could you just hold on
and do I have the baby? And he looked at
and he said, I can't. How do I tell her
(10:23):
I'm done? I don't want to do this anymore? So
I said, let's bring her in and tell her. And
he just had terror in his eyes. And we had
the most amazing hour of if you love me, you'll live,
and if you love me, you'll let me die. And
we had that beautiful, difficult conversation which was sort of
a bit heated at times, but really negotiations, so a
big death. Doller's job is getting a family talking in
(10:46):
an honest and open way. But again there's a lot
of disagreement, and one daughter wants this, and one daughter saying,
come on, you can help you live. Let's give him
vitamins and let's duce another twenty three thousand karat to
be giving kale, and it's making drink his own urine.
I mean, I've been through everything, and then I just say,
let's all go inside and talk to them, and I say,
(11:08):
do you want to live? What do you want to die?
I mean, nobody answer that question because it seems selfish,
and I've already told me they want to die usually,
So you know, I feel really comfortable bringing the family
and just saying can we let him go if you
love him? Just saying about I've always thought a lot
(11:34):
about death, even as a little kid, and you hope
that when the time comes, you can spare the people
you love pain or discomfort. But it hadn't occurred to
me that I might help my loved ones by releasing
them from any obligation they might feel to stick around
when someone's really sick and maybe dying. I already know
to ask, does it hurt? Okay, then let's talk to
(11:57):
the morphine nurse. Now. I also know to ask, hey,
do you just want to leave now? Because I don't
want to keep you. This is your show, so don't
stay late for me. That's a kindness, that question, and
I'm grateful to Denis for handing it to me. Our
(12:28):
next guest, Dr Sam Parnia deals in total totally different
sorts of questions. Do you think that there might be
a future where a good number of us died? Many times?
I think what you're going to see is when resuscitation advances,
(12:51):
then there'll be many people who can say, oh, I had,
like you know, full cardiac rest in my life and
nothing mattered. I was dead for twelve hours, sixteen hours
they brought me back. If our body is still in
good shape, we will be able to be revived and
allowed to live another ten or twenty or thirty years.
Dr Sam Parnia is the director of the Critical Care
and Resuscitation Research Program at New York University. He specializes
(13:14):
in bringing people back to life, and he thinks that
his technology advances will have a lot more lazaruses and
lazarettes amongst us, I asked him to start with a
working definition of death in practice, How would a physician
know if a patient is dead like dead dead dead.
It's interesting because I think most people listening will think
(13:37):
that they understand death and it's pretty simple. You're either
dead or you're alive. And the reality is that was
true because for thousands of years, whenever a person's heart stopped,
they would essentially reach a point where they were irreversibly dead. So,
to answer you a question, the way the physicians declass
somebody dead is that their heart stops. When the person's
(13:57):
heart stops, they also stop breathing, and because there's no
blood flowing around the body, there's no energy, and the
brain also shuts down almost immediately. So the three criteria
that they look for are no heartbeat, no breathing, and
absence of brain response. But as our tools and understanding
have evolved, the heart, breath, and brain don't always stop
(14:20):
on the same time. Ventilators can breathe for a body
that's unable to respire on its own, for example, So
what if machines performed the duties of the heart and
lungs but the brain has stopped working. Is that person dead.
To answer that question and others like it, a commission
(14:40):
appointed by US President Jimmy Carter published a report called
Defining Death. It said a person was dead if one
of two criteria were met, either irreversible cessation of circulatory
and respiratory functions, so like your heart stopped and you're
not breathing, or irreversible cessation of all functions of the
(15:04):
entire brain, including the brain stem. But not all the
states adopted this definition in exactly the same way. New Jersey,
for example, provides an exemption for patients whose religious views
might be compromised by declaring brain death, so their families
can ask that doctors use only the cardio pulmonary definition,
(15:24):
the heart and long one, which means that a person
would be considered dead in one state might not be
dead in another. As definitions get more clinical, even our
fundamental intuitions about death can start to give way. We
(15:44):
socially have defined death as this irreversible moment where a
person becomes lifeless, motionless, and they can never come back
to life again. But it's important to understand that's just
simple social and philosophical notions, and that as medicine and
science have evolved have understood that actually death this far
more complicated than we ever thought it could be. To
further complicate the question, not all of the cells in
(16:06):
your body die at the same time, So how long
does it take for the human brain to go offline?
If you were to be decapitated, would consciousness stop instantaneously?
That question was not at all hypothetical when the guillotine
was in vogue. The device was invented specifically to serve
(16:28):
as a humane method of execution, which would hardly be
true if a head severed from its body had the
chance to appreciate its circumstance. In nineteen o five, a
physician named Gabrielle Bourier conducted an experiment. He witnessed an
execution of a criminal, approached the decapitated head and shouted
the man's name. The doctor said that the man's eyelids
(16:50):
lifted normally as they would in life, the pupils focused,
and the eyes fixed on his own. Okay, trying to
play the cool former goth kid over here holding steady
in her combat boots, But I cannot fathom more chilling
experience on all of the earth than commuting with a
severed head. It may be difficult to demarcate the exact
(17:13):
threshold where life ends, but of course all of us
will die eventually, and we'll lose people we love too.
The human animal is fully aware of our own impermanence
and the fragility of our family and friends, but we
go ahead and love them anyway. John Troyer, the expert
and poet who we met at the beginning of the show,
(17:33):
devoted his career to contemplating death and dying. But all
those years of professional expertise didn't prepare him for a
big personal loss. So on July, my younger sister, Julie,
died from brain cancer at age a couple of young kids,
(17:53):
husband lived in Italy, so she died in Italy. I
was diagnosed in flight July, and then, you know, had
a year of life and it was shocking, and I
discovered a couple of blind spots that I had in
the context of my sister's dying process, which is one
it was clear at the end of April that she
(18:15):
was dying, like there was no coming back from where
she was the cancer of progress. And I knew it,
My dad knew what, my mom knew it, and no
one was saying anything about dying. Fast forward, I will
then actually be the person who tells my sister she's dying.
Used the word dying in July of twenty eighteen, so
(18:38):
sixteen days before she dies, and she was already in
the summer receiving outpatient hospice care from a wonderful hospice
in Italy. So as to why I was actually talking
about that, I don't know. Partly that's a cultural practice
in Italy, but too because I think, you know, some
of her friends just were they were unsure what to say,
and my brother in law was being told by the
counselor is like, well, you know, let her ask, And
(18:59):
I mean, they're a whole lot of things going on involved,
and it all in a way it makes sense. But
I think it was also very important to tell Julie
she was dying, because one I did, and she said, well, yeah,
I mean I guess I knew, but thank you for
saying this. And it changed then her end of life
trajectory and care because suddenly then everyone was saying dying
and it no longer meant that we had to pretend, right,
(19:24):
how does it change it using that word? You know?
How does that change care well, I think. And what
I told my sister was, Julie, I can tell you
you're dying. You're hearing me say dying. You have to
be the one who says I'm dying because everyone needs
to hear you saying it, because you saying it will
make people take it more seriously. And she said, okay,
(19:44):
I understand. Um, That'sai. Well I got choked up, but
that's okay, Um, I'm happy to talk about because it's
it's it's interesting to me that I've gone for so
long without getting choked up about t story about the
one thing she said to me that I has always
stuck with me. You know, she says, I would do
(20:06):
the same for you, and and she would and she
would have done the same exact thing for me, and
I the thing that I think this is why I
always think about it, Like for everything I know about
death and dying, which is perhaps a lot more could
be learned than on the first to admit that for
everything I know, when presented in this moment, I will
(20:28):
always wonder why I didn't say what was clearly obvious.
And and again it's not a moment of regret. I
just won't I don't understand why, fellow immortals. Now would
(20:51):
be a great time to pause this podcast and send
a text to someone you love. I'm gonna h While
Julie was dying, John was working on a book called
Technologies of the Human Corpse. He included some poems about
(21:12):
his sister, and at the end of the book he
lists a bunch of questions that you can answer now
to make choices about the way you'd like to die
and be memorialized. I'm going to paraphrase a few of
them here. Think about drotting down your responses and sharing
them with someone you love, or maybe listen together and
swap answer sheets. Number one, the price range I would
(21:35):
like spent on my funeral is Number two? Does someone
have all your passwords and log ins? If so, who?
Number three are there's certain songs you'd like included on
your funeral playlist? Number four? Do you want life support?
(21:58):
Under what conditions would you like to be removed from it?
Number five? Do you have an outfit you'd like to
be dressed in? I really like that last one. There's
this almost universal protocol that dead people should be dressed
(22:18):
in their Sunday best, But I suck in high heels.
I want to go out in my combat boots. I've
walked the world in those, I've done my best work
in them. I've fallen in and out of love in them.
So lace them tight and double not them, please, I'm clumsy.
Special thanks to Dr Troyer for his time and his
(22:40):
candor John you aren't class act. And thank you, esteemed
listener for hanging out. Our time is finite and ever fleeting,
and so I'm very grateful you've spent some of yours
with me. Deeply Human is a BBC World Service, an
American public media co production with I Heart Media. Many
(23:07):
humans of great depth have been involved in the making
of Deeply Human, so credit where it's due to Senior
commissioning editor Steve Titherington, editors Rich Knight and Hugh Levinson,
series producers Ben Crighton, Sandra Canthal and Simon Mabn, producers
Monica Whitlock, Jemma Nuby and Hannah Moore, researcher Beth and
head production coordinators Janet Staples and Blaze Hesselgren, and for
(23:31):
making it all sound beautiful. Our studio managers James Beard
and Tom Bricknell, and the composer of the deeply human
theme that is in your ears right now is Nick Thorburn.
I think I said this already, but I'm Dessa. Thanks,
see you next time.
If we were at a party and everybody had two beers,
and then I asked, what do you do for a living? Like,
what do you actually say? In social setting? It depends
how quickly I need to leave. If I need to
leave soon, I'll usually say I teach sociology, which isn't
(00:28):
really true, but I know it's really boring sounding, so
then everyone's like, okay, bye. However, if it looks like
I've got some time and I know the person will
want to talk to me, I'll say I'm Director of
the Center for Death and Society and I do research
on death, dying, and the dead body, and interdisciplinary studies
(00:49):
around everything to do with death and dying. That is
Dr John Troyer, who lectures at the University of Bath
in England and is the m v P of Every party.
I am ess a host of Deeply Human and Deeply
Human is the podcast you're listening to, And a podcast
is like a balsamic reduction of pure knowledge drizzled in
(01:12):
through your ears to season your brain. Today's episode is
about dying and why you shouldn't put off talking about
it until you're dead. So part your hair down the
middle and your best Wednesday Adams and stretch out for
rigorous conversation about death, activism, the guillotine, and the ferocity
of human love. Love of mine, someday will die, but
(01:38):
I'll be close behind. I'll follow you into the dark.
You're blinding line. Okay, So back to the party scene.
How does John introduce himself when he's off the clock
in that scenario where you give him a long, interesting answer?
Do you know what they're going to say next? Yeah?
(01:59):
Usually this is actually almost always the way it happens.
They'll say, oh God, wow, Okay, I have to ask
you this question, and then it just goes into about
thirty minutes to an hour or a couple of hours
of just relentless questioning about everything and anyone's ever wanted
to know about death and dying, which is normal. I
expect that because people are genuinely interested in it, like
(02:19):
it is a constant and if you can say anything
about humans as a species, and this might strike some
listeners is a bit grim, but I think it's completely accurate.
Is that if there's anything we're good at, it's dying,
that eventually it's going to happen. I met John a
bunch of years ago before he'd moved to England and
before he was a death rock star. We met in
(02:42):
our twenties, both of us competing in the slam poetry
scene in Minneapolis. He seemed funny and weird and smart,
an assessment that still holds. And my delivery of a
rhyming poem about metaphysics at one of our competitions must
have passed mustard because he invited me to sit in
on the defense of a PhD dissertation, and that seemed
(03:02):
like a terribly adult way to spend an afternoon. So
I went, and I was mesmerized listening to John talk
about the science and culture of death. How the first
embomed bodies were carted around the US like sideshow attractions,
how people used to pose for pictures with their recently
deceased relatives, and unless you look really closely at the photos,
(03:24):
it's tough to tell who's warm and who's dead. Death,
as it turns out, runs in John's family. So my
dad was a funeral director for many years, owned a
couple of funeral homes, worked at other couple of funeral homes,
and you know, I just grew up watching him organized,
run and do funerals. But He also taught cosmetology, so
(03:45):
he taught the makeup classes. Apparently he was a very
good at matching skin tone. His students would tell me,
it's like Dan really good at the makeup, and I
was like, well, it's good to know. For the record,
John didn't want to follow in his dad's footsteps, and yes, dude,
he has seen the HBO series six ft Under. John's
(04:08):
interest was more intellectual. He wanted to investigate how technology
affects the way that society treats death and dead bodies.
For example, these days, we're living further apart from our families,
which means that we're dying further apart. Two and so
embalming services are in steady demand because by injecting a
body with preservatives, we get a shelf stable corpse that
(04:30):
allows the family time to gather. Because of this embalming technology,
the dead body in your imagination might look sort of
like a living person who's asleep, But before the Civil War,
dead bodies looked really different than living bodies. They start
to decompose, they turned black. Okay, quick extra credit fact.
(04:50):
Abraham Lincoln played a really big part in popularizing embombing
after his assassination. His body was taken across the country
in a special train car for public viewing, and it
was embombed more than once along the way. New technologies
can shape the way that we handle are dead, and
new political ideas can change the way that we die.
(05:14):
For example, California becomes a first state to pass in
what's called the Natural Death Act, and the Natural Death
Act states you have a right to refuse treatment and
to die naturally. And we think about that today is
almost being given, But it wasn't. It wasn't. There had
to be a law that was created and then passed
along you could tell people both medically and ethically, but
(05:37):
also philosophically and politically. And again I think the political
side of this is very important. You have a right
to die by refusing treatment if you no longer want it.
And why is that political? Well, because it was a
statement of autonomy. I will die as I choose. And
there's a longer history here of a break than from
religious tradition because of course, for many centuries you did
not die the way you chose. You died the way
(05:59):
God chose. Is well, if you say I die the
way I choose, that means then that the state or
whatever governing powers in place, no one will tell me
how I can die. In the nineteen seventies, universities in
the US and the UK taught sociology of death, courses
and activists fought to change our approach to death with
(06:21):
conversations about assisted suicide, end of life, rights and dignity
and death, and the living Will was invented, a document
that expresses a person's wishes for healthcare when they're no
longer able to make those decisions. I thought that all
these shifts in thinking and practice were designed to provide
(06:42):
people with a good death. John not so much. There's
been lots of conversations around this idea of a good death.
I've never been big on that terminology because then it
suggests there's a bad death. And I'm not saying you
can't create qualitative judgments around these things, because I think
we can talk about preferred ways of dying. But I
(07:03):
think ultimately what we're talking about in terms of death is,
you know, death is a phenomena you're, regardless of goodness
or badness, is going to happen. But I'm see I'm confused.
I mean, in some ways it feels like, oh, I
don't know, like why shy from normative terms, because if
I were to compare two ways of shark attack versus
(07:25):
in the arms of my beloved, like one of those
deaths is clearly sort of lousy and one is like
why better? Right now, I understand that the concern you
can come up with, and this is something that it's
been discussed that because once you start to create expectations
around dying, people can start to feel like they're doing
it wrong. And that's always been one of my big
(07:46):
concerns with a lot of the discussions around death and
dying in all different kinds of facets society, which has
been going on out for like the last twenty years.
It's never not been a hot topic as it were.
But I think that what happened is families, and usually
families more than the dying, but sometimes the dying they
can feel like they're doing it wrong. That fear that
(08:13):
I'm somehow messing up at this basic biological function is
one you might have also heard. In relation to childbirth,
Moms can face a lot of pressures about how and
where to deliver at home, at the hospital, in a
birthing center, with or without pain meds in a tub
of water, preferably on a weekday. A lot of parents
hire birth doulas to help with their pregnancy and delivery.
(08:36):
Doulas aren't part of the medical team, but there are
a source of support and encouragement and they've got a
lot of experience helping tykes into the world. There are
also death doulas who help people to leave the world.
I die with people. I say die with them because
I feel like with every person I die with, I'm
(08:56):
a little closer to understanding what death is. And that's
just the last breath. There's nothing more magical about it.
Denise Love has worked as a death duela for twenty
eight years. She's also helped set up hospices and worked
as a registered nurse, and part of her motivation in
life is to help people talk about death, to be
less afraid of the whole conversation. I think the fear
(09:19):
is just too great. I could talk about it, you
might drop dead. It's just terrified to use the word.
Even most people don't ever use the word. In their eyes.
We pass away or somebody's ill, we avoid the language
of death. Denise has spent a lot of time working
in the developing world with people in Nepal, Myanmar, Cambodia,
(09:39):
and Thailand, which is where she was when I spoke
with her. The death's Denise has witnessed and the developing
world look really different than those she's been a part
of in Western societies. Whatever this thing we're telling everybody
is to fight, that's a lot of nonsense. There's nothing
to fight. Surrendering to death means a comfortable death. That's
my theory behind it. To die people often have to
(10:02):
fight with their loved ones to die, absolutely, So come on, dad,
you can do it. Fight it. You're going to be
seventy six tomorrow, or you know. A young pregnant woman
kept saying to her husband, could you just hold on
and do I have the baby? And he looked at
and he said, I can't. How do I tell her
(10:23):
I'm done? I don't want to do this anymore? So
I said, let's bring her in and tell her. And
he just had terror in his eyes. And we had
the most amazing hour of if you love me, you'll live,
and if you love me, you'll let me die. And
we had that beautiful, difficult conversation which was sort of
a bit heated at times, but really negotiations, so a
big death. Doller's job is getting a family talking in
(10:46):
an honest and open way. But again there's a lot
of disagreement, and one daughter wants this, and one daughter saying,
come on, you can help you live. Let's give him
vitamins and let's duce another twenty three thousand karat to
be giving kale, and it's making drink his own urine.
I mean, I've been through everything, and then I just say,
let's all go inside and talk to them, and I say,
(11:08):
do you want to live? What do you want to die?
I mean, nobody answer that question because it seems selfish,
and I've already told me they want to die usually,
So you know, I feel really comfortable bringing the family
and just saying can we let him go if you
love him? Just saying about I've always thought a lot
(11:34):
about death, even as a little kid, and you hope
that when the time comes, you can spare the people
you love pain or discomfort. But it hadn't occurred to
me that I might help my loved ones by releasing
them from any obligation they might feel to stick around
when someone's really sick and maybe dying. I already know
to ask, does it hurt? Okay, then let's talk to
(11:57):
the morphine nurse. Now. I also know to ask, hey,
do you just want to leave now? Because I don't
want to keep you. This is your show, so don't
stay late for me. That's a kindness, that question, and
I'm grateful to Denis for handing it to me. Our
(12:28):
next guest, Dr Sam Parnia deals in total totally different
sorts of questions. Do you think that there might be
a future where a good number of us died? Many times?
I think what you're going to see is when resuscitation advances,
(12:51):
then there'll be many people who can say, oh, I had,
like you know, full cardiac rest in my life and
nothing mattered. I was dead for twelve hours, sixteen hours
they brought me back. If our body is still in
good shape, we will be able to be revived and
allowed to live another ten or twenty or thirty years.
Dr Sam Parnia is the director of the Critical Care
and Resuscitation Research Program at New York University. He specializes
(13:14):
in bringing people back to life, and he thinks that
his technology advances will have a lot more lazaruses and
lazarettes amongst us, I asked him to start with a
working definition of death in practice, How would a physician
know if a patient is dead like dead dead dead.
It's interesting because I think most people listening will think
(13:37):
that they understand death and it's pretty simple. You're either
dead or you're alive. And the reality is that was
true because for thousands of years, whenever a person's heart stopped,
they would essentially reach a point where they were irreversibly dead. So,
to answer you a question, the way the physicians declass
somebody dead is that their heart stops. When the person's
(13:57):
heart stops, they also stop breathing, and because there's no
blood flowing around the body, there's no energy, and the
brain also shuts down almost immediately. So the three criteria
that they look for are no heartbeat, no breathing, and
absence of brain response. But as our tools and understanding
have evolved, the heart, breath, and brain don't always stop
(14:20):
on the same time. Ventilators can breathe for a body
that's unable to respire on its own, for example, So
what if machines performed the duties of the heart and
lungs but the brain has stopped working. Is that person dead.
To answer that question and others like it, a commission
(14:40):
appointed by US President Jimmy Carter published a report called
Defining Death. It said a person was dead if one
of two criteria were met, either irreversible cessation of circulatory
and respiratory functions, so like your heart stopped and you're
not breathing, or irreversible cessation of all functions of the
(15:04):
entire brain, including the brain stem. But not all the
states adopted this definition in exactly the same way. New Jersey,
for example, provides an exemption for patients whose religious views
might be compromised by declaring brain death, so their families
can ask that doctors use only the cardio pulmonary definition,
(15:24):
the heart and long one, which means that a person
would be considered dead in one state might not be
dead in another. As definitions get more clinical, even our
fundamental intuitions about death can start to give way. We
(15:44):
socially have defined death as this irreversible moment where a
person becomes lifeless, motionless, and they can never come back
to life again. But it's important to understand that's just
simple social and philosophical notions, and that as medicine and
science have evolved have understood that actually death this far
more complicated than we ever thought it could be. To
further complicate the question, not all of the cells in
(16:06):
your body die at the same time, So how long
does it take for the human brain to go offline?
If you were to be decapitated, would consciousness stop instantaneously?
That question was not at all hypothetical when the guillotine
was in vogue. The device was invented specifically to serve
(16:28):
as a humane method of execution, which would hardly be
true if a head severed from its body had the
chance to appreciate its circumstance. In nineteen o five, a
physician named Gabrielle Bourier conducted an experiment. He witnessed an
execution of a criminal, approached the decapitated head and shouted
the man's name. The doctor said that the man's eyelids
(16:50):
lifted normally as they would in life, the pupils focused,
and the eyes fixed on his own. Okay, trying to
play the cool former goth kid over here holding steady
in her combat boots, But I cannot fathom more chilling
experience on all of the earth than commuting with a
severed head. It may be difficult to demarcate the exact
(17:13):
threshold where life ends, but of course all of us
will die eventually, and we'll lose people we love too.
The human animal is fully aware of our own impermanence
and the fragility of our family and friends, but we
go ahead and love them anyway. John Troyer, the expert
and poet who we met at the beginning of the show,
(17:33):
devoted his career to contemplating death and dying. But all
those years of professional expertise didn't prepare him for a
big personal loss. So on July, my younger sister, Julie,
died from brain cancer at age a couple of young kids,
(17:53):
husband lived in Italy, so she died in Italy. I
was diagnosed in flight July, and then, you know, had
a year of life and it was shocking, and I
discovered a couple of blind spots that I had in
the context of my sister's dying process, which is one
it was clear at the end of April that she
(18:15):
was dying, like there was no coming back from where
she was the cancer of progress. And I knew it,
My dad knew what, my mom knew it, and no
one was saying anything about dying. Fast forward, I will
then actually be the person who tells my sister she's dying.
Used the word dying in July of twenty eighteen, so
(18:38):
sixteen days before she dies, and she was already in
the summer receiving outpatient hospice care from a wonderful hospice
in Italy. So as to why I was actually talking
about that, I don't know. Partly that's a cultural practice
in Italy, but too because I think, you know, some
of her friends just were they were unsure what to say,
and my brother in law was being told by the
counselor is like, well, you know, let her ask, And
(18:59):
I mean, they're a whole lot of things going on involved,
and it all in a way it makes sense. But
I think it was also very important to tell Julie
she was dying, because one I did, and she said, well, yeah,
I mean I guess I knew, but thank you for
saying this. And it changed then her end of life
trajectory and care because suddenly then everyone was saying dying
and it no longer meant that we had to pretend, right,
(19:24):
how does it change it using that word? You know?
How does that change care well, I think. And what
I told my sister was, Julie, I can tell you
you're dying. You're hearing me say dying. You have to
be the one who says I'm dying because everyone needs
to hear you saying it, because you saying it will
make people take it more seriously. And she said, okay,
(19:44):
I understand. Um, That'sai. Well I got choked up, but
that's okay, Um, I'm happy to talk about because it's
it's it's interesting to me that I've gone for so
long without getting choked up about t story about the
one thing she said to me that I has always
stuck with me. You know, she says, I would do
(20:06):
the same for you, and and she would and she
would have done the same exact thing for me, and
I the thing that I think this is why I
always think about it, Like for everything I know about
death and dying, which is perhaps a lot more could
be learned than on the first to admit that for
everything I know, when presented in this moment, I will
(20:28):
always wonder why I didn't say what was clearly obvious.
And and again it's not a moment of regret. I
just won't I don't understand why, fellow immortals. Now would
(20:51):
be a great time to pause this podcast and send
a text to someone you love. I'm gonna h While
Julie was dying, John was working on a book called
Technologies of the Human Corpse. He included some poems about
(21:12):
his sister, and at the end of the book he
lists a bunch of questions that you can answer now
to make choices about the way you'd like to die
and be memorialized. I'm going to paraphrase a few of
them here. Think about drotting down your responses and sharing
them with someone you love, or maybe listen together and
swap answer sheets. Number one, the price range I would
(21:35):
like spent on my funeral is Number two? Does someone
have all your passwords and log ins? If so, who?
Number three are there's certain songs you'd like included on
your funeral playlist? Number four? Do you want life support?
(21:58):
Under what conditions would you like to be removed from it?
Number five? Do you have an outfit you'd like to
be dressed in? I really like that last one. There's
this almost universal protocol that dead people should be dressed
(22:18):
in their Sunday best, But I suck in high heels.
I want to go out in my combat boots. I've
walked the world in those, I've done my best work
in them. I've fallen in and out of love in them.
So lace them tight and double not them, please, I'm clumsy.
Special thanks to Dr Troyer for his time and his
(22:40):
candor John you aren't class act. And thank you, esteemed
listener for hanging out. Our time is finite and ever fleeting,
and so I'm very grateful you've spent some of yours
with me. Deeply Human is a BBC World Service, an
American public media co production with I Heart Media. Many
(23:07):
humans of great depth have been involved in the making
of Deeply Human, so credit where it's due to Senior
commissioning editor Steve Titherington, editors Rich Knight and Hugh Levinson,
series producers Ben Crighton, Sandra Canthal and Simon Mabn, producers
Monica Whitlock, Jemma Nuby and Hannah Moore, researcher Beth and
head production coordinators Janet Staples and Blaze Hesselgren, and for
(23:31):
making it all sound beautiful. Our studio managers James Beard
and Tom Bricknell, and the composer of the deeply human
theme that is in your ears right now is Nick Thorburn.
I think I said this already, but I'm Dessa. Thanks,
see you next time.
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