28 February 2023

the exact opposite of control

It is now two months since my father decided to stay in bed and keep his eyes shut most of the time, sleeping, dozing, waking for brief moments. Sometimes, he seems to be aware of time and place, mostly not. He is calm. No medication.

Some researchers think that one of the reasons why humans have become thinking beings is because we have to make a lifelong effort to deny our mortality.

I read that from a psychological point of view, our dying begins as soon as we become aware that our death is imminent. As soon as this awareness determines our life.

I read about research where young people were asked to imagine their eventual death and most described it like a wind-up toy, you know one that runs and runs and runs, losing a critical function, a bit like a broken gearbox that forces it to stop working - a sudden death, unexpected, out of full health. But very few of us will die like that, because our body is too complex a machine for that.

Remember, our body is supported by more than 200 bones, more than 600 muscles perform our movements. When we are in a hurry, our heart beats more than a hundred times a minute, pumping blood with such pressure that we can hear it  ringing in our ears. Our brain, barely three pounds of tissue, generates our thoughts, actions, memories, dreams, sends impulses through our nerve cords at an incredible speed. We are made up of billions of critical components, some self-repairing at full speed, some duplicated again and again throughout life - we are more complex than a power station. Such a system rarely stops in one fell swoop. It happens gradually.

From 30 onwards, our heart loses strength. From 40, the muscles lose mass. From 50, the density of the bones diminishes. From 60, on average, a third of our teeth are missing. From 70, the brain in the skull has shrunk.

We wear ourselves out until we can't do it any further. Then the system falls apart. And even that is usually slow.

When we die in old age we can call ourselves lucky. We did not drown while fleeing. We were not taken in the dark of night and killed. We did not die during birth or shortly afterwards, not in war, not from a plague, terrible wounds, an infection, a mad shooter, none of the catastrophes that bring death elsewhere.

We may even be able to choose the place where we die, maybe safe at home, maybe in a hospital with specialist care and support. And above all, with luck, we can choose whose hands will close our eyes.

I read another research paper, how some dying people speak in pictures, like my father asking for his (non-existent) hunting jacket, organising catering for his birthday. The symbolic language of the dying they call it. 

My father drinks less and less. The doctors tell us that his body will slip into a state of dehydration that is natural in the last stages of dying. They tell us that his body is releasing neurotransmitters dulling any pain. They tell us that his skin still feels touch, that he can still hear us. But he is already so distant, like in another world, maybe he also sees and hears people we don't.

His breath is still regular, no sign of Cheyne-Stokes respiration as yet, but could be any day now, we are told. Or maybe another month. His skin is waxy pale.

I read another bit of research, about the last hours, how the activity of our brain begins to die down. Some researchers think that during this time our body floods our brain with serotonin and endorphins. The same hormones we experience when we fall in love, have sex, experience euphoria. I read of an experiment with anesthetized rats, in the seconds before they died, their brain waves flared up more than they did in life.

Maybe this is just a last gasp of a dying brain desperately trying to figure out what is happening or maybe it's a beautiful final firework sending us off.

But there's the problem with all the stuff I read, research on dying in the language of science is always etic, i.e. obtained by observation from the outside, never emic, i.e. based on descriptions from the dying person. (For more on emic and etic, click here.)

Whatever, dying is the exact opposite of control and I wonder if or when my father accepted this, whether as defeat or blessing.  Maybe he didn't need to. I'll never know.

Anyway, it could be weeks.


  1. I would have to disagree with your last statement that dying is the exact opposite of control. I think some people do have control over when they die. Both of my parents died six days after they were told they would have to go into a nursing home for care, neither of them wanted that. Dad got pneumonia the next day and mum had a stroke four days after she was told. My good friend waited until her husband was out of the room before she took her last breath, he was talking to me in the hallway.
    The one thing I do know is that death is usually peaceful, unless beaten to death I imagine. It's not painful and it comes to all of us sooner or later. Your father is just taking his time.

    1. Yes, I've seen it as well, people who waited to be alone to die, couples who died within days. But in my father's sense of control, the way he acted it all his life, that never included a slow death, I don't know what he imagined but not that.

  2. Emic. I wonder, too. Two months. His calmness. Not needing medication.

    My R was unable to speak as he neared the actual process of dying but was able to hear and indicate "yes" or "no" with thumbs up or thumbs down. He made a decision to be taken off the ventilator that was prolonging his suffering. A defeat or a blessing? I'll never know.

    Some synchronicity with your mention of the concept of emic, I had watched a movie on DVD early this morning that showed life and death in Inuit culture. It was based on a book with Greenland as its location, written by a Danish man. The story was adapted to Inuit culture by Inuit filmmakers.


    Thank you for this post, Sabine.

  3. 37paddington:
    Your father is allowing you a final vigil. This slow slipping away is a mystery, leaving grief and questions that will not be solved, not until it’s our turn. You’ll be facing a deep loss soon. But you seem clear sighted. Still, loss is loss. Sending love.

  4. I have read that hearing is the last sense to go before death. I remember my siblings quietly playing my mother's favorite music while she was making her exit. They told her of all the love that was coming to her in that moment. We all hope for peace at that moment of the last breath.

  5. My late husband's last days were like this. His doctor advised us to keep talking quietly to him, assure him we'd be fine, whenever he was ready to go. He died while I was out of the room for a minute. Our son was alone with him. I think he decided this. It was calm, at home hospice, no equipment needed. A good death.

  6. Sounds like your father is absolutely taking his time with the process. As with birth- there is no set schedule for how things will proceed, is there?
    I am so glad that he is peaceful in his going.

  7. I am sorry you are going through this. It is as hard for those watching the process as for those going through it. I have friends concerned with their own mortality. They free it will happen suddenly. I warn them that the body can take a lot of abuse. While many of us would like to go quickly, spared the slow decline, it doesn't often happen. It is hard for a strong independent person to loose control of that. It is hard to face the possibility as we get old. Seeing it happen to others makes us become aware of it in ourselves.

  8. we become thinking beings because we 'have to' deny our mortality? why 'have to'? I don't deny my mortality. if it lives, it dies, there's no denying that. and that bit about dying beginning as soon as we become aware that death is imminent? if death is imminent then we have already begun dying. the body wears out, the soul tires of the activity to keep the body going. a 'natural' death is a letting go. I've read that death is not painful, it is the fight against death that is painful. there is plenty of 'emic' descriptions of the dying process from people who had near death experiences and those who have died and been brought back, it's just that science doesn't consider them as valid. your father is in the space between alive and dead. or another way to look at it is that death is just another form of birth. instead of falling into a meat suit he is falling out of it.

    1. Maybe "deny" is not the best way to express it, maybe we spend a lot of our thinking life to distract from or even avoid any idea of our mortality, in a world that offers little pause, hence the "have to". One of the people I worked for, a pathologist, would always stress that dying starts right after birth and getting old was simply a chance our body takes on, over and over, no guarantees. I think it's not that science fails to consider near death experience (NDE) as valid, science works with repeatable data, verification, rather than anecdotal reports. There's lots of stuff published on NDE in science papers and I would not be surprised if eventually there's a way to verify this, we have functional MRIs to show amazing stuff in the brain.

  9. The uncertainty of the event -- its timing, at least -- is always hard in situations like this. I'm facing a similar scenario with my mother, who is physically still quite strong but completely absent, mentally. Despite her relative physical soundness I think she could go at any time. All it takes is a fall, a virus, a collapse of a critical function -- any one of a hundred things. And honestly, I don't think she'd mind. I think she'd welcome it, if she could understand it.

  10. Hmmm...did my comment just disappear?!

  11. I slept in the bed next to my mother's in the week before she died, at her nursing home. She no longer interacted with any of us towards the end, but I believe she was aware on some level of the activity and people around her. The whole experience of watching someone who was actively dying was surreal. It was also quite beautiful in a strange way. For me. I'll never know what it was like for her.

  12. Thank you, Sabine. What a beautiful post. I so appreciate your thoughtful description. I speak of my own death quite often, not in a morbid way, just to keep my (our) mortality in the room. As another spring begins to visit our town, I think, how many more will I see? Helps me to enjoy right now what is here. Right here. As did you lovely post.