What if I die today

death: When we die, fireworks will be set off

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How do people deal with the fact that everyone has to die? In the series "Death is great" we ask about the role of dying in life and in society.

When does it begin? When does a person set out towards death?

Our death begins long before we are born. Still in the womb, in the transparent heap of cells from which each and every one of us arises. Superfluous body cells have to make room here. Only in this way can the organs of the growing heap of humans develop. This is the only way to be born with only two kidneys and only ten fingers. Programs that act like an ejection seat are inscribed in the genome of every cell in the body. This triggers as soon as a cell is no longer needed or it could be dangerous to the body. The cell flies to voluntary death.

Incarnation is a fragile game of dying and letting live. Dying, writes the palliative care specialist Gian-Domenico Borasio in his book About dying, "is an indispensable prerequisite for us to come into the world as viable organisms at all."

Death is omnipresent - and yet we forget it from birth. If all goes well, it will not reappear in our lives until decades later. Often in the form of an illness that doctors can no longer cure: cancer, a heart condition or kidneys that no longer want to filter the blood. The process of dying that then begins is gradual. "What we know for sure is that humans do not die all at once, but that the individual organs restrict their function at different speeds and at different times and then stop later," says Borasio. Following a chain reaction, the liver, kidneys, lungs and heart give up. Despite the diversity of diseases, there is one thing in the end: the heart stops beating, the breath goes out and consciousness disappears.

Dr. Jakob Simmank

Our author himself once sat in on a palliative service that accompanies people at home as they die. He was amazed at how calmly many people face their death.

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Meanwhile, the heart and brain can hardly be separated from each other. Because if the heart stops pumping oxygen-rich blood through the body, the brain cells begin to die within seconds. Brain death occurs after minutes: If you tried to divert brain waves, you would see a straight line in the EEG instead of waves and jaggies. The reflexes of deeper brain areas, which are important for breathing, swallowing and wakefulness, also go out. When the heart finishes its work, the brain follows shortly afterwards. But sometimes it's the other way around: there are centers in the brain that control all vital functions: blood pressure, heartbeat, breathing. If they are damaged, breathing stops or the heart loses its rhythm. The centers are often damaged when the pressure in the brain rises rapidly as a result of an accident or stroke. Because the bone-hard skull does not allow the brain tissue to evade, it is sometimes pushed into the only opening the skull has: the foramen magnum, through which the spinal cord enters the skull and becomes the brain stem. The brainstem gets stuck, the person dies.

No clear signs, but similarities

How a dying person experiences his last years, months and days is anything but uniform. "The process of dying is very individual," says Lukas Radbruch, President of the German Society for Palliative Medicine and professor at the Bonn University Hospital. It often lasts for months or even years. Doctors divide it into three phases: At the beginning there is the terminal phase, which lasts one to two years and in which the function of the individual organs slowly deteriorates and the dying person becomes more and more tired. This is followed by the pre-final phase of weeks or months, in which symptoms such as shortness of breath and pain are added. And finally the final phase, the last days of the dying person, in which he or she no longer likes to eat or drink and slowly fades away. "But this division is nothing more than a crutch," says Radbruch. She helps in care and treatment, but is anything but precise. "It doesn't help to gauge when a person dies."

"It used to be considered a sign of imminent death when a white triangle appeared on the patient's skin around the mouth," says Radbruch. But that is not a reliable indicator. The research that aims to find parameters for how much time a person has left is still in its infancy. Even if there are already researchers looking for markers in the blood that could predict the remaining life expectancy (PLoS One: Fischer et al., 2014; PLoS One: Reid et al, 2017). Radbruch says it works best to ask the attending doctor whether she would be surprised if a person dies tonight or next weekend. If she answered no, then everything should be prepared for death.