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It must surprise my readers to find how little science knows about death.
- Elie Metchnikoff
Cause-of-death as an established global medical institution faces its
greatest challenge in the commonplace observation that the healthy
do not necessarily survive and the diseased do not inevitably die. A
logical analysis of the assumed relationship between disease and death
provides some insights that allow questioning the taken-for-granted
relationship between defined disease/s and the final common
parameter of death. Causalism as a paradigm has taken leave of all
advanced sciences. In medicine, it is lingering on for anthropocentric
reasons. Natural death does not come to pass because of some
(replaceable) missing element, but because the evolution of the
individual from womb to tomb has arrived at its final destination. To
accept death as a physiologic event is to advance thanatology and to
disburden medical colleges and hospitals of a lot of avoidable thinking
and doing.
The Prolongation of Life: Optimistic Studies
We know not if any death diminished John Donne, but certainly it
diminishes modern medicine, bringing it down a peg or two in its
avowed crusade to save any life at any cost. Medical science has taken
upon itself such an onerous task for it has convinced itself that death
is something that happens for want of something else that the medical
science could offer, later if not sooner. Hence the macabre but manifest
idea of preserving a cancerous cadaver in liquid nitrogen until such
time that a cancer cure arrives, and presto, the Rip Van Winkle can
come back to normal life. Ditto, for other killer problems.
Some Consequences of the Causal Mindset
A general conviction that rides the lay, and more so the learned, mind
is: If the cause is known, the cure shouldn't lag behind. So the cliches,
like unnecessary deaths, preventable deaths, premature deaths . The
USA decides that since the life-expectancy of an American is 65, any
death prior to that age falls into the premature-and-therefore-
preventable lot, totally oblivious to the fact that the magical figure of
65 was arrived at averaging, say, 100+30. A cardiac surgeon, at a recent
Rotary meet, hurled a j'acusse at the Rotarians by declaring that any
death from heart attack before the age of 80 is your fault . Medical
men tend to be too poor in biological perspective, with consequences
nothing short of tragicomic.
October 10, 1974, the Karolinska Institute awarded the Nobel to
Claude, de Duve and Palade with the citation that the three together
had demonstrated that "what used to be a cell with often mysterious
parts is really a sophisticated organisation with units for the production
… of life and units for disposal of worn-out parts, and for defence
against bacteria and other foreign organisms." Nowhere is there a
mention that the cell has within itself a mechanism to end its own
existence, as also of the owner. Little wonder, then that medical
curricula, world over, give no room to the most certain event within
or without the hospital.
Thanatology that started off with a bang after Kubler-Ross lifted her
pen, has ended with a whimper. The psychodynamics that underline
the avoidance that greets thanatology in medical circles is rooted in
the continuing faith that sees death as but an avoidable failure of
modern medicine. Till medical science chooses to come to terms with
the integrality, nay , the cliché-worn but remarkably well-structured
inevitability of death, death will continue to be obscene.
The gigantic edifice of modern medicine rests on an ocean of animal
blood. The telling words of Burnet, the immunoNobelist provide the
basis of the astronomical animal slaughter: "I believe, however, that
one might justly summarise American medicine as being based on the
maxim that what can cure a disease condition in a mouse or a dog
can, with the right expenditure of money, effort and intelligence, be
applied to human medicine." Whatever is American, is global, is
Indian, and hence so much of animal-experimentation in Gandhi's-n-
Buddha's India.
Tenet of Causalism and Death
Causalism, as a discipline, has a 2-way tenet: For any causalism to
hold water, the cause must be followed by the effect, and, the effect
must invariably be preceded by the cause - without loss of time . The
ordinary observable fact of the diseased often outliving the disease-
free puts paid to the causalistic obsession vis-à-vis death. The
italicized part of the causalism's tenet is impossible to satisfy for,
any of the great "killers" - coronary, cancer, carotid (stroke) - take
a leisurely long time before they dis-ease or kill. This temporal
asynchrony between the presence of disease and the moment of death
is the most insurmountable waterloo of disease-causes-death
mindset.
Natura non facit saltum - Nature makes no leap. With this in mind,
read Pickering: "Thus, the myocardial infarction, the cerebral
infarction, or the gangrene of leg which terminates a patient's life
may be seen as the final episode of a series which remain silent
over a long period of life before they obtrude into his experience
and finally terminate it." Please note, in the foregoing, that the so-
called cause-of-death is coeval with the moment of death and hence
held guilty, although the same disease-process had existed for too
long. Talking of atherosclerosis, Boyd poetizes that it is a song that
is sung in the cradle . And the so-called death-causing disease is
never single, or isolated. "Most people who die of neoplastic
disease," writes Smithers the noted UK oncologist, "also have a
number of other senile changes, which would have carried them off
fairly soon in any case."
Once again, Smithers is unable to free himself from the assumed causal
link between the "senile" changes and death, forgetting that many a
senile outlives a person in the pink of youth. "She was thirty-one.
Not old, not young, but a viable, die-able age." (Arundhati Roy) What
medical scientists and practitioners fail to see, the poet in Chesterton
saw so clearly.
Six detectives went fishing
Down by the sea-side.
They found a dead body
And inquired how he died.
Father Brown he informed them
Quite mild and without scorn:
'Like you and me and the rest of us,
He died of being born'
- G.K. Chesterton
Isn't DEATH the 5-lettered obverse of BIRTH: Two faces of a coin
called LIFE?
Death : Designed Event Acclimaxing Timed Happenings
If the whole Earth were to be reduced to the density of a black hole, it
will not be larger than a golf ball. If the whole Earth comprises so
little of spaceless, pure matter, what to talk of the minuscule man?
Alfred Portmann thus, was right when he described animal life as
configured time . The configuration, disfiguration, dissolution of
human life is time itself. One dies when, they say, one's time is up.
Conception onwards through embryogenesis, fetal growth, birth,
milestones, puberty, sexual maturity and decline, reading glasses and
arthritis are all a part of more or less precisely timed trajectory. If
configuration is precisely timed, so is disfiguration so that you have
precisely repetitive statistics of heart attacks, cancer and stroke, with
their age-distributions spanning from one end of the lifespan to
another. Dobzhansky, the Harvard biologist, calls all stages of human
existence as continuing development, whose climactic acme is death.
Death is but a step in development, resulting, as some would like to
put, in the next birth.
As a first generalization, it may be said that the length of life
itself, the span of the natural life cycle, is one of the organism's
most integral characteristics, genetically programmed in some
mysterious way by a kind of biologic death clock. Each species
has a characteristic average lifespan. For the mouse, this is two
years; for the rhesus monkey, 20 to 25 years; for the African
elephant, 70 to 75 years; for the Galapagos tortoise, 100 years;
and for human beings, about 85 years. Many years ago, the
German physiologist Max Rubner pointed out that the total
number of calories burned per gram of body weight and the
total number of heartbeats in the lifetime of each of these
vertebrate species, including humans, are about the same,
despite the great differences in their size and lifespan. Further,
the span of human and other animal life correlates roughly with
the size of the brain.
Adams, Victor and Ropper
The Biblical three scores and ten and the Vedic blessings of Satam
Jiva Sharada - May you live a 100 years - comprise human lifespan,
being the maximal time that an individual of that species can live.
The average lifetime of a group of a herd is the life-expectancy -
being about 63 in India and 75+ in the West. Yet death, as a
programmed event stalks life from conception to 100 years. The very
high mortality at conception dwindles to its minimum at five years
after birth (herd quality control), is at its lowest from five to fifteen
(herd stability), and, then, obeying Gompertz curve, steadily mounts
up (herd lysis) for every year of human existence, doubling every
eight years, to reach its high between 45-55 years. Death at 19 is as
well-timed and programmed as death at 91.
"The common belief that medical science has greatly lengthened life
is a misconception, arising from a failure to distinguish between
lifespan and life expectancy." Having so generalised, Adams et al
declare that even if all coronary artery disease were eliminated, life
expectancy would possibly be extended by 3.1 years, and if all cancer
were eliminated, another 3.5 years. So, even if the circle were squared,
and the apple made to fall up, human life-expectancy will remain far
short of human lifespan for most people and will never exceed it.
Therefore such Quixotic ideas as No More Dying are good on paper,
but totally irrational in reality. Living to 100 is the latest in the line
of books that presuppose that any death on this side of 100 or 76 or
65 is an outcome of some exercise not taken, some antioxidant missed
out, some Methuselah Enzyme not made available to you in good time.
Chronicle of A Death Foretold
As a designed event, death is thoughtful. Strange as it may seem, it is
a common experience that an uncluttered mind gets the whisperings
of death's imminence at least 3 days in advance. So the Indian
scriptures aver. And so does Ariés who studied the modes of dying in
medieval Europe. Ariés records that, before medical men started to
claim and assure that they can pull you out of the jaws of death, a
foreknowledge of one's death was a common experience. If someone
died without communication to others in advance of the would-be-
death, such a person was assumed to have had mors repentina - a
repentable death. Such a person's burial was not ceremonalised by
the church.
The title above is of a novel by Gabriel Garcia Marquez the 1982
literary Nobelist of Colombia. In contrast to the macabre plot of the
novel, one's Foretold Death is a gentle event, rehearsed and
rerehearsed for a lifetime before the final dramatic exit. A human being
with life expectancy ranging from conception to 100 years has the
maximum of 4 billion heartbeats and 1 billion breaths. Each heartbeat
records the lubb of life and the dupp of death . More significantly,
with each breath one first inspires , and then, expires . So you expire
every moment of your existence till you can expire no more. Death,
in a way, is an end to all dying. And Nature in its infinite
foresightedness has organized your psyche to feel death's aura 72
hours well in advance.
You Die, You Aren't Killed
If you don't know how to die, don't worry; Nature will tell you
what to do on the spot, fully and adequately. She will do the
job perfectly for you; don't bother your head about it!
- Ambroise Pare
Killer-disease is a favourite phrase of Reader's Digest writers and of
medical conferences. Heart attack is killer No.1, cancer No.2, and
stroke No.3, a rating that has remained unchanged for decades,
showing that there is some method even in death's madness. Is one
killed, or does one die?
As lexicons imply, to die is "to cease to live" whereas to kill is "to
deprive of life/put to death/cause death of." You die yourself - as an
active measure. You are killed - by an external agency that did not
allow you to die for, in the first place, it did not allow you to live. A
knife, a bullet, a vehicular accident, drowning, even a rope round
your neck put by your own hands, the cup of hemlock that Socrates
was given - all these arrested your living processes and so you were
killed. To kill is akin to quell , meaning to smother, to extinguish. A
glowing candle, not yet at the end of the quota of wax, gets blown,
extinguished. You didn't die; you were declared dead after you were
killed. It's a pity that as yet the lexicons have no word for death by
killing. How about quelled = dead by factors that did not allow
living?
Thanatologists have talked of, searched for a death hormone but have
found none. Malarial parasites causing Acute Respiratory Distress
Syndrome (ARDS) or cerebral malaria, sepsis following surgery or
trauma, even the virus of Guillian-Barré, one and all secrete no death-
causing toxin, but interfere with life-processes. This is where medical
science has an edge, a choice. The person did not want to die, and
hence could be saved. This classically illustrates the Chinese proverb:
A doctor 's medicine works on a patient who is fated to survive. Cladius
Galen (131–201 A.D.), the pioneer allopath and prolific penpusher,
put the foregoing self-exoneratingly: "All who drink this remedy will
recover... except those in whom it does not help, who will die.
Therefore, it is obvious that it fails only in incurable cases." This
may smack of fatalism, yet the need for the finer distinction between
dying and getting-killed necessitates such an approach.
Coming back to the killer-diseases that we all carry with ourselves
through life, do they really, can they really kill us? The fact of their
being present non-lethally for a long time, the fact that a person with
no such disease or such disease in a milder form should die and the
diseased/more-diseased should survive denies to these diseases the
right of being killers. You die with them; you don't die because of
them, since through all your life, and in terms of cytofibral realities,
they comprise, what the lovable rascal Mr. Doolittle said of Elisa in
the movie My Fair Lady : "Me own flesh and blood!"
How Does One Die?
Knowing how one's first heartbeat is made to arrive to eventually
fashion oneself in the mother's womb may be the best way of
comprehending how one is unmade for the final heartbeat to come to
pass. This entails referring to the Indian concept of causal or celestial
body or Caran shareer , subtle body or Sukshma shareer , and gross
body or Sthula shareer . One's causal body is forever, having had had
no need to be born and hence having no compulsion to die. Biologic
facts fully support this superb concept that is encapsulated in Lord
Krishna's four words: Na jaayate mriyate vaa.
When, in the celestial scheme of things, one's time to be a body arrives,
the causal body, as an integral part of the cosmos, orders the formation
of the subtle body. The subtle body, as it were, forms the invisible
container into which the body matter is poured. The content assumes
the exact shape of the container to accord to an individual tritimensional
uniqueness. The nearest evidence of the subtle body is the perilife aura
that Kirlian photography so clearly demonstrates. The subtle body is
one's matrix, one's angel mother, one's mind, one's interface with the
cosmos. And in terms of the first and the subsequent heartbeats, it is
the subtle body that powers the heart to do what it does.
When one's time is up, it is the subtle body , at the command of the
cosmic causal body , that winds up the game and you declare that the
heart has arrested. The sequence ab initio and ab ultimo is clear: The
subtle body arrives first to initiate the heartbeat and the game called
life; the subtle body and the final heartbeat leave first, and then the
rest of the gross body follows suit. The universal condemnation of
suicide is based on the realisation that the deliberate killing of the
gross body leaves the subtle body in a lurch with consequences that
are right now only in the realm of imagination.
In a life-threatening situation following an accident or infection, the
subtle body plays a stellar role. It comes to the rescue of the doctor
and the diseased to allow vis medicatrix naturae to play a positive
role and thus to pull the chestnuts out of fire. No wonder, Ambroise
Pare's lasting legacy - Je le pensay, et Dieu le guarit meaning, I
dressed him and God healed him - still dominates the medical scene.
Perlstein, in the early part of the 20th century, uttered an assuring
aphorism: "If your time hasn't come, not even a doctor can kill you."
It was around Perlstein's time only that the truth of his words was
experienced in a telling fashion. In 1939, acetylcholine was injected
intravenously as a therapeutic convulsant by psychiatrists in the
justified expectation that the ensuing fits would be less liable to cause
fractures than those following convulsions caused by leptazol
injection. Recovery rates up to 80% were claimed in various psychotic
conditions. Enthusiasm however began to wane when it was realised
that the fits were due to anoxia following cardiac arrest. "Forty
seconds after the injection the radial and the apical pulse were zero
and the patient became comatose. The pupils dilated .… In about 90
seconds, flushing of the face marked return of the pulse." The trial
reports many cases and no death which means all the cardiac arrests
returned to life. They did so because the acetylcholine had left the
subtle body unmolested. May be this is how cardiac massage gets
rewarded, and the critics of modern medicine are able to declare that
many a person survives despite the doctors.
The Moment of Being Born There
Rajan Parab, an intern at Seth G. S. Medical College, Mumbai died in
a swimming accident while saving a drowning cousin's life. The small
memoir published in his name gave his time of his birth as "Born
Here" and of time of his passing away as "Born There." The word
death did not feature anywhere.
One short sleep past
We wake eternally.
And death shall be no more;
Death thou shalt die.
John Donne
The compassionate causal and the subtle bodies, thoughtfully, create
for each dying person a fleeting but eternal-looking moment that
heralds either the next "birth hereafter" or being "born there", or, if
you are prepared a birth-and-death-free eternity.
Question of Brain-Dead
Gould has talked of animal life measurable in terms of heartbeats and
breaths allotted. Neil Armstrong, the pioneer astronaut put it heartily:
"I believe every human has a finite number of heartbeats." A breath, a
heartbeat is a measurable, calendar-event that serving as a currency of
life allows the temporal measure of a given life. Thought, on the other
hand, is abstract, immeasurable. Its presence or absence, makes little
difference to the body's inner clock. Hence the long life that a brain-
dead person may have. The issue of brain-dead is important in the
current times that sees them as "cadaveric donors." Brain-dead people
are heart-alive, and therefore not dead. The solution to the current
acrimonious debate about brain-death is the medical candor that sees a
live individual as live, and not as dead just because a part of the brain
is not functioning. Such an unconscious patient is a live donor, like
any other live donor, and should be respected and treated as such.
Life-Saving Feathers in Modern Medicine's Cap
Wildavsky a on the western side of the Atlantic, writing in (medical
men and manufacturers are) Doing Better and (patients are) Feeling
Worse , is candid: "The best estimates are that the medical system
(doctors, drugs, hospitals) affects about 10 per cent of the usual indices
for measuring health: whether you live at all, how well you live, how
long you live ... Most of the bad things that happen to people are at
present beyond the reach of medicine."
In Wildavsky's "10 per cent" let us see where and how really medical
science saves life. Be it an obstructed labour, congenital tracheo-
oesophageal fistula or duodenal atresia, polytrauma, angioneurotic
oedema, increased intracranial tension, malignant hypertension,
hypovolaemic shock, coronary infarction, obstructed bowel, infective
peritonitis, cerebral malaria, or ARDS, modern medicine with its in-
depth knowledge of normal and disturbed physiology, does its best to
restore the disturbed physiology to status quo ante , without so often
wanting to or being able to remove the precipitating cause. Thus it
gives to the afflicted individual the right-to-live , and thus in a way,
the right-to-leave . The latter explains why after the best of
physiological restorations the person decides to take leave of the
doctor and the world.
Implications for Modern Medicine in Particular and ModernMan in General
Time's Relativity
Man's own time sense is seldom nearly so precise, and its range
has obvious limits. When you are told, for example, that heavy
subatomic particles are created in high-energy collisions lasting
only one hundred-sextillionth of a second, but that these same
particles "decay" much more slowly, taking a ten billionth of a
second, you probably have trouble realizing the distinction
between such seemingly instantaneous events. Yet actually the
time ratio between them (10-23 : 10-10 sec.) is the same as that
between a second and a million years!
- Guy Murchie
Relativity is at the heart of temporalities of all sorts. The Webster's
Dictionary defines relativity as (a) the quality of variability arising
from necessary connection with or reference to something contingent
(b) the mutual dependence or concomitant variability of two or more
related things, (c) dependence on the subjective nature of man or upon
limitations and peculiar character of individuals (the relativity of
knowledge). Time (and space) is, a la Einstein, the free creation of
the mind, and has remained free of any precise definition. There are
too many times to contend with, for they are all relative.
Vis-à-vis the trajectory of human life which is but a time-curve, there
are 4 times that are presently pertinent: (a) physical or chronological
(b) milepostal (c) pathological (d) vivothanatological. Physical time,
under ordinary conditions on Earth, remains one constant for all
humans. Milepostal (milepost = milestone, hence milepostal) time for
conception, through embryogenesis, gestation, infancy, dentition,
puberty, sexual maturity and decline tends to vary so little from one
person to another as to form reliable, general landmarks in anyone's
history. Whatever the variations, they are normally distributed, albeit,
over so narrow a range that the range can be ignored.
With the absolute constancy of the physical time and the near-
constancy of the milepostal time serving as the backdrop, pathological
and vivothanatological times exhibit the widest range from womb at
conception to the tomb at 100 years. The varied pathological processes
on the one hand and the occurrence of death at the other hand, exhibit,
independent of each other, a wide variation that is governed by the
divine distribution called normality . So the occurrence of carcinoma
prostate in a newborn, and of tongue in a child of 3, of stroke in a
child of 8 and Winston Churchill fit as a fiddle at 80. One can safely
generalize that on a normal curve that stretches from conception to
100 years of human existence are plotted the various pathologies, and
the various times of death (vivothanatological times), that working
independently, make clinical medicine and pathology into fascinating
disciplines characterized by tantalizing uncertainty at every stage, at
every age.
Physiologicality of Death: A Summing Up
The terms physics, physiology, and physician are rooted in Gk.
physike , meaning nature, from L. natus which is past participle of
nasci - to be born. The emphasis in all these related terms is an
inherentness. In birth that happens to be precisely timed there inheres
death that is precisely timed as well. If the making of oneself
(embryogenesis) and the emergence of oneself (birth) are seen as
physiologic events, why should death which is but the other face of
birth and the dissolution thereafter be deemed as a pathological
failure?
The Kiplingean 6 teachers - How, Why, When, Who, Where, and, What
- as relate to the still mysterious phenomenon of death hopefully find
their appropriate place in the scheme of things in the foregoing
intellectual deliberations. The celebrated institution of postmortems
and clinico-pathological correlations have failed to assist the
Kiplingean teachers and hence the offbeat path that we have had to
take.
We are led to propose that located within the subtle body of an animal
is a physiologic mechanism to switch on the heartbeat, as also a
physiologic mechanism to switch it off, the will-to-live as also, equally
a strong, will-to-leave . Both are time-governed and depend only on
time and not on any normality or abnormality of cells or tissues. It's
time to offer a decent burial to the long-dead medical institution, called
the cause of death . Acausalism governs the phenomenon of death.
The modern man and modern medicine need to have a new world-
view on death, a todanschauung , of a new order.
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