Death Mat­ters

Geist - - Findings - EVE JOSEPH

From In the Slen­der Mar­gin: The In­ti­mate Strange­ness of Death and Dy­ing. Pub­lished by Pa­trick Crean Books, an im­print of Harpercollins Pub­lish­ers Ltd., in 2014. Eve Joseph is the au­thor of two books of po­etry, The Se­cret Sig­na­ture of Things and The Star­tled Heart, and many shorter works of po­etry and non-fic­tion. She was a pal­lia­tive care worker for twenty years. She lives in Brent­wood Bay, BC and at eve­joseph.word­

In the end, we breathe from our rep­til­ian brain, the part of the brain pos­sessed by the rep­tiles that pre­ceded mam­mals roughly 200 mil­lion years ago. Breath­ing, heart rate and the fight-or-flight mech­a­nism are con­trolled by the part of our brains also found in lizards, croc­o­diles and birds. The im­pulses of the brain stem, lack­ing lan­guage, are in­stinc­tual and rit­u­al­is­tic. Dur­ing the process of nat­u­ral death, the rep­til­ian brain guides the body through the com­plex process of shut­ting down, turn­ing out the lights, slow­ing down the lungs un­til the last breath is taken.

It has been noted that when moun­tain climbers are in dan­ger of fall­ing, this brain takes over; the eye­sight in­ten­si­fies and the feet mirac­u­lously take the right steps. Could it be that our rep­til­ian brains help us to step mirac­u­lously to­wards our deaths? The Amer­i­can neu­rol­o­gist Paul Ma­clean the­o­rizes that we have not one brain but three: the rep­til­ian brain, sym­bol­ized by cold; the mam­malian brain, by warmth; and the new brain, whose sym­bol is light. The gold light around Bud­dha’s head in stat­ues is an at­tempt to show he is liv­ing in his new brain. Some Ti­betan med­i­ta­tors of the thir­teenth cen­tury, says Robert Bly, were able to read in the dark by the light given off from their own bod­ies.

It is not un­com­mon for there to be pe­ri­ods of ag­i­ta­tion shortly be­fore death. Peo­ple of­ten try to rise from their beds as if they have to get some­where. When they are too weak to get up, they might reach with their arms to­wards some­thing only they can see, pinch­ing their in­dex fin­ger and thumb to­gether re­peat­edly in an ef­fort to catch what­ever is float­ing by them. In clin­i­cal terms, it is known as pre­death rest­less­ness and is di­ag­nosed by the med­i­cal pro­fes­sion as a kind of delir­ium brought about by phys­i­cal changes. When my friend’s hus­band was close to death, he pumped his arms as if about to fly. Some doc­tors dif­fer­en­ti­ate toxic delir­ium, an al­tered

state caused by pain med­i­ca­tion and other drugs, from ter­mi­nal delir­ium, which is seen as part of the dy­ing process. Ei­ther way, the med­i­cal pro­fes­sion sees delir­ium as a phys­i­o­log­i­cal prob­lem pos­si­bly caused by some un­known source such as de­hy­dra­tion, elec­trolyte im­bal­ance or the re­lease of en­dor­phins or other brain chem­i­cals shortly be­fore death. I’m not so sure.

Over time, it be­gan to ap­pear to me as if the dy­ing were ven­tur­ing out on a kind of test flight; as if they were work­ing hard to fig­ure out how to leave the body. Episodes of ag­i­ta­tion were off­set by pe­ri­ods of deep still­ness, pe­ri­ods in which fam­ily mem­bers would com­ment that it felt as if their loved one was not there. It was as if the sil­ver cord, in the book of Ec­cle­si­astes, bind­ing the spirit to the body, were stretch­ing far­ther and far­ther un­til it fi­nally snapped. Other than The Ti­betan Book of Liv­ing and Dy­ing, there are few man­u­als on how to leave the body—the con­tainer that houses all that we are; it’s up to each of us to fig­ure it out. “How,” one man asked, “will I know that I am dead?”

Imag­ine the dy­ing as test pi­lots: fig­ur­ing out ways to best re­cover from spins, break­ing the sound bar­rier, fly­ing straight to­wards the sun, bail­ing out when the plane is go­ing down.

Of course, things don’t al­ways go as planned. One af­ter­noon I went with a nurse to the home of a man who was ex­tremely rest­less. As much as pos­si­ble, a nurse and a coun­sel­lor work to­gether on the pal­lia­tive re­sponse team so that the coun­sel­lor can at­tend to any emo­tional and prac­ti­cal needs while the nurse deals with the im­me­di­ate med­i­cal cri­sis. We parked in front of his house and walked up the side­walk to the door. There were roses grow­ing be­neath the bay win­dow on our right and we could see the man at­tempt­ing to climb out of his hos­pi­tal bed on the other side of the win­dow. His wife, who had not slept for days, was be­side her­self. While the nurse drew up a sy­ringe of Hal­dol, I spoke gen­tly with the man.

“You can rest now,” I said. “You can rest.”

He looked at me and lay very still. His wife, over­joyed, couldn’t thank me enough. I felt good, even a bit smug, un­til he mo­tioned his wife over. “Call our lawyer,” he said.

“Why?” she won­dered.

“Be­cause,” he said, point­ing di­rectly at me, “that woman just ar­rested me.”

What­ever works, I thought to my­self, what­ever works.

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