Stuff You Should Know - How Dying Works

Episode Date: September 20, 2013

Chuck and Josh have covered just about every aspect of death except dying itself. Here, they fulfill the death suite of podcasts with an in-depth look at just how people die, what happens to the body during the dying process and how people accept death -- and what they regret not having done while they lived. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

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This is Operation Trade Bomb, an Apple original podcast hosted by Mark Smerling. Follow Operation Trade Bomb on Apple podcasts. Welcome to Stuff You Should Know from HowStuffWorks.com. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. Chuck Bryant. How you doing? Hey, and Jerry's over there.

Jerry, for the first time, just saw a meme that's been out for a couple of years. Yeah, that's it. That happened. That's like when you rolled me like two years after it was popular. You were like, isn't that the best? Well, I was lying in wait. Yeah. I thought that happened, so.

And there's nothing more obnoxious than sending someone something and be like, I saw that two years ago. Well, I'm so sorry I tried to show you something funny. Right, right. But yeah, Jerry just saw the, do we even say? The mumblemouth reporter, maybe? Yeah. The lady who supposedly had a migraine but appeared to have had a stroke.

Right. Reporting from the Grammys in Los Angeles a couple of years ago. Yeah, I still don't know whether it's okay to laugh at that because I don't know really what happened to her. Well, we didn't laugh. We very solemnly showed Jerry. Yeah. Yeah.

And she laughed. Terrible, Jerry. Terrible, Jerry. Territation. I've got one for you. Okay. I've got a bit of an intro. It's not much, so.

Great. Get your hopes up. All right. Have you ever heard of the Population Reference Bureau? No. You have because I've mentioned it before. I've mentioned this article before. It's on prb.org.

It's called How Many People Have Ever Lived on Earth. Oh, okay. And I don't know what we mentioned in it. Maybe the Population Episode or something. But it's a really cool little article by this demographer named Carl Hobb, H-A-U-B. And there's even a video of him explaining it if you couldn't get what he was going with. But Hobb, he reckons that modern humans, people who are virtually indistinguishable from you or me, aside from the fact that they're not wearing any clothes really, showed up about

50,000, 52,000 years ago. So Hobb puts the population of humanity at 2 in 50,000 BCE. Oh. Okay. Yeah. So from that point to 2011, he extrapolates, does the math, does this little demography thing. Yeah.

And Hobb comes up with the number that 107,602,707,791 people have ever lived between 50,000 BCE and 2011 CE. That's pretty neat. It is. That's a lot of people. Because that means about 6.5% of that are alive right now or were in 2011. All right. So we're dying off?

Yeah. That's the point. All 107,602,707,791 of those people had one thing in common. One thing, aside from being humans. Taxes. No, not even. Not even. Pre-tax.

Yeah. Yeah. They didn't have tax in 50,000 BCE. They were running from saber-toothed tigers. And death. Death. It was death. That's the one thing.

All 107,602,707,791 of those people had in common. You know, when I was thinking of your intro driving here today, I thought that'd be funny if Josh was like, how long people been dying, Chuck? And you know what? This wasn't that far off. Nice. I was like, he wouldn't do that. You were like, that'd be way too boring.

What a stupid way to do this. That's a good number, and I like that, 107,602 million, 701,000. 7,000. 791. Yeah. Wow. Yeah. And that includes you and me, pal.

You know what that means? You're going to die. I'm going to die. Yeah. Jerry's going to die at least two or three times. We're all going to die. Yeah. This is our dying podcast.

And we have covered just about every aspect of dying. When you die from a broken heart, how rigor mortis works, what's the worst way to die? Is there a best way to die? Did we do that? That was kind of in the, is there a worst way to die? We've covered everything from autopsies. Peak oil. What can be done with the dead body?

Ninjas. Yeah. Well, ninja, at least. You should know better than that. Yeah. We really have danced around everything except just how dying works, and this is going to be a sad podcast in many ways and gruesome in some ways. Yeah.

Because we're going to touch on some of the stuff we hit on, and like rigor mortis and autopsies and the actual dying process. Right. But I mean. So brace yourselves. And I've mentioned this guy scores of times at least, but as the great, no, it's Charles Mann, you're thinking of. Oh, okay.

The great psychologist, Ernest Becker, shout out to our pal, Joe Randazzo, who's like into Becker now. Isn't it Ernest? Or is it Ernest? Ernest. Okay. You're thinking of Max Ernst. Okay.

Ernest Becker wrote The Denial of Death, the seminal work that basically says, we're all just doing everything we can to think about our own demise, and there is some sort of health, whether it's spiritual, emotional, there's some sort of health or well-being, I think, from facing the fact that you're going to die. Sure. I've been talking about it. So let's talk about death, baby. Let's talk about you and me.

Let's do it. Okay. So Molly Edmonds, who used to be on Sminty, Stuff Mom Never Told You, we call it Sminty, wrote this one. And I think it is interesting, and I usually don't like it in articles today, like the definition of blah, blah, blah. But it's kind of interesting that in the first encyclopedia, it was just the separation of the soul from the body, and now it's 30 times that long in the encyclopedia.

And that's just sort of indicative of how we used to think of it and how, I don't know if it's ironic or not, but how medical science has complicated that over the years. Yeah. Well, it's definitely ironic, because we used to be confident that we understood death. It's like, that person isn't moving anymore. If you ask him what he wants to eat, he's not going to respond. If you choose something for him to eat like a block of cheese, it's not going to be swallowed. Like that's death, and since there was perhaps a lot more religiousness associated with death

and dying than there is today, that kind of underscored the belief in death. It's the soul departing from the body. That's right. And what more do you want to know, Egghead? It's death. Well, yeah. And way back, you know, a few hundred years ago, you'd call in a priest, and they'd check the body, see if it's breathing, and say, yep, they're dead, and that was pretty much

it. The doctor wasn't even involved at that point. Well, there may not have even been such a thing as doctors, and if there were, they were wearing like masks that made them look like crows to protect them from the plague, so they weren't any better at ascertaining death than a priest was. That's true. When doctors did come along and they invented things like the stethoscope, they could actually check and see if there was a heartbeat.

Before that, there was Balfour's test, which I couldn't find out a lot about this other than you stick needles into the heart with little flags on it and see if the flags move. I think that's pretty straightforward. Really? Yeah. I think that's about it. Okay. That's the test.

How about that? And there were other tests that like a priest who may have come to say whether you were dead or not would use like placing a feather above the mouth or around the mouth or nose to see if it moves. The old mirror check. Mirror trick. That's still useful. It is, but only if the mouth is still moist.

If it's a dried mouth, it's probably not going to fog up a mirror. Well, if it's not breathing, it's not going to fog up a mirror. Right, exactly. So I said that medical science has complicated it, and that's exactly what's happened over the years because as we progressed with medicine, we discovered a lot of ways to actually reverse death, like bring people back from the dead, whether it's something as easy as CPR or as complicated as machines that help you breathe and feed you. And not only that, we've entered this really awkward period in human medical history where

the machines that can tell us whether someone is alive or not are more advanced than are machines that can bring a person back from death. So we have ways to sustain the body, but not necessarily the person depending on your definition of death. Yeah, like the faintest trace of a brain wave, maybe. Right, yeah. So we went from holding a feather under somebody's mouth or nose to see if they were alive, too, using the MRIs to see whether there's electrical activity.

And we're finding that all of these old signs, these old outward signs of death, don't necessarily mean that the person's dead. And even if the person is dead, we have technology, like you were saying, to resuscitate them. The question is, if we resuscitate them and they're still not talking, they still don't tell you what they want to eat. Are they alive? Well, yeah, and this hasn't been that long, you know, I mean, in the 52,000 years or whatever that people have been dying, it's only been the past, you know, 60 something that we've

had to come up with terms like persistent vegetative state and irreversible coma. Because of those machines that can resuscitate or sustain a body. And in 1958, that was when the French neurologist described the coma de passe, which was a state beyond coma, basically brain death, although that didn't come along until technically until 1968 when Harvard Medical School did basically defined it for the first time. Although they didn't even call it brain death at the time. What'd they call it? Just irreversible coma, like you're not coming back.

Brain death was kind of tagged on later. So yeah, so coma de passe, persistent vegetative state, brain death, all of these things would indicate, again, that you're dead. The problem is, is we have these machines that can keep your body warm and keep your chest rising and falling can keep your body going indefinitely. Yeah. But the thing is, there's something that's not there. And it does that mean you're dead.

There's been a lot of talk about exactly what constitutes death, defining death is a very, very difficult thing to do, especially with through the advancement of medical technology. It's kind of changed. Every time you come with it, okay, I got it. This is the definition of death, right? Medical technology can provide some picture of a state of consciousness or life that throws a wrench in the works, you know. Yeah.

And it's actually after 1968, it took to 1981, a presidential commission is when they finally in the United States wrote a paper called defining death, medical, legal and ethical issues and the determination of death. That was the basis for the Uniform Determination of Death Act, which basically rejected the Harvard idea that the higher brain, which is like when your personality and your memories are gone, the cortical brain, that means you're dead. And they rejected that in favor of the whole brain, which includes the brain stem, which is what keeps you breathing and functioning.

They rejected it in favor of that. So Harvard was like, yeah, right, I, I, I don't know, I think I subscribed to the higher brain death definition of death. Yeah. Um, the brain stem, I'm, yeah, it's pretty significant. Sure. Um, you can be born with just a brain stem. We talked about Mike, the headless chicken before, um, he had his head cut off, which

included his brain, but his brain stem was still there and he's a chicken, so it didn't really matter. Sure. But the, the, that is a, there's a huge division between the two because there's a big difference between breathing and being able to swallow for yourself and making a conscious decision whether, again, what you want to eat right there or having memories or just reacting to people aside from like, you know, physical reaction to a stimulus. Yes.

And that's one of the, one of the, there's a whole article on brain death, maybe we'll do that one. I thought we did that. No. We did it in the organ donation procurement episode. We talked about brain death and testing for brain death, like they shoot ice cold water in your ear canal. I definitely remember covering it at some point.

Somehow. Yeah. I think it was in the organ donation. Or maybe living wills. Obviously. We might have touched on it. Did we do that one? We did wills.

We did wills, but we hit on living wills in that. But you know, you mentioned organs. I don't think we said that, that was a big kind of a quandary in the 1960s. Um, and the late, I'm sorry, mid 1950s and then really in the 1960s is when we went organ transplant crazy, um, actually kind of not just the United States all over the world. Doctors said, Hey, we can actually give people a shot at life because we can now transplant kidneys and lungs and hearts. Uh, the problem was, and this is sort of one of the sad things that Molly points out

is that the definition of death kind of came about was hurried along maybe because we needed organs from these bodies that were still technically alive, which is very ghoulish proposition. I mean, it makes sense from a very utilitarian standpoint. It's like this guy doesn't even know he's laying there. Yeah. And he's got a great kidney that could go to his sister who knows that she needs a kidney. She's going to die and she's got kids that she wants to hang out with and like can put this kidney to good use.

So let's, let's figure this out. But um, as Molly says, like most developed countries have signed on to the brainstem where it's like your brain can no longer keep, uh, you alive, like on your own. You can't swallow. You can't take a breath for yourself. So you're dead. Um, the problem is that's, that's just, that's different. That's a much, much, much more, it's a narrower definition of death.

I guess. And I think that that probably rules out a lot of people who might otherwise be used to harvest organs. Yeah. Harvest. I know. Um, all right, so let's talk about death itself. It's funny that you, well, it's not funny, but out of all the different ways people can

die, I thought it seemed simplified to break it down into three ways, but that's really kind of the three ways. Yeah. I think we talked about that in all top seas too, right? Yeah. It can be an accident, obviously. Um, that's called the oopsie mode of death. Um, yeah.

The violent death, which is also an oopsie, I guess, well, not an oopsie. No. It's tragic. Yeah. Homicide or suicide. So Chuck, let's talk about what it's like to die from different types of death. You dug this up. You ghoul.

Yeah. Because I really wanted to know like, what is it like to drown or to be burned alive? Yeah. And people have survived some of these things and come back to tell the tale. That's obviously the only way we're going to find this stuff out. Yeah. It's like, lucky people. Um, drowning.

I've always heard drowning is a good way to go because it's not so painful. Yeah. And like the brain supposedly releases endorphins at the end. Yeah. Same with freezing. I've heard too. Maybe true. Um, although, uh, drowning victims have reported, uh, aside from the panic, a tearing and burning

sensation, uh, when your water starts filling with lungs and quickly, hopefully really quickly after that is the feeling of calmness. Yes. And tranquility. Yeah. Um, heart attack, you've got the squeezing chest pain in your chest or your left arm. Yeah. Like a weight on your chest.

Right. Um, what I didn't know is that because of the heart not delivering oxygen to the brain any longer, you can lose consciousness, um, within like 10 seconds. Uh-huh. Um, I didn't realize that. I thought like it was, there was a lot more to it. Well, it depends, you know, everyone has their own signature heart attack as well. Um, if you bleed out, I imagine this is not one of the best ways to go, um, after about

a liter and a half of blood, you're going to be thirsty and weak and anxious. Mm-hmm. Anything over two, you're going to be pretty confused and dizzy and probably lose consciousness pretty soon after. And all of that would be, that would relate to how fast you're losing blood. Sure. And it would probably be very unpleasant depending on how you're losing blood, like why? Because you would imagine that if you're stabbed in the gut or something like that.

Yeah. You got the attendant pain in addition to this dying from loss of blood. Yeah. Or like man reservoir dogs. Yeah. Like one of the most hardcore ways to open a movie. Yeah. Or not open, but they cut right to that scene after the diner scene.

Right. After the walk. Yeah. Yeah. Um, electrocution, um, if you're in your house and you get electrocuted, uh, it could stop your heart right then and there, and, uh, if you're in an electric chair, you may have actually heated your brain up to the point where you die or suffocated to death. Right.

But the, there's indications that being electrocuted with enough voltage that it instantly, you lose consciousness. Right. That's the idea probably. Yeah. With the quote unquote humane, I'm sorry, quote humane, end quote. I'm going to stop doing that and go back to quote unquote. Yeah.

What if you fall from a height? If you fall from a height, supposedly, um, time slows, which is awful. Yeah. It's like, well, you're going to experience all of this. Yeah. That's, uh, yeah. The idea that you, that you really can take it all in. That's really awful.

And so they've, they, uh, did a study of, um, jumpers from the Golden Gate Bridge, uh, which is 75 meters. What is that, uh, 230, 40 feet? It's high enough. Um, and they, they found evidence that a lot of them died from it, exploded lungs, exploded hearts. Um, their organs were all cut up from their ribs, which would indicate death was pretty much instantaneous.

Yeah. I talked about that on something too recently, I think, or maybe I heard it, someone else talking about it. That's pretty bad way to go. What the Golden Gate Bridge or just, just falling, dying from a height. Yeah. I can't remember what I was talking to about jumping in the water. I was like, what actually kills you when you jump in the water from the eye and it

was like your organs smash into each other and explode. Yeah. I guess from any height, yeah, when you, when you die from that, it'd be from organ explosion or whatever. Yeah. Or, uh, you know, the brain, obviously, yeah, if you go head first. Uh, yeah. Yeah.

That's, um, the long drop back in the day would, although they still, you can get hung in certain states if you choose. Really? Yeah. Washington State, I know you can. Huh. Um, you can choose that as your method and they'll build you the gallows and, uh, the idea that there is, you want your neck to snap, otherwise you die slower and, you know,

suffocate. The problem is there is a study of 34 prisoners that found four fifths of them died partly from asphyxiation. Really? That's the wrong way to hang somebody. Yeah. If you, if you don't snap their neck or they don't lose consciousness immediately, um, they sit there and hang and, and die of asphyxiation, that's a bad way to go.

Wow. Uh, and speaking of bad, I think being burned to death may be one of the worst. Isn't that what we came up with on the worst way to die? I think so because you feel it and you'd think like you're nerve endings. That's what I thought. Like, oh, your nerve endings are probably like stop responding quickly, but apparently that's not the case. No, not only is that not the case, apparently you're the fire further sensitizes your nerve

ending. So you feel even more pain. Wow. Yeah. But luckily most people, I think the vast majority of people who die in fires actually die from smoke inhalation before they ever feel pain from fire. Yeah. I don't know about before they feel pain, but hopefully quick enough.

Well, you know, carbon monoxide sinks. So like where there's a lot of smoke, you are down low to the ground and that's where the carbon carbon monoxide is. So you're inhaling mostly that so it's possible it's before that's true. And then the natural death, which is a passing of old age or disease. And here in this country, we have kind of whipped up a lot of the disease over the years into into they sniff them off the case. Right.

Well, it depends. Like some of the ones that like kill undeveloped countries like diarrheal diseases, like dying from diarrhea. You don't have that much in the US, but we have chronic disease like obesity and diabetes and cardiopulmonary disease. We have that down pat. I've got the top five here actually. I think they're all in there, aren't they?

Heart is number one. Heart is number two, lower respiratory is number three, stroke is four and accidents are five. Yeah. And it's a huge drop. Cancer and heart are close to 600,000. And then number three, lower respiratory is only 138,000. So that shows you what cancer and heart disease are doing in the United States at least.

And the upshot of all this is that most of us are not going to die suddenly either by accident or by violent death. Yeah, dying of old age didn't used to be a thing. No. It was like... It was like a lot of ways to die, but that wasn't one of them. Right. You picked off some traveling night or there was a dispute over grazing rights or...

Yeah. Or plague. Yeah. You walked into a bear cave. Yeah. Yeah, the plague's another one. But yeah, old age is... It's kind of a new thing, but it's one of the most prevalent forms of death in developed

countries. It actually has its own name, frailty. Yeah, which is great. It's sad, but it's great that now we can live out our lives and we're about to talk about it. But sometimes the body, just like any other machine, just stops working. It's not designed to keep going indefinitely and ultimately the system shuts down as its subsystems shut down.

It is shutting down every second. Right. Right now, our bodies are shutting down very slowly. And for that reason, because you and I are both dying, I guess once you're born, you start dying. Yeah. Or after you stop growing, you start dying, right? Is that just the positive outlook?

But I mean like you're shedding cells and like this is like the dying, we're in the midst of the dying process. Just this natural system is in the winding down, although it takes decades and we still have plenty to do. Yeah. Like you said, you're dying, I'm dying. That's why they have a more specific definition of death, which is called active dying. Like you and I are not actively dying right now.

No. No. Instead, if we are actively dying, we're in the midst of the dying process. Yeah. It is started. The dying process is started. The descent, if you will, has started. Right.

So all this kind of happens since different types of cells die at different speeds. That's what it is. It's cell death. Right. Cellular death. I don't want to let the cat out of the bag, but oxygen doesn't happen to different parts of the body. Your cells are going to die.

Exactly. And so as the cells die at different speeds, different systems are going to shut down. But just from watching frail people die of old age, they kind of have like this, the order in which it happens kind of down pat. So there's the pre-active dying phase, which can take about three weeks. Starts about three weeks before death, two or three weeks. Yeah. And then there's the active dying phase, which can take a few days.

And obviously that's not set in stone. None of this is set in stone, but this is all just kind of accumulative knowledge from observations of people dying in like hospice and things like that. So you get the pre-active phase of dying. And like I said, it starts a couple of weeks ahead of the actual death. Because we have, this is a big deal right now, what we're talking about. It's becoming very clear in our modern age that death is not an instant. It's not a moment.

There's a process. Yeah. Well, unless it isn't an instant. But yeah. Old age dying. Yes. Or like other kinds of dying, but how about non-accidental dying? Okay.

We'll call it that. Because that's like the instantaneous thing. Right. And even sometimes in a very short scale that can follow some of these, you know, oh, yeah. I forgot to talk to you. Yes. I was nodding my head 2023 is already well underway everybody. So don't wait any longer to level up your small business.

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much energy, you're going to start sleeping more and more. Your skin might become cooler to the touch, might turn a little bluish gray. Yeah, cyanosis, that's what that's called. Oh, is that what that's called? It's just becoming oxygen deprived, like apparently your body's like, okay, don't really need to use the legs anymore because we're bedridden, so I'm going to start focusing more of the circulation on the inner organs. Okay, that makes sense.

Well that probably causes the modeling too, which is your skin can become sort of reddish, like splotchy with reddish blue splotches as well. Right, you're going to be a little restless probably, you're going to possibly come off as confused, you're not going to be hungry, no, you're going to probably withdraw from social activities, you're going to become a little withdrawn. You might want to settle unfinished business with family, you might request family come visit you for that kind of thing. Oh, sure, the non-physical parts, that's definitely something you'd be interested in doing.

Right, but that's like apparently something that people intuitively know, like apparently patients know when they're dying. I've seen that happen. And one of the signs that's mentioned in hospice care, palliative care, is that the patient may even state, I'm dying, like I started, it's coming. That's pretty common, yeah, and that's sad that when you realize, alright, this is it, like I feel myself, I'm going to be gone soon. But that's neat though, especially if you are...

If you have that time, yeah. But if you're like, okay, I'm going to put everything in order, then die happy or peacefully. That's neat that you have that time to take care of that. Yeah, if you're fortunate enough to go that way for sure. Back to physically, you won't be able to heal from a wound or an infection any longer. Yeah, you might lose control of your bladder and your bowels over the course of some time. You might be in pain, but chances are, here in the modern world, they're going to take care of you in that respect.

Right, and again, that's called palliative care, where at some point it's very obvious that you're going to die, and a lot of it can be based on what you want, but even without your wishes, there's probably a point in time where medical science says there's nothing we can do for you. We just want to make you comfortable. Exactly. So we're going to give you pain meds. We're going to – your care is being transferred over from a physician who wants to save your

life and keep you going to hospice workers, healthcare professionals who are trained to just keep you as comfortable as possible for the duration of your life. Man hats off to those people. Yes. All healthcare professionals, of course, but man, hospice nurses, that is tough stuff. You've got to be made of the right qualities as a human to be able to tackle something like that and still get up and go to work every day. Like they're literally in the business of dying.

Yes. I mean, very valuable service people provide. So that's the pre-active phase. That's the, I'm getting ready to die. I've got a couple weeks, and all of my systems are starting to wind down. In the active phase, the systems are starting to shut down. You may not have consciousness, and if you do, you may – if you are able to be aroused from unconsciousness, you're going to slip right back into it again, possibly.

You are probably – and apparently families find this very disconcerting. You're probably going to talk about people who are dead as if they're in the room or you can see them or hear them. Yes. This is the mind-slipping. They don't know. These workers from what I can tell tend to just treat it like it's real, treat it on its own terms.

Yes. They're not saying it's real or it's a hallucination or something like that, and they advise families not to treat it like a hallucination, just to – Not to correct them. Yes. That makes sense, because you're there to provide comfort, not say, no grandpa, grandma's been gone for years. Exactly.

Why would you want to do that? There is an exception to that. You would want to do that if they're fearful from their visions. Then you can say, it's not real, it's just you're – that's not real or whatever. Yes. Again, all about comfort. Yes. But you don't want to contradict them if they're happy or even saying it in a neutral

tone. It's only if they're fearful that you want to say that. But apparently families are kind of like, oh God, they're gone crazy. But it's a natural part of the active dying process. Patience is going to become really weird. The patient's going to stop breathing for disconcertingly long periods of time. Yes. This is called Chaney Strokes Respiration Stokes.

Sorry. Chaney Stokes, named for John Chaney and William Stokes, obviously the first dudes who described it. Sure. Yes, let's get all the press. Quick, deep breaths, sometimes very slow ones, like you said, sometimes stopping altogether. And that is caused by receptors in the heart and brainstem basically being too sluggish to respond to different amounts of oxygen in CO2 and it's just kind of lagging behind.

Again, think of it as a machine that's just slowing down. And those receptors can't pick up on it in time, so it doesn't know how to tell you to breathe basically. Yes. Like at a steady rate. We should say that there isn't evidence that that is physically painful. True. Again, it's awful for a healthy person in the room.

Yes. For the family watching it, you think that the person is suffering. There's not evidence that they are in fact suffering. But it seems like it. And that, from what I understand with palliative care, not only making the patient comfortable is one of the priorities, making the family comfortable is a priority as well because how you die has a very lasting impact on the people who are there to witness your death for family.

So explaining that they're not suffering is helpful, but not necessarily enough. Yes. And I think actually this podcast itself could help like some people because I don't think a lot of people do this sort of research when they go into a hospital room in the last hours of a loved one's life. Yes. And they may not be told. They may even if it is explained to them might not sink in what they're being told.

Because seeing somebody gasping for breath and then being told that they're not really suffering. Those two things might not job. Well, yeah, your your instinct is to probably try and get help. Yeah. Like they can't breathe clearly. Let's get a nurse in here. And the nurse is like, no, that's, that's, that's part of it.

Yeah. Another one that's very disconcerting, another sign of active dying is the death rattle. And I did a, I guess I don't be dumb on death rattles. Oh, really? And basically either you have fluid in the lungs or like, you know, when you clear your throat like I just did, yeah, that's a normal ability you have until you start dying. Yeah. You can't clear your throat anymore.

Yeah. Those are your laryngeal muscles, right? Basically spasming. What clearing your throat? No, the death rattle. No, the death rattle is just breathing through the mire. It's both. It's, it's either liquid or it's the muscle spasms.

Is that right? Yeah. Okay. Did you find that that's painful because I found that it's, it doesn't cause pain. It's just, it sounds terrible again to the people in the room. Exactly. Yeah. And this is a, I don't think we pointed out this is the agonal phase of death and it's

Greek for struggle and agony. Yeah. That's sort of just encapsulates it. I think that's probably why they call it the active phase of death now rather than agonal. Oh, do they, they don't even call it that anymore. I mean, I think some people do, but I think that active and agonal are the same one and the same.

Gotcha. It's just, you know, they're in the agony phase or they're in the active phase. Your muscles, aside from your vocal cords, might start convulsing and spasming. You can get all, you know, perky jerky and do things that wouldn't seem like you should be able to do in your state. Like card tricks, I don't know if you could do card shuffling card tricks from one hand to the other and grandpa never could before. Yeah.

I knew he gets some humor in here somehow. What else? Well, let's see your blood pressure is going to drop, your jaw is going to drop. You might end up in a really weird, rigid position and your, I think we said your extremities are going to be cold to the touch. Yeah, actually the death rattle as a result of the spasming of your laryngeal muscles, that can also produce what was described in what I read as a barking sound. Oh, yeah.

Yeah. And I've never, I didn't search that out to see if that was recorded anywhere, but I'm curious what that sounds like. I've heard everything from gurgling, like gurgle to, it sounds like there's marbles in your throat. Right. It's a barking, that's a new one, but I think everybody has their own signature death rattle, you know?

Yeah. But the rule of thumb apparently among hospice workers is once the death rattle comes, it's a sign that they got about 48 hours or less left to live. Yeah. And all of these are tells really, and all of them, and we'll talk about what happens after the body is dead too. And that helps with finding out, you know, in forensics, I think we pointed out plenty of times at the time of death, depending on the various things that happen, you know,

when they find you. But all of these are almost like markers on a clock. Yeah. And if you're in hospice care, you know these things like, oh, this is, this means this. Well, there are signs and symptoms of the system shut down that the person's body is going through, you know? So the senses apparently also are lost in a healthy person or a person who has all five senses.

Yeah. And they're lost in a certain order. And touch and hearing are the last to go. Oh, really? And another... That's kind of nice. Another very important point that hospice workers make is never, ever talk about the patient like they're not there because they can hear you up until the end.

Yeah. Like hearing is kept so long as the person could hear before then, and there's not any damage from, you know, during the active dying period, they can hear you until the moment they die, and you need to be careful what you say. Yeah. And I think that's a really nice thing that the last things that you can experience are the touch of a loved one or the voice of a loved one, you know, needs to see him. You may not even be able to respond to that, but you can still hear.

That's true. Yeah. I would definitely pick that over sight. I'd rather hear someone's words as I pass rather than having silence and just seeing their faces staring at me. So long as the words are, wait, one more thing. I think it would be almost cruel to be able to see and not hear at the end, you know? Yeah.

Like, who wants to see your family upset? You want to hear, feel them hold your hand and say, everything's going to be all right. So you raise a good issue, like there's... If you have a dying family member, especially if they're dying of frailty, or they're just dying, like they're in the dying process or they're about to enter the dying process. You could do worse things than to go online and educate yourself on how to be around them. Yeah.

I think people don't intuitively know how to be around a dying person, and there's certain things that you should do, certain things you shouldn't do. Like, for example, they say that you should talk to the person, not the condition. Yeah. So don't treat them like they're frail or dying, like treat them like they're your old friend, who they are. It's extremely important to make sure that they're in a peaceful, calm environment. So like, maybe yelling at somebody over the will is a really bad idea.

Yeah. They seem like no-brainers, but I guess some people need to be told this stuff. Yeah. But I mean, think about it. Like, it can put you on edge being around a dying person. Like, do you mention the fact that they're going to die, or do you, you know, I mean, like, do you dance around it? If they make a joke or something, like, can you laugh, or do you laugh too hard?

Or do you not laugh enough? Like, there's, I think it's not necessarily like, I think it's just put you on edge. Not everyone is as sensitive too. So I'm going to add one. Don't bring your laptop in there and watch reruns of the office. No, yeah. Are you speaking from experience? No, I'm just going to add that.

Okay. That's on my list. Okay. Get off your cell phone. Yeah. Pay attention to them. Sure, yeah. I mean, that's what you're there for.

Because hospice workers put it, you're giving them a very heartfelt gift by being there sure with them while they're dying and maybe receiving a gift, you know, sure. And many religions and cultures, it's very much an honor to like be a part of this whole thing. And even if you're not religious, you could just feel that way spiritually as a human. Yeah. You know, okay. Well, let's pause here because Chuck, it's time for a message break.

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Okay. So are we dead yet? Are we at that point? Yeah. The person has passed. You just sounded very cheery. Yeah. Well, I mean, like we rattle off some pretty what seems like suffering, but now the suffering

is over if there wasn't any, the person is dead. So once you immediately, immediately after you die, your pupils are going to dilate because the muscles controlling the iris are, you know, going to have their final rest. So your pupils are going to dilate. And then have you heard of the terminal tier or the lacryma mortis? No, this is a usually in the right eye and there's no real explanation for it, but it is a final tier that you shed. Wow.

And it doesn't always happen right after you die, although it can, they did a study in the early nineties in New Zealand and out of a hundred deaths, 14 of them right at the time of death had the lacryma mortis here and 13 of them in the final 10 hours. And they say to, to look out for that if you're the family, because it can be a sign. And also they try to talk you into the fact that it's a comforting thing to see that tier being shed. Wow. Yeah.

And since we're on eyes, you know, the old thing where you close someone's eyes after they die. Oh yeah. Or you put silver dollars on it's, it's the old West. Yeah. Um, I guess people do that too. So you're not having someone, a dead body staring at you. Right, cause if they're looking dead forward, straightforward, they're like following you

all throughout the year. Yeah. And it's definitely a movie trope. But if you don't close the eyes, and I never knew this, um, something called T A C H E noir. I don't know if it's Tash or Tash, noir. Okay. That is a black, a dark reddish brown strip that forms horizontally over your eyeball. And I guess it's just, you know, your eyeballs dry out and has that air.

So if you don't close the eyes and I looked it up, you're going to see this weird horizontal stripe across your eye. There's a plus the, the effect that has on the living, the difference between seeing a dead body with their eyes closed and a dead body with their eyes open is just, it's like a galaxy between the two as far as discomfort goes. Yeah. Somebody should edit together the, uh, like every time that's ever been done in a movie. Yeah.

There's like super fast. Yeah. All right. So that's all I got on the eyes, um, so Chuck, I want to alarm you right now boy, you have living in your guts right now, the very organisms that are going to decompose your body when you die. They're just sitting around waiting, waiting for action, waiting for the signal. Yep.

Um, when you die, there's a lot of stuff that's still alive that's still going on, even though your brain dead, whole brain, higher brain, heart dead, your heart stops. You're dead. Yeah. That's another definition of death. I don't know if we mentioned your heart. Yeah. Your heart's not beating anymore.

Right. You're dead. Yes. Um, there's no bringing you back. You've been in your, your heart hasn't, or your brain hasn't had oxygen for a while. You died of hypothermia, uh, and they warmed you up. So now you're officially dead. You're gone.

Right. But there's still a lot of stuff. Like for the, um, poop shake episode. Yeah. Who can forget? We talked about the microbiome. We have this whole other like part of our life, our living organism that's still around. That's still operating.

Yeah. And a lot of stuff living within us, including part of our microbiome, they're still carrying on processes. Like apparently you can harvest skin cells for 24 hours and, and they're still alive. Just use them. Yeah. For all sorts of stuff. Yeah.

Use them, uh, and then of course inside your intestines, there's little tiny organisms that are still living and they're going to help do the work that comes next. Starting a couple of days after death, like if you just fell over in the woods and no one was around. I always love the setting. Right. Um, and you're just left there within about three days. These organisms, the micro flora is going to go to work on you starting in your intestines.

Yeah. And after the various mortises, correct? Yes. Which, I guess we should kind of go over it, but I would recommend everybody, um, go listen to what causes rigor mortis. Yeah. For sure. It's on the website.

You can go to stuff. You should know. Dot com slash podcasts, uh, slash what hyphen causes hyphen rigor hyphen mortis. Um, we'll just run through the mortises real quick then, um, algor mortis or the death chill. Mm hmm. That's the first, first thing that's going to happen. That's where your body starts dropping in temperature, about a degree and a half Fahrenheit

per hour until you are just like a nice red wine at room temperature. Yeah. Actually, that's not quite true. Red wine is like 64 degrees. I guess it depends what kind of room you're in. Yeah. If you're in a 64 degree, it's perfect. Yeah.

All right. What else? Uh, well, after algor mortis, um, you get rigor mortis a couple hours after death where the body, um, settles into a, um, stiff state. Yeah. Uh, and that lasts for what, like 24 hours? I don't remember. We talked about it.

Uh, yeah. Yeah. I think so. Um, and then between those, you have live or mortis or a sec, sedulation. That's where like all the blood coagulated. Yeah. Basically your red blood cells are pretty heavy and they just sink and, um, it's about 20 minutes to three hours after death is when you're going to be in live or mortis.

Yeah. And then after that is rigor. That's right. Yeah. So now back to putification. Right. Well, that's the best thing to talk about. Yeah.

That's, that's basically like you're, these organisms go into work breaking down your body and they do it pretty quick. Yeah. Um, the pancreas apparently has so many in there that it just eats itself, eats itself. The pancreas consumes itself. It's pretty efficient. Um, your other organs are going to eventually, eventually be consumed in, turned into liquid. Yeah.

You're liquefied from the inside out. Yeah, you're going to turn colors in this order, green, then purple, then black, which is just like a, like a black eye, I guess. Yeah. And that the same stage? Yeah. Except it never fully heals. Yeah.

It explodes. Um, you, uh, within a couple of weeks, you're going to be liquid inside the organisms that are eating you produce a gas as a byproduct from their consumption. So you're going to be bloated, your tongue's going to stick out. He's going to turn dark too. Your tongue. Yeah. And that gas really stinks.

Your eyes are going to protrude. Yeah. Um, there's something called purge fluid that is a putrid reddish brown fluid that can be expelled through just everywhere you've got an opening. Right. It can come out of your mouth, your nose, your vagina. It can be mixed with feces and come out of your rectum. And there, um, there's something else that can come out of your vagina too.

Yeah. This is maybe the worst thing I've ever heard. I, I just, I had no idea. Yeah. I had no idea. You know, I know all about death and all that, and it's like interests me. I had never heard of this before. I don't even want to talk about it.

You don't either. Maybe we should type it into the computer and make the computer say it. Do we have that ability? Custom birth. Oh, wow. That was pretty good. That was a good computer impression. So wait, that's what you do when you don't want to say something yourself.

You pretend you're a computer. Yeah. That Emily and I, most of our fights are like that. Really? Yeah. It's pretty cute. I go into a war games mode. What was it again?

Computer. Uh, coffin birth, coffin birth. So basically those gases that, um, this is a real thing. We're not making this up. Yeah. But post mortal fetal extrusion is another name for it. So the gases that build up in the body before the body ruptures, um, which comes a little later can become so pressurized that a pregnant woman who has died with the fetus still in

utero can actually, the gases can push the fetus out of the vagina, um, which is coffin birth. Yeah. And this doesn't happen much anymore. No. Thankfully, because we pick care of dead bodies pretty quickly, um, although they did find evidence of it in a case in 2008 where this woman was found like in the woods. But, um, it was described a lot in like 16th to 18th century medical literature.

Oh, you know, it just drove them crazy. Oh, sure. She was obviously alive for weeks afterward. Yeah. And archeologists apparently too are, are, I have to rethink, uh, sometimes when they find, because sometimes you would die during childbirth, but the, um, they would bury the, the, the baby with the mother. Right.

And so you would find the bones like cradling each other almost, but then they go back, uh, they've had to go back and look at somewhere they find the, you know, between the legs, the bones of the baby. And they think that might be the case like a coffin birth. Right. Boy. So there's the worst thing in the world. Yeah.

Um, there's probably death metal band with that name. If there's not, there is now. Yeah. Um, so the, the gases ultimately eventually, once they start, once they really get down to business and they're no longer just what, what's it called where the fluid's coming out of little orifices here or there purge fluid. Okay. So once it's like enough with the purge fluid, the, we're just going to tear the sucker open.

Your body ultimately ruptures. Yeah. And this is, you know, your skin is already blistered at this point. Um, your hair, nails and teeth have fallen out. They don't keep growing. No, it's your skin receding from drying out from desiccating. Yeah. So pass that around in school kids.

And someone says that your fingernails keep growing after death. You set them straight. Tell them Josh. Oh God. I just realized there's kids listening to this and then the old de-gloving, which we've talked about before. Oh yeah. I forgot about that.

Remember that? Yeah. Where the, um, that can happen to you if you drive at 10 and two and you have an airbag, the gases that expand the airbag out of your steering wheel are very hot. And if you're not driving at nine and three and you have your hands at like 10 and two or something, like you're going to be de-gloved. Really? Alive.

Yeah. But yeah. Your skin is just burned right off your hands or it's burned and separated and then eventually comes off. So 10 and two is not how you should drive any longer? No. Really? That's what I've learned.

Yeah. I drive it either just a straight up six o'clock with one hand or a noon or just a straight up noon. Noon. I rarely have two hands on the wheel. You don't drive with like your knees with your hands behind your head relaxing? Occasionally. If I'm, uh, you know, relaxing, yeah, or playing the guitar or something.

So de-gloving. Yeah. De-gloving is, I know we talked about this in, uh, probably rigor mortis, but that's when you're. Or body farms. Maybe. Yeah. That's when basically your skin is removed, still attached to things like fingernails

and things like that. And it's, they call it de-gloving for a reason. I don't think we'd need to explain. Yeah. That makes perfect sense. Or desocking. Sometimes, you know, can happen to your feet. Well, I hadn't heard of that one.

Did you just make that up? Well, they said gloves or socks, if it's your feet, but I did make it desocking. De-socking. Well, I'm going to have to use that from now on. Yeah, that's good stuff. That might be a new thing. Um, so the body, it, once it, once it ruptures, your organs are already liquid. Um, and all that's left is a skeleton, which will eventually turn to dust too.

Can we be done? No wait, we can't be done because we do need to talk a little bit about, um, assisted suicide. Yeah. I just teed that up for you. Boy, you should have. Um, that's quite a controversial subject. Like we said, um, I don't know if I said or not, like this has just been such a huge whirlwind of input.

Yeah. Of information in my head in the last like 36 hours studying for this, um, that I don't know what I've said yet or not, or what we talked about in another podcast. But yeah, so we talked about dying of frailty of old age and that it's increasing. Yeah. Supposedly five out of 10 people in the United States will die in the intensive care unit. And I saw this Ted talk from Newcastle, Australia with this guy. I can't remember what his name is, but it's, it's about dying.

I think it's called it. Can we talk about dying or something? Right. The thing was you're going to die in the ICU, whether you want to or not, right? If you die of a degenerative disease or frailty, unless you say you don't want to die there because the way medical science is currently set up, you are going to be treated most of the time, uh, up until the bitter end with life-saving measures and you're going to die in the ICU with tubes hooked up and things beeping and like other people having crash

carts taken in and out of their room and people making a big ruckus up until the point you die unless they give you palliative care or, or you say, I don't want to be sustained like that. I don't want to go to the ICU. And this point was if half of Americans are going to die in the ICU, you have to assume that maybe not all of them would want to die in the ICU and therefore they need to think of things like I want an advanced directive, a living will, I want a living power of attorney to somebody to say, no, no, do not put them on a ventilator, do not put them on feeding

tubes. Like they don't want that. They just want to die or they want to go to hospice, they want to go back home. That's another big one. Like they don't let you go back home, especially if you can't speak for yourself. Like to medical science these days, that's crazy. You don't leave the hospital when you know you're dying. You stay in the hospital and we keep doing stuff until you die.

Right. That's not the way it jobs with a lot of people, but if you don't stop and think about it and then write it down or tell somebody who can speak for you, that's, you're not going to go home. Yeah, you need to do that. You're not going to go to hospice. You have to do this ahead of time. And part of that that's kind of come out of this idea is, okay, well, if we have autonomy

to say, I don't want you to intubate me, why don't we have the autonomy to say, I want you to give me some stuff that's going to painlessly end my life because it's either that or facing a tremendous amount of pain and suffering through this degenerative disease. Yeah, basically saying I'm ready. I am ready. It is my life. It's like the Richard Dreyfus movie from the 80s to cover this, whose life is anyway, I think.

I have no idea what you're talking about. Yeah, I think so. It was a movie. Okay. About assisted suicide. And do you, should you have the right to be able to, you know, it's a hot button issue for sure. But apparently most Americans or the majority of Americans actually support it until you

start using a word like suicide. Right. When you pull them and say, do you, are you in favor of doctors helping someone to painlessly end their life or something? Yeah. At the end of life. They say, sure. Yeah.

And then they're like, okay, so you're in favor of physician assisted suicide? No, no, no. Right. What's that word? You know. And doctors who are in favor of euthanasia is another term for it. Say, look at palliative care. It's like half of a step away from physician assisted suicide.

Yeah. Like you're keeping somebody, if they request it, knocked down on morphine for the rest of their life. So they're never going to regain consciousness. Yeah. There's this, you dug up this one article by a British physician who argues that that agonal gasping reflex, apparently when part of the apnea is that your body has a reflex where you gasp for air and it's really disconcerting to family members.

Even though they don't think that you're suffering, it looks like you're suffering. And this doctor argued, well, we have drugs that can block this response so that the person can't gasp for air and what's going to cost them their last couple of breaths. But these last couple of breaths make it appear like they're suffering and the family remembers that their kids suffered. So why wouldn't we do that? And there's this conversation that's taking place more and more and more that ultimately it's kind of like, who is somebody to say that somebody can't choose to end their own

life painlessly through the use of like drugs? Yeah. Or like Hunter Thompson did. Well, I mean, that's another way to go and anybody can do that, but there are some people out there who don't want to die violently. They want to die peacefully. Yeah, or to leave that for their family. Like that's the part that I was upset about with that was his wife, like finding him and

stuff. Yeah. His wife and his son. Yeah. And it was like, not only that, he did it in his own basement, which I can understand doing it at home, but he left quite a mess in his own basement for his family to clean up. But if he had other options these days, like doctor assisted suicide, he might not have

had to make a mess in his basement for his family's. Yep. I think we know that Hunter Thompson is far from the only person to make his own exit his own way. Sure. Another very famous person, uh, Sigmund Freud did too, huh? Oh yeah? Yeah, you know that.

Assisted suicide. Yeah. Literally physician assisted suicide. He was diagnosed with cancer of the palate because he smoked tons of cigars, which were sometimes just a cigar. I was about to say. And for 16 years, he lived with that diagnosis and finally toward the end, he asked his surgeon, his physician, go ahead and hit me up with, I think, five grams of morphine, like just

a ton of morphine. And he died three hours after the injection of it, but which was more than his usual two grams of morphine, right? Or cocaine. He loved cocaine. Yeah. Um, but he had, um, developed what was called Todin angst, Todin angst, which is a dread of death.

Yeah. So, and so he lived with that for 16 years, but he finally, he, he decided along the way, like, I, I fear this, but I'm going to take it into my own hands. Physician assisted suicide, 1939, and there's definitely more than one side to this coin. Oh yeah. There's a lot of people, there's very strong opinions on either side, but I think it's a, and at the very least, even if you remove emotion from it, it's an extremely interesting conversation in that it reveals so much about our attitudes toward death and autonomy and

like who's, who has the right to decide whether they're going to die or who has the right to tell somebody that they can't do that. Whose life is it anyway? Yeah. Richard Dreyfuss. Uh, and then Chuck, one, one other thing that we want to hit on is, um, regret. Yeah. I actually saw this a few weeks ago just by chance and then you sent it to me.

Um, I think it was in England, a hospice nurse, uh, spent a lot of time researching life regrets over the course of a certain amount of time and came up with the five most common life regrets. And, uh, I think this is like a good way to end it, you know, number one, uh, wish I had the courage to live a life true to myself and not the life others expected of me. Right. That was the number one regret. Yeah.

Uh, number two was, I wish I didn't work so hard, I didn't surprise me at all. Yeah. Uh, number three, I wish I had the courage to express my feelings. Uh, number four, I wish I'd stayed in touch with my friends. It's a very sad one. And I wish I'd let myself be happier. This number five. Yeah.

Like that. She was saying that they didn't realize toward till the end of their life that happiness is a choice. Right. You make it's not something that happens to you. It's something you go search out. It's a state of mind that you strive for. Sure.

And to figure that out, like at the end that, that's a regret. Yeah. So call the action people. Yeah. Think about this stuff. You don't have to wish these things on your deathbed if you start doing something about it now. Exactly.

Dying Chuck, you know what we might have just done? We might have just finished the death of the death suite. I bet there's something else. Yeah. Only time can tell, but I, I don't know how much more aspects of death we can cover. And I'll tell you what, I'm going to put all of them together in a blog post. Oh, nice. The death suite.

So everybody can go listen to all things death via stuff you should know. What a gift. Yeah. And in the meantime, if you want to look up more about dying, just type dying into the search bar, how stuff works. I think it has its own channel. There's so much to it. And since I said search bar, it's time for listener mail.

This is a nice one. We don't normally do shout outs, but this was a nice one. And I thought what better way to end such a depressing show. Hey guys, and Jerry loved the podcast. Josh, I have to thank you for teaching my fiance Danny and me about the flashlight trick this he's spiderizing. Oh yeah. I still haven't done it, man.

I never think about it at night. Jerry, you said you tried it, right? And it worked. Yeah. Okay. I need to do it. I need to set a reminder. And my, my response to people who can like, can you, can you explain it again?

Practice. That's my explanation. Just practice. Just try it from a different angle. Okay. Just practice. It's a real thing. It's not a trick.

It is completely amazing. And this is from Peachy, by the way, and it's wonderful and frightening at the same time. But the problem now is that whenever we walk our dogs at night, I just can't have my normal fiance. I have this dude with the flashlight stuck through his forehead, stopping at every field to let me know just how many spiders or dogs are stepping on and how we are always surrounded. Thanks for the show. And now for a shameless request.

I know you don't often give shout outs, but it would be the most amazing thing ever if you could give a shout out to Danny on the podcast. The air is sometime before our wedding on October 13th. Oh no. Let him know that I love him more than anything and that I'm excited to share my life with him, even if he does have a flashlight stuck to his forehead for the rest of our lives, walking our dogs together. I know this is a totally blown away and I would even let him listen to that podcast

first. So thanks to Jerry. Thanks guys. That is from Peachy. Way to go Peachy. And Thousand Oaks, California. I think Peachy just expressed it very nicely. Yeah.

So Danny, Peachy. Congratulations. Best of luck. Best wishes from us. I told her, listen up for it on that dying podcast and she thought that was kind of funny and it's like, great. Yeah. And Danny, maybe put down a flashlight once in a while.

Yeah. And Peachy, don't use the word fiance so much. Okay. That's a life lesson from Chuck right there. No one likes to hear that. If you want to see if you can talk Chuck into a shout out, take your best shot. You can tweet to us at S-Y-S-K podcast. You can talk to him directly on facebook.com slash stuff you should know.

It's where you spend all of this time. You can send us an email to stuffpodcastthescovery.com and you can join us at our website, our very own website. It's called stuffyoushouldknow.com. For more on this and thousands of other topics, visit howstuffworks.com. Like a good neighbor, State Farm is there with 18,000 agents across the country who are ready to help you 24x7, 365, that's getting to a better state. Once again, use promo code HEART20 through January 30th to receive 20% off your 2023

trip. The South Dakota Stories, Volume 3. It was my first time traveling alone, packed my car with hiking boots, a camera, and my dog Randy. I don't know what I was searching for. Maybe it was something new with adventure. Maybe it was the idea of vacation I would never expect, filled with wildlife, national parks, rivers.

Whatever it was I set out to find, it was all there and more. Because there's so much South Dakota, so little time.