Hi everyone, Hope you're having a good weekend. Here's a podcast about dying from September nine, two. Uh. It is My Stuff You Should Know. Select pick for the week How Dying Works. This is a tough one, but necessary and this may be as much or more so than any other show we've ever done. We got a lot of feedback on on just understanding the process of dying literally physiologically. Has helped so many people over the years, over the past five or six years, when their own relatives are going through this kind of thing. So I'm glad it's help people out in the past and hopefully it will in the future. So, uh, enjoy maybe the wrong word, but I hope you learned something today with How Dying Works. Welcome to Stuff you Should Know, a production of My Heart Radios How Stuff Works. Hey, and welcome to the podcast. I'm Josh Clark, There's Charles w Chuck Bryant, How you do It? 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 that happened. That's like when you rec rolled me like two years after it was popular. You're 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 sold it two years ago. Well, I'm so sorry. I tried to show you something funny, right, you know, but yeah, Jerry just saw the do we even say the mumble mouthed reporter maybe, Yeah, the lady who supposedly had a migraine but appeared to have had a stroke, reporting from the Grammy's 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 Station, Um, I've got one for you. I've got a bit of an in show. It's not much, so get your hopes up all right. Um? Have you ever heard of the Population Reference Bureau? No? You have, big because I've mentioned it before. I've mentioned this this article before. It's on PRB dot org. It's called how Many People have Ever Lived on Earth? And I don't know what we've mentioned and 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 he Um. There's even a video of him explaining it if you couldn't get what he was going with. But hobb Um he reckons that modern humans people who are virtually indistinguishable from you or me, aside from the fact that they're not wearing like any clothes. Really um showed up about fifty thou years ago. So hobb puts the population of humanity at two uh in fifty BC. Okay, so from that point to two thousand eleven, he extrapolates, does the math, does this little demography thing, and hobb comes up with the number that one hundred and seven billion, six hundred two million, seven hundred and seven thousand, seven hundred nine people have ever lived between fifty thousand BC and two thousand eleven. See, that's pretty neat, it is. That's a lot of people. He says. That means about six point five of that are alive right now or were in two thousand eleven. Al Right, so we're dying off. That's the point. All one hundred and seven billion, six hundred two million, seven hundred seven thousand, seven hundred ninety one of those people had one thing in common, one thing aside from being humans, no, not even not even yeah, yeah, they didn't have tax and in fifty thousand BC they had running from sabre tooth tigers death. It was death. That's the one thing all one hundred and seven billions, six hundred two millions, seven hundred seven thousand, seven hundred ninety one 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. I was like, he wouldn't do that. You're like, it'd be way too boring. That's a good number. I like that. Hundred seven billion, six hundred two million, seven one thousand seven seven Yeah, yeah, and that includes you and me, Pal. You know what that means. You're gonna die. I'm gonna die, Jerry's gonna die at least two or three times. We're all gonna die. Yeah. This is our dying podcast, and we have covered just about every aspect of dying. Can you die from a broken heart? How rigor mortis works. What's the worst way to die? Um? Is there a best way to die? Did we do that? That was kind of in the is there was way to die? Yeah? Um, we've covered everything from autopsy, peak oil, what can be done with the dead body? Ninja's 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 gonna be a sad podcast in many ways and gruesome in some ways. Yeah, because we're gonna touch on some of this stuff we hit on in like rigor mortris and autopsies and the actual dying process. Right, But I mean, so brace yourself. And I've mentioned this guy scores of times at least, but as the it's a Charles Man. You thinking of the great psychologist Ernest Becker. Shout out to our pal Joe Randazzo, who's like in the Becker Now, Ernest, Ernest, Ernest, you're thinking of Max Ernest. Okay, Ernest Becker um wrote the Denial of Death seminal work that basically says, we're all just doing everything we came 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 and talking about it. Yeah, so let's talk about death, baby, Let's talk about you and me. Let's do it. Okay. So Molly Edmonds Um who used to be on Sminty stef Mom never told you we call it sminty Um wrote this one, and I think it is interesting. And I usually don't like it when article's day 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 you know, thirty times that long in the encyclopedia, right, 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 I mean, 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, yeah, that's death. And since there was perhaps a lot more religiousness associated with death and dying than there is today, um, that kind of underscored the belief and death. It's the soul departing from the body. And what what more do you want to know, egghead? It's death? Well yeah, and uh, way back, you know, a fe d years ago, you'd call him a priest and they 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 its 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 bal force 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. I mean, that's the test. I'll buy that. And there were other tests that like a priest who may have come to say whether you're dead or not, would use like placing a feather above the mouth or around the mouth or knows to see if it moves. Um, the old mirror mirror trick that's still you know, 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 gonna fall up a mirror, right exactly. Um. 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 you know, machines to help you breathe and feed you. Right, And not only that, we've entered this really awkward period um in human medical history where the machines that can tell us whether someone is alive or not are more advanced than our machines that can bring a person back from death. Yeah. So we have ways to sustain the body, but not necessarily the the person, depending on your definition of death, like the faintest trace of a brain wave maybe right. Yeah. So we went from holding a feather under somebody's mouth or knows to see if they're alive, to using MRI s 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 is 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. Yeah, are they alive? Well? Yeah, and we in this hasn't been that long, you know, I mean in the fifty two thousand years or whatever the people have been dying. It's only been the past you know, sixty 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 that was when the French neurologists describe the coma DePass, which was a state beyond coma basically uh, brain death, although that didn't come along until technically until nineteen when Harvard Medical School did UH basically defined it for the first time. Yeah, although they didn't even call it brain death at the time. What they call it just irreversible coma like you're not coming back. Brain death was attacked on later. Um. So yeah, so comma to pass umge, persistent vegetative state, brain death. Um, all these things would indicate again that you're dead. The problem is is we have these machines that can keep your body warm, and can keep your chest rising and falling, can keep your body going indefinitely. Um. But the thing is is there's something that's not there, and does that mean you're dead. There's been a lot of talk about, um, 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. 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 um. Actually, after it took one 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. Um, they rejected in favor of that. So Harvard was like, right, Um, 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. Yeah, Um, he had his head cut off which included his brain. His brain stem still there and he's a chicken, so it didn't really matter. Um, but 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. Right. 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 now I think 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. Definitely remember covering at some point. Yeah, I think it was in the organ donation moment where maybe living wills. Obviously we might have touched on it there. We did. We did wills, but we hit on living wills. But you know you mentioned organs. I don't think we said that. That was a big kind of a quandary. In the nineteen sixties. Um, in late I'm sorry, mid nineteen fifties, and then really in the nineteen sixties is when we went oregan 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. 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 we're still technically alive, which is a 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 or she's gonna 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 onto the brains where it's like you're brain can no longer keep 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 m it's much more. It's a narrower definition of deaths. And I think that that probably rules out a lot of people who might otherwise be used to harvest organs 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 seems 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 autopsies two. Right. Yeah, it can be an accident obviously. Um, that's called the UPSI death. Yeah, the violent death, which is also an opsie. I guess, well, not an it's tragic, yeah, homicider suicide. So took, let's talk about what it's like to die from different types of death. You dug this upo, 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, didn't come back to tell the tale. That's obviously the only way we're going to find this stuff out or from lucky people. Um, drowning, I've always heard drowning is a good way to go because it's not so painful. Yeah. And then 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 when your water starts filling with lungs and quickly, hopefully really quickly after that is the feeling of calmness that overcomes in tranquility. Yeah. Um, heart attack. You've got the squeezing chests, pain in your chest or your left arm. Yeah, like I weight on your chest. 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 ten seconds. Um, I didn't realize that. I thought like it was there's 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 gonna be thirsty and weak and anxious. Anything over too, You're gonna 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, 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 or like man reservoir dogs. Yeah, that was like one of the most are ways to open a movie 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, could stop your heart right then and there. And 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 instantly you lose consciousness. That's the idea probably with the quote un quote humane I'm sorry quote humane end quote. I'm gonna stop doing that. I'm going back to quote unquote what if you fall from a height. If you fall from a height, supposedly time slows, which is awful. Yeah, it's like, well, you're gonna 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. So they've they did a study of UM jumpers from the Golden gate Bridge, which is seventy five ms what is that two hundred thirty ft it's high enough, and they they found evidence that a lot of them died from exploded lungs, exploded hearts, um. Their organs were all cut up from their ribs, which would indicate death was pretty much instantaneous. Yeah. We talked about that on something too recently, I think, or maybe I heard it someone else talking about it. It's pretty bad way to go. What the Golden gate Bridge or just just falling dying from a height? Yeah, I can't remember. 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 smashed into each other and explode. Yeah, I guess from any height. Yeah, when you when you die from that would be from organ explosion or whatever. Yeah, or you know the brain obviously if you go ahead first. Yeah, that's UM. The long drop back in the day with although they still you can get hung in certain states if you choose really yeah, Washington State, and now you can huh. Um, you can choose that as your method, they'll build you the gallows and uh. The idea that there is you want your neck to snap, otherwise he died slower and you know, suffocate. The problem is there's a study of thirty or four prisoners that found four fifths of them died partly from asphyxiation. Really, that's the wrong way to hang somebody, if you if you don't snap their neck or they don't lose consciousness immediately, Um, they sit there and hang and die of asphyxiation. That's a bad way to go. Uh. And speaking of bad, I think being burned to death maybe one of the worst. And then what we came up with on the I think so because you feel it, and you'd think, like your 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 fire further sensitizes your nerve endings, so you feel even more pain. 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, that are well, I don't know about before they feel pain, but hopefully quick enough. Well, you know, carbon monoxide sinks, so like well there's a lot of smoke you are download to the ground and that's where the carbon carbon monoxide is. So you're annailing mostly that, So it's possible it's before it's true. And then the natural death which is uh 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've sniffed them off the case right, Well, it depends like some of the ones that like kill undeveloped countries, like diarrheal disease like dying from diarrhea. UM, you don't have that much in the US, but we have chronic disease like obesity and diabetes and UM cardio pulmonary disease. UM, we have that downpat. I've got the top five here. Actually, I think they're all in there, aren't they. UM Heart is number one, Cancer is number two, UM, lower respiratory is number three, strokers for an accidents or five and it's a huge drop. Cancer and heart are close to six. Hundred thousand, and then number three at lower respiratories only a hundred and thirty eight thousand. 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, um, either by accident or by violent death. Yeah, dying of old days didn't used to be a thing. No, it was like, like a lot of ways to die, but that wasn't one of them. You ticked off some traveling night, or there is a dispute over grazing rights. Plague, Yeah, you walked into a bear cave. Yeah, the plagues another but um, yeah, old ages. It's kind of a new thing. But it's one of the most um 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 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. Dude is shutting down every second right right now 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, or after you stop growing, you start dying, right Is that just the positive outlooker? But I mean like you're shedding sails 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. Like you said, you're dying, I'm dying. That's why they have a more specific definition of death, which is um called active dying. Like you and I are not actively dying right now. No, no, uh. Instead, if we are actively dying, we're in the midst of the dying process. Yeah, it has started. The dying processes started. The descent, if you will, has started, right. So, Um, all this kind of happens since different types of cells die at different speeds, that's what it is. It's cell death. Cellular 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 gonna die exactly, um, 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, um, they kind of have like this, the the order in which it happens kind of downpad. So there's the UM, there's the pre active dying phase, which can take about three weeks, starts about three weeks before death, two or three weeks. 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 um kind of cumulative knowledge from observations of people dying in like hospice and things like that. So you've got the pre active phase of dying UM, 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, Like it's becoming very clear, um, 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 die, 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 it's audio, yes, nodding my head. So the preactive phase of dying, Chuck, what do we got? Well, Um, you're gonna start sleep, You're gonna get sleepy, You're not gonna have much energy. You're gonna start sleeping more and more. Uh, your skin might become cooler to the touch, might turn a little bluish gray. Yeah, cyanosis. So what that's called I was with us, 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 gonna start focusing more of the circulation on the inner organs. That makes sense. Yeah, well that probably causes the modeling too, which is, uh, your your skin can become sort of reddish like splotchy, with reddish blue splotches as well. Right, you're gonna, um, you're gonna be a little restless probably, Yeah, you're gonna possibly come off as confused. Um, You're you're not gonna be hungry. No, you're gonna probably withdraw from um, social activities. You're gonna become a little a little withdrawn. Um. You might wanna 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, um, apparently something that that people intuitively know like they need to. Apparently patients know when they're dying. I've seen that happen. And one of the one of the signs from UM that's mentioned in hospice care palliative care UM is that the patient may even state I'm dying, like I started, it's coming. That's pretty common. Um. Yeah, and that's sad that when you realize like, all right, this is this is it, Like I feel myself, I'm gonna be gone soon. But that's neat though, especially if you yeah, if you're like, okay, I'm gonna put everything in order then die happy or peacefully. Yeah, that's neat that you have that that time to to take care of that. Yeah, if you're fortunate enough to go that way for sure. Back to physically, UM, you you won't be able to heal from a wound or and infection any longer. Yeah, you might um lose control of your bladder and your bowels over the course of some time. Um, you might be in pain, but chances are here in the modern world they're gonna 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, um, and a lot of it can be based on what you want, even even um, without your wishes. There's probably a point in time where medical science says, there's nothing we can do for you. Um, we just want to make you comfortable, exactly, so we're gonna give you pain meds. We're gonna like your your care is being transferred over from a physician to who's you know, wants to save your life and keep you going to hospice workers, health care professionals who are trained to just keep you as comfortable as possible for the for the duration of your life. Right, Man, hats off to those people. Yeah, like all health care professionals, of course, but man, hospice nurses as tough stuff. You've got to be, like, 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. I mean, very valuable, valuable service people provide. So that's the Um, that's the preactive phase. That's the I'm getting ready to die. I got a couple of weeks and all of my systems are starting to wind down. In the active phase, the systems are starting to shut down. Um, you may not have consciousness, and if you do, you may. Uh. If you are able to be aroused from conscious from unconsciousness, you're gonna slip right back into it again. Possibly. Um, 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. Yeah, it's just just the mind slipping. They don't know. Um. Hospice workers, from what I can tell, tend to just treat it like it's real, treated on its own terms. 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. Yeah, that makes sense, because you're there to provide comfort, not say no, Grandpa, grandma has 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 that's it's not real. It's just you your brain, that's not real or whatever. 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 they're fearful that you want to say that. But apparently families are kind of like, oh god, they're gone crazy, you know. But it's a it's a natural part of the active dying process. Breathings can to become really weird. Um, the patient's gonna stop breathing for disconcertingly long periods of time. Yeah, that's just called Cheney strokes respiration stokes sorry, Cheney Stokes name for John Cheney and William Stokes obviously the first dudes who described it. Let's get all the press quick. Deep breaths, sometimes very slow ones, like you said, sometimes stopping altogether. Uh, And that is caused by receptors in the heart and brain stem basically being too sluggish to respond two different amounts of oxygen and CEO two, 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 times, so it's it doesn't know how to tell you to breathe basically like at a steady rate. Um, we should say that there isn't evidence that that is physically painful again, like awful for the healthy person in the room. Yeah, yeah, 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, UM, not only making the patient comfortable is one of the priorities. Making the family comfortable as 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 UM, explaining that they're not suffering, uh is helpful, but not necessarily enough. Yeah. 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. Yeah, and they may not be told. They may even if it is explained to it might not sink in what they're being told because you know, seeing somebody gasping for breath and then being told that they're not really suffering, those two things might not jibe. Well, yeah, you're you're instinct that's probably trying to 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 uh, I did a I guess it. Don't be dumb on death rattles. And basically either you have fluid in the lungs or like you know, when you clear your throat like I just did. That's a normal ability you have until you start dying. You can't clear your throat anymore. Those are your laryngeal muscles, right, basically spasm NG 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. Yeah, Okay, so 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. And this is uh, I don't think we pointed out this is the egonal 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 don't even call it that anymore. I mean, I think some people do, but I think the active and agonol are the same one and the same. It's just you know, they're in the agony phase, right or they're in the active phase. Uh. Your muscles, aside from your vocal cords, um might start convulsive and spasm ng. Um. You can get all you know, herky jerky and two things that wouldn't seem like you should be able to do in your state, like um, card tricks. I don't know if you could do cards shuffling card tricks from one hand to the other, and Grandpa never could. Before I knew we could get some humor in here somehow. Um what else? Uh, well, let's see, your blood pressure is gonna up, your jaw is gonna drop, you might end up in a really weird rigid position. Um and uh you're I think we said your extremities are going to be cold to the touch. Yeah. Actually, the the death rattle as a result of the spasming of your laryngeal muscles that can also produce um. 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. Uh, barking. That's a new one. But it makes I think everybody has their own signature death rattle, you know. But they rule of thumb, apparently among hospice workers is once the death rattle comes, it's a sign that they got about forty eight 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 finding out, you know, in forensics, I think we put it out plenty of times at the time of death, depending on the various things that happen, you know, when they find you. But all all of these are almost like 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 there are signs and symptoms of the system shut down that the person's body is going through, you know. Yeah. So, Um, the senses apparently also are lost in a healthy person or a person who has all five senses. Um, they're lost in a certain order, and touch and hearing are the last to go. 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. Like hearing is kept so long as the person could hear before then there's not any damage from you know, during the act dying period. Um, 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. Needs to see him. You may not even be able to respond to that, but you can still hear that's true. 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 aren't. Wait, one more thing, I think it would be almost cruel to be able to see and not here at the end. You know, like he wants to see your family upset. You want to hear feel them hold your hand and say everything's gonna be right. So you so you raise a good issue like there's if you have a dying family member, especially if they're dying a frailty or they're just dying, like they're in the dying process, so they're about to enter the dying process. Um, you could do worse things than to go online and educate yourself on how to be around them. 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, um, they say that you should talk to the person, not the condition, So don't treat them like they're frail or dying, like treat them like they're your old friend who they are. Um, it's extremely important to make sure that they're in a peaceful, calm environment. Um. So, like maybe yelling at somebody over the will is a really bad idea. 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 gonna 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? Do you not laugh enough? Like there's I think it's not necessarily like yeah, I think it's it's just put you on edge. Not everyone is as sensitive to So you're going to add one. Don't bring your laptop in there and watch reruns of the Office. No, yeah, are you speaking from experience? I'm just going to add that. Okay, that's all my list. Okay, get off your cell phone. Yeah, pay attention to them. Sure, yeah, I mean that's what you're there for. That, as hospice workers put it, you're giving them a very heartfelt gift by being there with them while they're dying and maybe receiving a gift, you know, and many religions and cultures, it's very uh much an honor to be a part of this whole thing. And even if you're not religious, that you could just feel that way spiritually is a human you know. Okay, uh, well, let's pause here because Chuck, it's time for a message break and we're back. Okay, So are we dead yet? Are we at that point? Yeah? The the person has passed. It just sounded very cheery. Yeah yeah, yeah, Well, I mean like we've rattled off some pretty what seems like suffering, but now the suffering is over. If there was any other person is dead. So once you immediately immediately after you die, your pupils are going to dilate because the muscles controlling the iris or you know, gonna have their final rest. So your pupils are going to dilate. And then have you heard of the terminal tier or the lachrima mortis? No, this is a usually in the right eye, and there's no real explanation for it, but um, it is a final tier that you shed. Wow, And um 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, fourteen of them right at the time of death had the lacrymamortists here and uh thirteen of them in the final ten hours. And they say uh 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. 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 if it's it's the old West. Um. I guess people do that too. So you're not having someone a dead body staring at you, right, because if they're looking dead forward, straight forward there like following you all through out there. 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 taste more as 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 the air. So if you don't close your eyes, and I looked it up, you're gonna see this weird horizontal stripe across your eye. There's a plus the effect that has in the living, the difference between seeing a dead body with their eyes closed and a dead body with their eyes open, And it's just it's like a galaxy between the two as far as discomfort goes. Yeah, somebody should edit together the like every time that's ever been done in a movie. Yeah, there like super fast alright, 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 stopped dead. That's another definition of death. I don't know if we mentioned heart. Your heart is not beating anymore. You're dead, yes, Um, there's no bringing you back. You've been in your heart hasn't 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. Remember the Poop Shake episode we can forget, we talked about the microbio and we have this whole other, like part of our life are living organism that's still around, that's still operating, 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 twenty four hours and and there's still alive. Just use them, yeah, for all sorts of stuff. Yeah, you can harvest them. And then of course inside your intestines there's a little tiny organisms that are still living and are gonna 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 loved the setting, right, um, and you're just left there. Within about three days, these organisms of micro flora is going to go to work on you, starting in your intestines. Yeah, and this is 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 mortis is real quick. Then um, algor mortis, or the death chill, that's the first first thing that's gonna 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 wines like sixty four degrees from you. I guess it dep into what kind of room you're in. Yeah, if you're in a sixty four degree it's perfect, all right. What else? Well, after alger mortis, um, you get rigor mortis a couple of hours after death where the body um settles into a stiff state. Uh. And that lasts for what like twenty four hours? I don't remember. We talked about it. Uh yeah, yeah, I think so. Um, And then between those you have live remortis or subdulation. That's where like all the blood coagulates at the Yeah, basically that your red blood cells are pretty heavy and they just sink and Um it's about twenty minutes to three hours after death is when you're going to be in live remortis, and then after that is rigor. That's right, Okay, so not back to putrification right, Well, that's the best thing to talk about. Yeah, that's that's basically like cure. These organisms going to work breaking down your body, and they do it pretty quick. Um. The pancreas apparently has so many in there that it just itself eats itself. The pancreas consumes itself. It's pretty efficient. Um, your other organs are gonna eventually eventually be consumed in turned into liquid. You're liquefied from the inside out. Yeah, you're gonna turn colors in this order green than purple, than black, which is just like a like a black eye, I guess, yeah, in that the same stage. Yeah, except it never fully heals explodes. Um you uh, within a couple of weeks, you're going to be liquid inside. Uh. The organisms that are eating you produce a gas as a byproduct from their consumption. So you're going to be bloated. Your tongue is going to stick out, it's gonna turn dark to 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, you can come out of your mouth, your nose, your vagina. Uh, it can be mixed with feces and come out of your rectum. Another. Um, there's something else I can come out of your vagina too. Yeah, this is maybe the worst thing I've ever heard. 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? Oh wow, that's pretty good, Chuck. That's 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? Cof 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 fet is 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, thankfully, because we take care of dead bodies pretty quickly. Um. Although they did find evidence of it in a case in two thousand eight where this woman was found like in the woods, but um, it was described a lot in like six to eighteenth century medical literature. Oh you know, it just drove them crazy. To she was obviously alive for weeks afterward. Yeah, And archaeologist apparently to or are have to rethink sometimes when they find because sometimes you would die during childbirth. But the um they would buried the the baby with the mother, and so you would find the bones like cradling each other almost. But then they go back, 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 of a coffin birth. 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. Um. So the gases ultimately, eventually, once they start, once they really get down to business, and they're no longer just what's the call where they're the fluids coming out a little orifices here, they're purge fluid. Okay. So once it's like enough with the purge fluid, the we're just gonna 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 drawing out from desiccating. So pass that around in school kids. When someone says that your fingernails keep going after death, you set him straight. Tell him Josh saying, oh god, I just realized there's kids listening to this. Yeah. Um. And then the old d gloving, which we've talked about before. Oh yeah, I forgot about that, remember that? Yeah? Where the that can happen to you? If you drive at ten and two and you have an air bag, the gases that expand the air bag 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 ten and two or something like, you're going to be de gloved alive. Yeah, but your skin is just burned right off your hands, or it's burned and separated and then eventually comes off. So ten and two is not how you should drive it on. Really, That's what I've learned. Yeah. I drive it either just a straight up six o'clock with one hand or a nooner, just a straight up noon nude. 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 you know, relaxing, Yeah, we're playing the guitar or something. Yeah, de gloving is I know we talked about this in the probably rigor mortis. But that's when your 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 need to explain it makes perfect sense. Or de socking sometimes, you know, can happen to your feet. And 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 up the socking. Well, I don't have to use that from now on. That might be a new thing. Um. So the body 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 eat that up for you. You should. 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 of information in my head in the last like thirty six 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 so we talked about dying of frailty of old age and that it's increasing. Supposedly five out of ten 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, And his point was, you're going to die in the I see you, whether you want to or not, if you die of a degenera, nrative 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 up until a bitter end with life saving measures, and you're going to die in the i c U 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 rucus 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 i c U. And this point was, if half of Americans are going to die in the i c U, you have to assume that maybe not all of them would want to die in the i c U. And therefore they need to think of things like I wanted 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 and we keep doing stuff until you die. 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, you're not going to get 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 intibate me, why don't we have the autonomy to say, I want you to give me some stuff that's going to painlessly end by life, because it's either that or facing a tremendous amount of pain and suffering through this degenerative disease. Basically saying I'm Eddie, I am ready, it is my life. It's like the Richard Dryfist movie from the eighties. Uh, covertis whose life is anyway? I think I have no idea what you're talking about. Yeah, I think so. It was a movie 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 painlessly in their life or something at the end of life? They yeah, And then they're like, okay, so you're in favorite physician assisted suicide? No? No, no, h um, what's that word? You know? And and the doctors who are in favor of youuthan Asia is another term for it. Um, say, look at palliative care, it's like half of a step away from physician assisted suicide. Like you're keeping somebody if they requested and knockdown on morphine of the rest of their life so they're never gonna regain consciousness. Um. There's this you you dug up this one article by a British physician who argues that, um, that agonal um 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 it'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. Um, 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 or like Hunter Thompson didn't. Well, I mean that's another way to go, and you anybody can do that, sure, but there are some people out there who don't want to die violently. They want 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. 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 families. Yeah, and chuck, uh, we know that Hunter Thompson is far from the only person to make his own exit his own way. 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 um diagnosed with cancer of the palette because he smoked tons of cigars, which were some times just a cigar and uh. For sixteen years he lived with that diagnosis and finally, towards 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 um, but he had um developed what was called todden angst totin angst as German, which is a dread of death. So and so he lived with that for sixteen years. But he finally he decided along the way, like I fear this, but I'm going to take it into my own hands. Physician assisted suicide. And there's definitely more than one side to this coin. There's a lot of people. There's very strong opinions on either side. But I think it's a at the very least, even if you remove a motion from it's an extremely interesting conversation and that it reveals so much about our attitudes toward death total 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, 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 hospice nurse 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, I wish I had the courage to live a life true to myself and not the life others expected of me. That was the number one regret. Number two was I wish I didn't work so hard. That doesn't surprise me at all. Number three I wish I had the courage to express my feelings. Number four I wish I had stayed in touch with my friends. It's very sad. Had one and I wish I'd let myself be happier. There's number five. Yeah, like that. She was saying that they didn't realize towards until the end of their life that happiness is a choice that 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 and to figure that out like at the end that that's a regret. Yeah, so call to action people, Yeah, really, like you think about the stuff. You don't have to wish these things on your deathbed if you start doing something about it. Now, 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 don't know how much more aspects of death we can cover. And I'll tell you what. I'm gonna put all of them together in a blog post the Death Suite, so everybody can go listen to all things death via stuff you should know. 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. Um, there's so much to it. Uh. And since I said search bar, it's time for a listener mail. This is a nice one. Um. 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. Uh. Hey guys, and Jerry loved the podcast. Josh, I have to thank you for teaching my fiance, Danny and me about the flashlight trick to see spiderizer. 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 have been like, can you can you explain it again? Practice That's my explanation. Just practice, Just try it from a different angle. Just practice. It's a real thing. It's not a trick. It is completely amazing. And this is from Peache by the way. Uh. 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 to his forehead stopping at every field to let me know just how many spiders are 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 Airs sometime before our wedding on oct let him know that I love him more than anything, and then I'm excited to share my life with him, even if he does have a flashlight stuff to his forehead, with the rest of our lives walking our dogs together. I know this is totally blown away. And I would even let him listen to that podcast first. So thanks to Jerry. Thanks guys. That is from Peachy in Thousand Oaks, California. I think Peachy just expressed it very nicely. Yeah, so Danny, Peachy, congratulations, Uh, best of luck, best witches from us. I told her listen up for it on that Dying podcast and he thought that was kind of funny, and it's like great, Yeah, and Danny, um, maybe put down with five slight once in a while, yeah, wife, Uh and Peg, don't use the word fiance so much. Okay, that's a life lesson from Chuck right there. No would likes to hear that. Um. 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 dot com slash Stuff you Should Know. That's where he spend all of this time. UM. You can send us an email to Stuff Podcast at how stuff Works dot com and you can join us at our website, our very own website. It's called Stuff you Should Know dot com. Stuff you Should Know is a production of iHeart Radios. How Stuff Works for more podcasts for my Heart Radio because at the iHeart Radio app, Apple Podcasts, or wherever you listen to your favorite shows