"Knowing" you are going to die (kinda long)

[lizerdbits]

My maternal grandmother had a fall earlier this month and has deteriorated quite a bit. The fall wasn't too bad but her cognitive abilities have been declining to where she sometimes doesn't recognize people. She is currently on some painkillers but this began prior to that so it doesn't seem to be a narcotic induced fog. My parents are both there since her main caregiver was her almost 80 year old sister (grandma is late 80's) and both of them haul around oxygen tanks constantly due to pulmonary hypertension. When I talked to my mom today she said grandma told her she was "going home in 2 days" (she's catholic).

My mom was a nurse and has had experiences where patients say they will be dead in a day or even half an hour and they were usually right. When they talked to my grandma's doctor he said sometimes older people 'just decide that it's time.' (Paging Warpy for other experiences with this) :)

It got me wondering- what is the biochemical/physiological basis for "knowing" you're going to die? Is it endorphins that give a sense of peace? I've tried google but all I get is psychic pets. Has there been much research in this area? How many of you believe it's a real physiological occurrence or just bullshit? I imagine it would be a morally tricky area, it's not like a family by a bedside is going to want people poking and prodding.

It reminded me of part of "The Lives of a Cell" by Lewis Thomas, a book that fascinated me in high school (from the chapter Death in the Open)

It is always a queer shock, part a sudden upwelling of grief, part unaccountable amazement. It is simply astounding to see an animal dead on a highway. The outrage is more than just the location; it is the impropriety of such a visible death, anywhere. You do not expect to see dead animals in the open. It is the nature of animals to die alone, off somewhere, hidden. It is wrong to see them lying out on the highway; it is wrong to see them anywhere.

...

Who ever sees dead birds, in anything like the huge numbers stipulated by the certainty of the death of all birds? A dead bird is an incongruity, more startling than an unexpected live bird, sure evidence to the human mind that something has gone wrong. Birds do their dying off somewhere, behind things, under things, never on the wing.

(Of course the exception to that last sentence is WNV, but I digress.)

[Orrex]

1. I'm so sorry to hear about your grandmother!

:hug:

80+ years is quite a span, and what a span to have lived through! So many astonishing changes have occurred during her lifetime that I can hardly imagine what someone her age must think of the world's transformation (for good and ill). And I hope that her painkillers are mitigating any discomfort she might be enduring.


I suspect that there is indeed a biochemical basis for "knowing" that the end is near. In some cases, I imagine it stems from a sense that the body is shutting down, or that something significant is on its way, and this sense is almost surely biochemical. Many minor analogous perceptions exist: the sensation of a sneeze bearing down on you; the feeling of nausea that preceeds vomiting; even the sense that you're drifting off to sleep. All of these strike me as basic information about the functioning of one's body, so I guess it's natural that we'd have a pretty well developed sensory mechanism for such things.

What you're describing though, is kind of different--she's making a prediction that's farther removed than a pending sneeze. In cases like hers (and I've likewise heard of many people "calling" their own deaths with apparent accuracy), it could be a case of something like selective sampling, in that we don't usually track how many "false positives" a person comes up with. My grandmother, for instance, suffered for decades from a host of psychosomatic disorders, and she frequently predicted her own death within a week or so. In the end it was pneumonia, of all things, and I don't believe that she predicted it.

I suspect also that some cases could be explained by a sort of resignation or even wishful thinking, so to speak. When a person is weary of suffering, it's understandable that he or she might simply be bracing for the end.

Here's a comical example: I had nightmarish stomach flu about three years ago. During the worst phase, I was like a disgusting, two-ended volcano for around eight non-stop hours, and I felt more wretched and foul than I ever have before or since. About three hours into it, in a semi-dim state of mind, it occurred to me that if someone had said "You're going to die from this" I wouldn't have been at all surprised. I didn't want to die, mind you, but based on the way that I felt and my then-current inability to perceive an end to the nightmare, I could understand how the reaper might show up and tap me on the shoulder.

Maybe among people of advanced age or who are terminally ill, a similar sensation starts to take hold, of perhaps differing degrees. If someone is able to plot a rough arc through "how I felt in my prime" and "how I felt earlier this year" and "how I feel right now," I guess it's feasible that the person could take a rough (but not baseless) guess as to how long things might go on.

All of this is off the top of my head, I confess, and I certainly don't have any citations to back it up. But it seems at least generally consistent with my own experiences with people in similar circumstances. In any case, it certainly doesn't diminish what you're going through, and if the ability to make a prediction can give your grandmother some comfort, then naturally there's no reason for anyone here to contradict her in it.

Best wishes to you and your family during this difficult time.

[conscious evolution]

2. Its not just age

or illness that brings this knowing on.
I have heard and read of many soldiers have this happen to them in war time.

[Orrex]

3. Like a premonition? I don't know--in wartime, that's not too convincing

When my wife was pregnant, friends were saying "I have this feeling that it'll be a boy." And then when a boy popped out, those same friends were claiming somehow to have been in touch with the infinite, or something. I mean, what are the chances of a correct boy/girl guess? 50.1% to 49.9% or something like that, right? Somehow I found their prognostications less than compelling!

I would think that soldiers in wartime would face a similar circumstance, though with different odds: in such horrific conditions, thoughts of one's mortality are entirely natural, and a sad fact of war is that everyone doesn't make it out alive. Those who guessed right and died are remembered for their guesses, while those who guessed wrong and lived are just thankful that they survived. And that's simply the soldiers who aren't yet injured--if a soldier is injured, then it's certainly understandable that he might experience a gut feeling of impending death.

I grant that this is a gross oversimplification of a complex phenomenon, but I'm reasonably satisfied that this is the essence of it.

[Heddi]

4. Let me tell you what i've noticed (in a hospital based setting)

1) when people are about to die, they are usually alone, or have about 13907838947 people in teh room doing everything possible to keep them alive. Family members are rarely, and I do mean RARELY around when a patient passes in a hospital.

2) What I see in the hour / few minutes before death is what I refer to as The Big Poop Of Death. People will have this URGENT NEED to have a bowel movement RIGHT FUCKING NOW and then their heart stops and they make horrible noises and they're dead. Or they have the BIG VOMIT OF DEATH which is the same thing except they puke instead of poo

I have never had the experience of a deathbed confession or someone saying "i'm going home now". Sometimes the more elderly and demented patients will start talking to their parents or dog or some other long-lost, but hell, they've been doing that for weeks, not just in the hours before death.

I have had people who have screamed "LET ME LIVEEEEEEEEE" as the juice is flowing out of them. I've had people who were fully conscious have CPR performed on them because some over-eager Med Student didn't look at the EKG tracing and the person is like WHAT *compression* THE *compression* FUCK *compression* ARE *compression* YOU *compression* DOING?!!?! I suppose teh most "amusing" would be the patient who punched the med student and said "Fuck, man, I'm not fucking dead" as CPR was being started on him.

Sometimes people are clawing at their face, peeing all over themselves the moment before The Big One.

Generally, a very huge bowel movement of Guiness Book Of World Record size is the most common factor.

[CanSocDem]

5. Geez.....

No wonder you're all afraid to die.


.

[Orrex]

6. I suppose that your doompoop will be scented with jasmine and myrrh

It's not always pretty when machines break down. At least my last car didn't shit all over the road when it's time had come.

[Heddi]

9. DOOMPOOP

omg! wtf? lol! I have a new phrase to humour and/or torture my coworkers with :)

[Orrex]

15. Ugh

My unbridled cleverness can't atone for the misuse of "it's."

I humbly apologize to the readership for my scandalous error.

:hide:

[conscious evolution]

25. I double dog dare you

to nominate that as the phrase for the day in the lounge.

[Silent3]

36. Although non-biological machines don't actually excrete feces...

...(septic system pumps a possible exception) I've heard the phrase "shit the bed" used in reference to a defunct contraption, as in, "My computer shit the bed and I lost all of my data."

[cosmik debris]

7. Who is afraid to die?

And where did you get that information?

Oh, I forgot. You just make up shit when you don't have facts.

You have to create a fantasy world that matches your expectation of the real world.

But most of us don't live in your fantasy world. And we are glad.

[Heddi]

8. who's afraid to die

Oh, I forgot that your reading comprehension skills are, um, lacking (for lack (ha ha) of a better word)

[CanSocDem]

10. Actually...

...it's more a case for not going to a hospital. Why not stay at home and die with a shred of dignity....oh, I forgot. We mortals don't have the tools or skills to keep ourselves alive.


.

[cosmik debris]

11. That's even more stupid than your last post.

There is nothing dignified about dieing no matter where you are.

In fact, death is the ultimate loss of dignity.

Why do you say such stupid shit?

And why are you still disrupting this group?

[CanSocDem]

12. Oh I'm sorry....

...you're one of those 'sensitives' that knows all about life and what happens after death. One-timers, we call you.

The essence of that myth is that if you think you are un-ceremoniously plunked into the world and only have one shot at 'getting it right', you're an easy target for any hair-brained explanation, science, religion or "woo".... that ultimately doesn't enlighten you; it just takes your money.

Therefore, you despise death. You build a culture around trying to avoid it. You use it as the highest form of punishment. Hospitals and churches get rich milking your fear of death. The drama queens get the attention they crave by whining about its' proximity.

"And why are you still disrupting this group?"


I'm sorry. I don't understand the question.


.

[cosmik debris]

13. How Bizarre

Are there more like you where you come frome?

Or are you unique?

[Orrex]

14. That's right!

I want to die at home after calling out for fictional characters and decades-dead relatives before one last, explosive bowel movement in my bed and a gurgling, final shudder.

That would sure dignify the hell out of me and everyone else who witnessed the spectacle.

[moggie]

16. I want to die peacefully in my sleep, like my father

Not screaming in terror, like the passengers on the bus he was driving.

Do you get the feeling that CSD has a particularly strong case of projection?

[semillama]

34. Props for the Emo Phillips joke! n/t

[Heddi]

17. You have a very black and white way of thinking. Let me tell you how it is

I work at a Level-One Trauma Center that is also a community hospital. 80% of the patients at my facility are homeless, underinsured, uninsured, immigrants, working poor, prostitutes, prison inmates. The other 20% are trauma patients that have been extricated from a car, pulled from a burning building, or had large pieces of metal removed from key organs because they fell and were impaled on a pole.

You seem to have in your mind (based on your numerous posts on the subject) that illness and wellness are just a mind-thought away. While I do agree in the Power Of Positive Thinking, there is no amount of positive thinking that can keep your skull from being crushed when a drunkard decides to go 75 mph on an ice covered road, hit your car, send you spinning and cause your car to flip 6 times.

There is no amount of Wishing It Away when 95% of your body is covered in 3rd degree burns because your house caught on fire.

---

This is not a matter of "staying home and dying with a shred of dignity". Not everyone who dies is 95 years old with a full, loving life behind them, family at the bedside, going gently into the night with a smile on their face and a hearty sigh.

Many times people are in the hospital because of the traumatic injuries they suffer at their own hands, or at the hands of others. There is massive bleeding inside their skull, their innards have been ripped open, they are losing more blood than we can replace. They have such bleeding inside their skull that the only thing we can do to prevent the blood from taking over the extra space in the skull (and therefore pushing the brain out the bottom of the skull) is to drill large, open holes in the skull to remove the pressure.

How about the very well bodied, healthy young males that go mountain climbing, get lost, and come to my hospital with frostbite up to their knees from being burried in the snow for a week, and leave with both of their legs cut off at the knees? Was that just bad thoughts and ill planning on their part?

How about the homeless who HAVE no home to die with dignity at? Should we just allow them to suffer under a bridge in sub-freezing temperatures? Should we allow their festering, gangrenous foot wounds to poison their entire body rather than just removing the foot that is causing the toxin?

Do we allow the terminally neglected elderly, who is malnourished and covered in bedsores so large I could stick my fist in them (all the while weighing no more than 80 lbs), just die in the home that she was starved and neglected in? Do we say that her death from massive systemic bodily infection, lack of nutrients, and lack of a functioning bowel is because she just didn't think that she could get better?

Do we allow the terminally mentally ill the right to persistently harm themselves through self mutilating acts and half-witted suicide attempts? Do we allow them to stay hypoxic with terminal brain damage because we find that, in a primitive way, to be dignified somehow?

----

The world is not black and white. Not everyone decides to walk into a hospital because they willed themselves into sickness and now are willing themselves into death. Death happens to us all, and as a Nurse I am probably more aware of the reality of death than anyone else on this board who is not in the medical field. I've seen death, smelled it, touched it, heard it, washed it, prepared it more times than I can count. I know that you have utter disdain for my profession, and you feel that I am a charlatan that makes others THINK they are sicker than they are because it somehow lines my pocket.

I know you think that health and ill health are just one positive thought away, that we choose our own destiny, that our reality is all part of our frame of thought.

Again, I ask you (as I'm sure I or others have asked you before), but how does one THINK themselves out of paralysis from the eyelids down because they fell 45 feet from scaffolding? How does one "think" themselves out of being burned on 95% of their body when they are pulled from a burning vehicle?

Sickness isn't just a state of mind---it is a real phenomenon that happens to our bodies and our brains and our organs through terrible disease and trauma that is unexpected and unplanned. I'm sorry that those terrible things don't fit into your neat world view of Good vs. Bad thoughts, but it's reality.

I would encourage you to spend a day shadowing an RN in your local trauma ward and seeing what real illness and sickness and injury is like because you seem to be very, very ignorant on the subject (as you repeatedly prove every time you open your proverbial yap and yammer on about shit you have obviously no idea about)

[CanSocDem]

19. I could write at length...

...long stories and anecdotes from acquaintances who have avoided all the trauma that happens around you. But I don't because it's not the point. It's not a numbers game. From the very beginning I said it is a matter of perception. You see what you want to see. You spent a lot of years making a place for yourself in the medical industry so I understand you not wanting to give it up.

Even if I'm the only one on this forum who see's the arrogance of the medical industry in their insistence on the "reality" of illness, I have a complete right to be SKEPTICAL of their 'perception'... I went to school with doctors and Bachelor of Science nurses so I know they have no greater insight into the mysteries of life and death, than I. You're no exception.

The essence of my belief is that I have the ability, with the proper feelings and thoughts, to avoid the multiple traumas that are such a part of your life. If something bad happens to me, I have to find out why. I'm at the stage of 'nipping it in the bud'....not re-growing limbs.

I spent over 20 years driving a semi-trailer truck around NA. You learn to trust your intuition. And you depend on what is, not what 'could' be...



.

[Heddi]

21. My dear, I don't see what I want to see

Rather, I see what is before me and do what I Can to make it better.

I have *never* wanted to see a 3 month old covered in 95% 3rd degree burns. A 3 month old that died in their mothers arms because of the severity of the burns they suffered when a drunk driver hit their car and the car exploded and the child was trapped inside. I never wanted to see that, but I did.

I never wanted to see another 3 year old who fell into a pool after he woke up before everyone else in the house did, and was found with a core body temperature of 32 Celsius, who had no brain wave or heart activity. I never wanted to see that, but I did see it when it was presented in front of me.

I never wanted to see a mother throw herself over the body of that child as he lay dead in the emergency room ward, begging the doctors to keep trying to save him (after they had done CPR for over 45 minutes). I never wanted to hear her wails down the ward hallways as she begged God to take her instead of her son.

I never wanted to experience that, but I did because I was there when that boy was brought in, and when his mother begged God and the Doctor, when she beat her chest and pulled at her hair and held her blue lifeless child to her chest.

If you don't think that everyone in that room---nurses, doctors, family, respiratory therapists, patients who were wandering by, didn't
"WANT" that child to live, you are so mistaken. THere was not a prayer or thought in the room that was not directed at that blonde haired boy who was blue and cold as ice. There was no "could" be for that boy. There was no amount of willing or thinking or positive that could have brought that boy back, but my god did we wish there was.

Friday May 13 2005. I remember that day that the boy was brought in and that he died and that his family's life changed forever.

Please, tell me what reality we should have been perceiving to make that boy not dead when he was pulled from the water. What positive thoughts more should we have had to restart his dead heart, or to oxygenate his dead brain, or to warm his icy body.

Please. I, and medical science around the globe would love to know.

---

You are heartless. You have constantly posted heartless and careless things in this forum. It is obvious your only purpose here is to antagonise. do you ever post in other forums? Do you go to the chronic illness forum and remind those people that they are to blame for their illness?

[CanSocDem]

23. You simply don't get it.

"You are heartless. You have constantly posted heartless and careless things in this forum. It is obvious your only purpose here is to antagonize."

This is simply bullshit. The only people who find my posts "heartless" are those who disagree with my conclusions.

And I said months ago, on this forum, that I don't "blame" people for their "illness". I respect each and every persons right to be responsible for their own wellness. It is medical industry folk like yourself, out there convincing people that illness is all around. And you can't stop yourself from listing all of the medical tragedies you've seen or heard of, even after I told you they were meaningless.

Listening to all my friends in the medical industry I know how they like to talk shop...but so do truckers and it doesn't make them any smarter.

Tell "John" that I suspected he was a worker in the industry, not by his 'superior' medical knowledge, but that he sounded like you.


.

[cosmik debris]

24. Wrong!

Some of the people who think you are heartless also believe that your ideas come from some children's fantasy book.

The distance between you and reality seems to grow with each of your posts.

But I am still curious. Do you believe that you are unique or do you believe that you are representative of a larger group?

[LeftishBrit]

39. There are truly some awful tragedies in the world.

No one could want to see them.

I haven't seen the post to which you replied (there *are* ways of 'creating your own reality' about what you see on DU! - though I use them sparingly); but I think that treating illness and death as a matter of perception or choice is just like the RW idea that the poor are poor just because they're not trying hard enough to be rich.

[Book Lover]

32. Then I invite you to come and visit me and my JKD/MMA/Thai boxing friends

See how well you do avoiding multiple traumas while you are taught how to spar.

[TZ]

33. You were obviously born out of time.

You belong in Europe in the time of the Black Death when everyone "knew" that it was caused by witches and their cats and thus killed the cats that killed the mice and rats that carried the bubonic plague and subsequently increased the amount of bubonic plague and killed 1/3 of the European population.
Funny how we now can easily treat bubonic plague with anti-biotics. But of course thats only because we believe we can right?
I believe there is a good society for you: the flat earth society. Because you know if you make your own reality how do we really know the earth is round? Its teh evil scientists making shit up again!
I love how you think DRIVING A TRUCK gives you magical insight into biology.

[Evoman]

27. Your stopping us from "seeing what we want to see". If you would just fuck off, it would be a lot

easier.

[TZ]

18. Hey Heddi, what do you think of Oscar the cat...

The cat who was documented in a scientific journal in knowing when someone was getting ready to die?
http://en.wikipedia.org/wiki/Oscar_(cat)

I find it interesting.

[Heddi]

20. My opinion

1) oscar is sucking the breath from the patients, causing them to die :)

2) what the MD said about the cat "smelling" death. SOMETHING happens in the hours before death--I've seen it. The blood begins to pool in the dependent parts of the body, the heart rate and breathing slows, the skin turns a waxy yellow colour. And this is HOURS from death. There is a distinct odor of a dead body-=---I don't mean someone that's rotting away---I mean an hour or so after they die. I would not be surprised if the cat can smell that before we can. And the smell isn't rotten or anything---it's the smell of new death. I cannot describe it other than I know when I walk into a room if the patient is dead or not by how the room smells. Again, nothing pungent or stomach-shattering. Just....different.

[lizerdbits]

22. That's sort of what I was thinking about

If your organs are shutting down are there metabolites present that usually aren't there or in higher/lower concentrations than normal that affect brain activity leading one to believe the end is near? Something is going on biochemically to have the effects you are describing so I was wondering if it's known what specifically is going on and how it would lead that person to think it's the end. Given her state of sometimes not recognizing people, maybe she's just spouting off so to speak.

(She was fine earlier today.)

[conscious evolution]

26. I know a nurse for a hospice

who says she can tell by how the patients body hair starts standing up.She likened it to goosebumps from a cold chill.
Ever seen anything like that?

[Heddi]

28. I've never gotten that close or even noticed that

I'm usually too busy pulling the overeager, CPR-performing med students off of the still living :)

[conscious evolution]

29. I can see that

You mainly see sudden death,usually from trauma,don't you?
That would be different than a patient in hospice.

[Heddi]

30. PRetty much. I work in Level - 1 Trauma and Community hospital

Granted, I'm not in the ER...I'm in ICU-stepdown, so I don't see the REALLY traumatic death stuff like they do in the ER, but yeah, most people die from long-term illness, like kidney and liver failure, or drug overdose, or gangrene, or they die from their injuries that were sustained in a trauma--- fire, severed spinal cord, stroke, bleed on the brain or what-not.

For the most part, like your hospice friend, the deaths I experience at this hospital are not really ever unexpected. Once in a while it's like 'Whoah....that dude was so....alive? like 10 minutes ago". Generally, though, it's like "oh, I knew that was coming"

The other hospital I worked at, though, was a community based but not level-1 trauma, so we'd get the little old ladies from nursing homes with bloody noses. I worked in the ICU there, though, and we'd get some sickies for sure, but nothing like I've seen where I work now.

I will keep an eye out on the goose bumps, though. We have several patients that at any given time are on "comfort care" so basically hospice in the hospital because they're too unstable or too far away to make it home for hospice.

[lizerdbits]

31. "I could smell the ketones"

So she died last night and my mom was glad to be there. Given the amount of pain she was in despite pain killers everyone felt it was better that way than to have her in the hospital/nursing home lingering for months. Her account was that several times during the day her breathing changed and since she was catheterized my mom knew she had not produced much urine in the previous 24 hours and said "I could smell the ketones so obviously her kidneys were shutting down." I'm guessing that due to the lack of urine production that was from her breath. :shrug: Given the circumstances I didn't ask for more details regarding other smells and likely won't in the near future, though what you describe still kind of fascinates me.

[LeftishBrit]

37. I am sorry to hear about your grandmother

Very best wishes to your family.

[Lisa0825]

35. My mother knew she was having her last lucid night.

She wanted no heroic measures, and since I was the one by her side, I was the one who had to ensure that wish. She died in her sleep, with me sitting by her side, watching the depth of each passing breath become more shallow. I saw her last breath, holding her hand, and then I walked down the hall to tell the nurse.

She may not have been able to tell me the moment, but she told me the day.

[LeftishBrit]

38. I would imagine that it 's possible to be aware from your sensations and symptoms that you are close

to the end, especially if you have had a lot of 'ups and downs' with illness already. I don't think it's a premonition exactly.

On the subject of smells, I do know that doctors can suspect certain diseases (I think diabetes is one) on the basis of smell; and I believe people were taught to do so to a greater extent in the past, when there were fewer diagnostic tests.

[lizerdbits]

40. I definitely don't think it's a premonition

which is why I posted it in this forum and not the lounge. ;-) I was discussing this with a coworker and her idea was possible anxiety resulting from liver/kidneys etc starting to shut down. She suggested gathering data on how often the 'prediction' that one is going to die is true, or if it's a coincidence where we only remember the 'hits' like psychics. Then if there was a high correlation of the prediction being accurate, then you'd have to try to get blood from the dying which is an ethically tricky area.

We also discussed our dismay with the statement of the doctor that people 'just decide that it's time.' You can't just will your own organs to shut down. If that were possible people wouldn't commit suicide with guns and razor blades, they would just make their organs all fail or their heart stop.

I think ketoacidosis can be a problem with diabetes but I'm not sure. If they're building up in your blood I assume they will be in your breath. I read about a condition once (kidneys also I think) where someone's breath smells like ammonia. Maybe something involving urea synthesis? I don't remember that part of biochem.