Is He Dead Yet?

A tale of family and death.

A mottled grey and brown beard-stubble covered his face from his cheeks down to his neck.  The rest of his skin was pale with a slight yellow cast. All of the bones of his body, once clothed in well toned muscle, now clamored for individual attention.  Each rib lined up neatly next to its brother as though posing for a portrait of “The Rib Family”. Knees and elbows showing off their lumpy condylar roundness. Every one of the tiny invisible bones in the hands and wrists, so long out of sight, now proudly displayed.  

He had eaten very little for the last couple of months and had taken neither food nor drink during the past week. The morphine, administered by his wife, that once dulled his pain but still left him able to interact, now kept him sleeping most of the time.

Dying wasn’t something that came upon Andrew unexpectedly. He had been working steadily at it for more than five years.  During the first three years of his dying he took endless doses of antacids to ease the pain in his stomach. They didn’t seem to help much but all he knew was to “just tough it out.”  Doctors were expensive and the nearest one was twenty miles away. Everybody had stomach aches from time to time. What could the doctors do for a stomach ache anyway?

Meanwhile, the cancer gained a silent, solid foothold at the top of his descending colon and began its relentless growth.  The cancer never intended to kill Andrew. It was just doing what cancers must do. When that cancer was around three years old, it had all but blocked the colon and Andrew was frequently seen bent over with pain. It was then we went to see the doctor.

The cancer, although it was very good at growing, was not at all skilled at hiding. It was easily discovered and removed, along with a length of Andrew’s colon. His waste was collected in a colostomy bag.  Andrew was a proud man and bridled at the humility of having a “s**t sack” as he called it attached to his body.

The doctor told Andrew that he had let the cancer go too long and it was very likely to have spread. The fact that Andrew was just forty seven years old suggested it was a very aggressive form of cancer. About a year later, the doctor’s prophecy was realized. Exploratory surgery found cancers throughout the abdominal cavity. Too many to remove.  Andrew was sent home to continue with his dying process.

When dying in a hospital, it is easy to overlook the presence of death in the room. The space is always full of a variety of distractions including noise from the nursing station, the coming and going of hospital staff, friends rendering the obligatory visit, and equipment huffing and beeping next to the bed.  It is possible, with all the distractions, to overlook the presence of impending death. While he was in the hospital, Andrew’s wife and son could be with Andrew and not be forced to confront the fact that he was dying.

At home, there is only the dying person and the impending death. Nothing to distract from the power of the inevitable. There is no room for anything else. When entering a quiet dying space, one can try to bring a cheerful demeanor and happy memories but they soon wither and die in the presence of the specter of death. There is no question about what is happening in the room. The only question is “When will it be over?”

Andrew’s life had not been an easy one. His parents had not been kind to him and he had not been kind to his wife and son. When family members entered the dying room, they weren’t sure how to act.  Closeness hadn’t been part of the daily routine. They weren’t able to comfort him. In part because he had never given nor accepted comfort. In fact, he had lashed out at those who tried to love him.  So, any attempt at comforting would feel very alien. Then there was the presence of death itself in the room.

When death moves into the house its presence is ubiquitous, it cannot be ignored. Andrew’s house was no exception.  At first Andrew’s wife and son tried to deny the presence of death and pretend everything was normal but that effort, of course, was doomed to failure.  When denial didn’t work and the presence of death had to be acknowledged, the acknowledgment came with resentment and anger. It was resented because it upset all the rules of order in the family: of power, of control, of certainty, of obedience, of obligation. As time went on, the family realized that there will be no negotiation with death.  Death was still resented but, at the same time, its place in the home became tolerated and eventually accepted.

Finally, Andrew’s wife and son began to actually embrace death.  They looked forward to it. They began to see death as their ally.  They embraced it for only one simple reason. Because they had become exhausted.   Andrew’s impending death filled their lives with uncertainty even though the end was inevitable.  Uncertainty walking hand in hand with the inevitable became their daily reality. The uncertainty of what their lives will look like after death finishes its work and the inevitability of eventually, and permanently removing the dying member from the family house.  In short, they had an existential need to just get on with their lives.

Andrew, of course, knew death better than any of the other family members. After all, he had been working at dying for five years or so. In the beginning, he didn’t realize that was what he was doing but he certainly became aware of it sometime before he was sent home to die. At first, like the other family members, he resented the presence of the uninvited guest. He went through the textbook stages of grief: denial, anger, bargaining, depression, and finally acceptance. What he discovered was an additional stage that went beyond acceptance. He also got to the point where he embraced death. He hungered for death. He was tired of the pain; the pointlessness of his own suffering. He was tired of his troubled, fragmented dreams when he was asleep. When he was awake, he was tired of laying in bed with his own morphine mangled memories. He too was ready for it to end.

Being ready to meet death has little to do with when the meeting will be scheduled. Death has its own calendar and can be very subtle about when it has arrived. Birth is loud and squally. Newborn legs kick. Newborn arms wave about. Newborn lungs pump air loudly and forcefully. Death announces its arrival in “the absence of” rather than “the presence of.”  First the breath slowly reduces in its forcefulness. It may slide in and out very quietly for an extended period before it finally decides to stop entirely. The pulse may slow and reduce its pressure for a lengthy time before it,too, finally decides to stop. Death never really announces its presence. It is up to the family to detect and announce the presence of death by noting the absence of breath and pulse. But, it is not easy. Hospitals have machines that can do it without effort, but humans are designed to notice life, not detect the presence of death. Not even the dead person can detect their own death. They have no idea what to look for.

During the past couple of week’s, Andrew’s wife and oldest son had been seeking the “absence of” that would signal death’s event. Although there was no bedside vigil, they checked on Andrew on a regular basis. At first, detecting life was easy.  As they stood in the hall outside the bedroom door, they could hear his rattling breaths.  When they entered the room, they could see from the position of his body whether he had moved since the last time they looked.  They knew the end was near when his breath became barely detectable and there was no evidence of him having moved. They stopped checking his wrist or carotid artery because the pulse was often too weak to be felt. They now laid an ear on Andrew’s chest to listen for a heart beat.

On Andrew’s last morning, his son checked for life signs in his father. The boy could detect no breath and he wasn’t certain whether there was any heart sound. He held his own breath so as to hear any slight indication that death had not yet completed its work. The boy wasn’t sure whether the sound he imagined he heard was his father’s heartbeat or his own. The constant unspoken question in his mind: “Is he dead yet.”

It seems like a simple question. It is anything but. A question to be neither asked nor answered lightly. There is so much more to this question than can be supplied by a yes or no answer. At death, a person becomes an object to be respectfully disposed of, rather than a life to be looked after.  The boy asked himself “Is he dead yet.” But, he was also asking “Is he my father or a corpse.” And, “Is he an object or a subject.” If in error, it is better to assume there is life when it is no longer present than to pronounce death on a living being. That feels like murder. If he couldn’t answer with absolute certainty, he wouldn’t answer at all.  

The boy called for his mother who asked “Is he dead yet.”  The boy replied “I don’t know. I’m not sure.”

The mother checked for breath and pulse and looked at the boy. She said “I think he’s gone. But, let’s check again in an hour.  We want to be sure.”

It’s not easy deciding someone is dead.

Author's Note

Are there any places where it really drags?

Reviews

[angel]

I finished reading this with a feeling of melancholy...the wife and son coming back later to be sure Andrew is, in fact, dead; the assurance that everyone gets a turn to ride the death bed (that is of course unless they instead die in a more violent or spectacular manner, which, I suppose, might be preferable to many),and then I began to scroll up to read the author's note.
A cheerful fellow with a banjo! I would like to find such a whimsical twist at the end of my own terminal tango. Makes it not so bad, somehow. We all have to go eventually, so as Eric Idle sang, why not look on the bright side of death(everybody whistle now)?
As to this very well-written piece, no problems that I could see.
Well done,sir! Now, play us out...

[barleygirl]

This is an intriguing piece, especially since I picked it up just before Halloween. You use a tongue-in-cheek tone laced with mocking humor, it seems, and this makes your piece feel like a fitting way to bring in Halloween, rather than a serious expose about death and dying. Your acerbic tone caused me to suspect there might be a twist at the end, but instead, your seemingly sarcastic observation was nicely caustic & brought a smile. Sometimes addressing death in a direct honest way can feel a little mocking, compared to our expectations of "propriety" & all that entails! *smile* Fondly, Margie

[Samuel Dickens]

This is powerful, engaging, and extremely well written. As I and many others know, it's also very true to life. We "mature" folks get to visit the dying, knowing full well that it will our turn one day. The diminishing breath is exactly the way my father went. Slower, slower, slower, then one last faint puff, then gone.