by Shiban Ganju
Jack arrived in the hospital a few minutes after midnight. Next morning he was dead.
Death visits a hospital in sobs, shrieks or stoic silence. It stumbles with stroke, burns with feverish sepsis, crashes in with a fractured torso, stuns a teenager with drug overdose, rams the chest with a heart attack, relieves agonizing cancer, or just sneaks in sleep with stealth. In all its forms, death is a process.
“The awful daring of a moment's surrender
Which an age of prudence can never retract
By this, and this only, we have existed” (T S Eliot)
But Jack’s death was different.
He was healthy just two weeks back – he did no drugs, he exercised, he worked, he voted and he was in love. And now he was on life support. Plastic tubes and wires connected his body to bottles, monitors and an armory of medical gadgets. With his chiseled nose, calm countenance, eyes shut, long dark black hair sprayed on the white pillow, he looked pristine – even on the ventilator. His face reflected the golden hue of bile seeped into his skin. The feeble pulse, high fever, low blood pressure and delirious thrashing of limbs foretold gloom. The air of death hung heavy over his bed. And he was only thirty-three.
The process of death unravels in the molecules deep inside the cells and shatters emotions on surface. Irrespective of the first cause, the processes have a broad similarity. But all death is not dangerous. Some part of us is dying all the time without any harm to our physique or emotions.
Body cells have a life span: red blood cells live one hundred eighty days, platelets live for a week, intestinal lining rejuvenates in one to seven days. Approximately fifty to seventy billion cells die every day. Even in children under fourteen, twenty to thirty billon cells vanish daily. With this continual destruction and proliferation, in one year, we probably replace cell mass equal to our body weight.
Our cells also disintegrate with a programmed protocol that paradoxically keeps the body in state of health. Scientists call it apoptosis. When something goes wrong inside the cell, cell generates an appropriate biochemical signal, which triggers a sequence of biochemical processes: scaffold collapses, cell shrivels, nucleus condenses, DNA fragments and its membrane blisters. Enzymes dissolve the contents of a cell and break it into small sacks. Roaming scavenger white blood cells mop up the debris.
This process is protective and apoptosis gone wrong can unleash havoc like cancer. Apoptosis does not damage the body, which differentiates it from another form of cell death – the harmful necrosis. Infection, physical injury, poisons and lack of oxygen can provoke a cascade of reactions producing toxins that irreversibly damage the cell and also its surrounding tissue. Examples are: heart attack or paralytic stroke due to lack of oxygen and staphylococcus bacteria grinding normal tissue into an abscess. The sequence of chemical events in necrosis differs from apoptosis.
Necrosis can damage a single organ, which may not cause death unless the organ is life sustaining like heart or brain. Both these organs are extremely vulnerable to oxygen deprivation; a few minutes of anoxia or absence of oxygen damages the heart muscle, which looses it strength to pump oxygenated blood into the brain cells. Neurons deprived of oxygen collapse fast – within four to eleven minutes – causing irreversible brain death. The sequence of anoxia can also initiate from the respiratory center in the brain stem – the part of brain at its junction with the spinal cord, where the neck meets the skull. The center controls the depth and speed of respiration. Any damage to this center- as in head injury or stroke- will depress breathing and cause anoxia, which then damages other parts of the brain, heart and the rest of the body. Irrespective of the initiating event, anoxia seems to be one of the prominent determining events of cell death.
What happened?