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may be your ex was knocked out while trying to knock you up?
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Dying in sleep is the way to go
- Thread starter nayr69sg
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I have never seen my ex husband drunk. Pui your evil filthy whore mother stinky phua cb!
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Her smelly pussy is glued shut and stitched up by her mother since she knew she will be a whore once her legs are open.
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www.pilotonline.com
Health & Medicine
:quality(70)/arc-anglerfish-arc2-prod-tronc.s3.amazonaws.com/public/3S6UH7EDIFARNL7TRWVJL2EH2Q.jpg "Dr. John Boone Simpson father to the author, Elizabeth Simpson, a staff writer for The Virginian-Pilot.")
Dr. John Boone Simpson father to the author, Elizabeth Simpson, a staff writer for The Virginian-Pilot.
It was the phrase "died peacefully in his sleep" that made me hesitate.
Only a few hours had passed since my 88-year-old father failed to wake on the morning of April 23.
He was a stickler for accuracy, and not much on euphemisms, so I paused when writing that in his obituary. As a journalist, I try to avoid any details I can't verify.
Did he die peacefully? Could he have awakened in terror the moment before? Would someone call me and challenge this brazen claim of peace?
This single task my family doled out to me was in danger of making me miss my flight. When you're flailing a little with your own emotions, there's comfort in phrases that have been used again and again. They are legion on the obit page:
"Was preceded in death by ... " "Survivors include... " And, yes, "died peacefully in his sleep."
So I went with the cliches, every one of them, journalism be damned.
In the weeks to follow, though, I found myself returning to my initial pause, partly because of this question from friends: "What did he die of?"
My answer-that-wasn't-an-answer – "He died in his sleep" – was usually followed by this response:
"That's the way to go."
Is it?
I couldn't stop wondering, which led me on a quest to answer two questions:
What is it you die of when you don't wake up in the morning?
And, is it the peaceful death everyone assumes?
No one was reporting from the other side, so I turned to the living.
The answers are not as simple as you might think. But neither are they unsettling to investigate, mostly because the people who have answers deal with death on a daily basis. They don't see it as a macabre subject, but as a natural part of life.
First I talked with Dr. Leah Bush, the chief medical examiner of Virginia. She's done roughly 5,000 autopsies in her career, and that's not counting what she calls "external examinations," which is what my father had.
She said in cases like my father's, there usually isn't an autopsy. That's reserved for homicides, suspicious deaths and unusual deaths of people who had no other health problems.
But in the great majority of cases, a death like my father's is due to "cardiac arrhythmia" – basically, an irregular heartbeat.
In fact, that's what the coroner penned in the little box on the death certificate.
Two words, taking up an inch on the form.
That's it?
It didn't seem like enough.
Bush explained that sometimes you can die in your sleep during a massive stroke or a ruptured aneurysm. But in those cases, a person usually will have complained earlier about symptoms like a headache or other pain. A heart attack or pulmonary embolism usually will cause enough pain to lead the person to wake and go to an emergency room.
But death during sleep with no symptoms at all is likely due to the heartbeat going haywire. In Bush's opinion, it is the way to go.
Peaceful? She thinks so.
Sometimes, she said, such a person will be curled up in a sleeping position, the blankets tucked around them, no evidence of thrashing about. Their faces are serene, their eyes closed. By contrast, in cases where death comes while not sleeping, there's a 50-50 chance the eyes will be open.
For the family, peace may be a different matter. Dying overnight is unexpected and sudden and often unexplained – especially if it happens to a younger person, and families want answers that are difficult to give.
"Why, why, why?" Bush says the families will ask.
I, too, wanted more.
An emergency room doctor elaborated on the condition, which I appreciated because she used a lot of big medical words. Why did that make me feel better?
In an email, Dr. Simone Gold, a California ER doc who did her internship at Eastern Virginia Medical School, wrote:
"If a patient simply dies, without any symptoms, which of course we don't know unless it is witnessed, but when that is what occurs, absolutely and without question the most common reason would be a cardiac arrhythmia, specifically ventricular fibrillation or pulse-less ventricular tachycardia. If you have to die, this is a great way to go."
The reason ventricular fibrillation is a good way to go, she explained, is that shortly after blood stops flowing to the brain, a person falls unconscious.
"An arrhythmia is a short-circuit of the electricity. A heart attack is the interruption of the blood flow to a section of the heart. They are totally different. A heart attack is very rarely fatal and instantaneous, although it can be if the blood flow to a very critical portion of the heart was suddenly blocked."
Often, it is the absence of symptoms that leads medical examiners to the correct cause of death.
Sleep apnea – pauses in breathing during sleep – can also play a role in overnight deaths, though it's not always documented. A 2005 University of California, Los Angeles study suggested that older people, as they age, lose nerve cells in the breathing command post of the brain.
That can spark something called "central sleep apnea." Older people whose lungs and heart already are weak because of age stop breathing during sleep, and their bodies fail to rouse them again.
At the other end of the age spectrum from my father lies another type of death that strikes in slumber: sudden infant death syndrome. Every year, some 2,500 babies die in this country of this mysterious condition. The cause is determined not by symptoms, but by ruling out all other possibilities.
Most of those babies die while sleeping – seemingly peacefully – in their cribs.
Jill Crafford of Norfolk remembers the moment eight years ago when she picked up her daughter, Jessie Grayse Watson, out of a baby swing she'd fallen asleep in.
"She wasn't cold, she wasn't blue, she wasn't sick, everything looked normal, she just looked like she was asleep."
But she was limp and lifeless, a victim of SIDS.
Her age? Three months, one week and five days, says her mother, a clue that peaceful deaths aren't necessarily so for those left behind.
Since then, Crafford has talked with dozens of other parents who have experienced the same sentiment of believing their SIDS babies died in bliss.
"She did die peacefully, that I know."
I posed the subject of dying in your sleep to colleagues who belong to the Association of Health Care Journalists. Their personal anecdotes gave a surprising range of responses.
One writer described her grandfather who died at 87 in his sleep:
"I was 17 and decided that was how I wanted to go. Twenty-five years later, when my mother was dying of cancer, I learned that, in fact, he had committed suicide. He had cancer and did not want to be a burden to his family. That's what he wrote on the note that he left for my grandmother and mother, pinned to his pajamas. He was a doctor and evidently had stowed away enough pills for when the time came."
Another colleague wrote about his mother, noting that he believed her death was more peaceful than his father's long battle with Alzheimer's:
"Mom died last year at age 82, most likely from a cerebral hemorrhage or stroke. She was physically active and mentally alert up until her final moment. She most likely thought warmly about her granddaughter's upcoming wedding when she went to bed that night. The TV in her bedroom was still on when her body was discovered the next morning. She was in bed leaning back against a pillow. The remote control was still in her hand."
Another journalist recited a line from a children's prayer – If I should die before I wake, I pray the Lord my soul to take – before asking: "Could it be that the frightening prayer some of us were taught as children is now a comfort & indeed, an ideal?"
And another comment led me to delve deeper:
"I have witnessed the deaths of two relatives medicated with morphine in hospice care. Technically, they were 'asleep,' but even so there was a period of what appeared to be respiratory physical struggle which is called 'agonal breathing,' which I was told by a nurse indicates the last hours of life, when the body 'struggles' to die. This was very different from the image of just quietly slipping away."
It was an observation Dr. Krista Dobbie understands well.
Dobbie directs Sentara's palliative care program throughout Hampton Roads. She's board certified in that specialty, which focuses on lessening the pain, symptoms and stress of a serious illness.
In the movies, she said, dying looks easy. People lie comfortably in bed, say their last words, usually poignant ones, and then their heads fall slightly to the side.
It makes for great cinema, Dobbie says, but a lousy representation of reality. And she would know, having been at the bedside of hundreds of deaths.
In some ways, dying a century ago was easier.
In the natural dying process, people with the likes of heart disease, emphysema and cancer lose their appetite, stop eating, then lose their thirst and become dehydrated. Toxins build up, and organs such as the kidney and liver begin to shut down.
For a period, they can become confused and delirious, then sleepy and finally unresponsive before dying.
But today, there's a lot more medicine and machinery to keep the body going. That's all well and good when extending a good quality of life. But sometimes there's a point where all you're doing is delaying the inevitable.
Dobbie and her team offer physical, emotional and spiritual care, and, they hope, "a good death."
Dying is an active process, she says, and the body is programmed to keep going at all costs, so there can be a struggle at the end.
Often, there's a period of time when the heart rate increases, blood pressure goes up, and breathing quickens as the lungs keep trying to oxygenate the body.
Sometimes people with a disease like lung cancer will be breathing 40 times a minute when normal is 12 to 14. That's a struggle, so doctors will give patients a dose of morphine to slow down the respiratory rate. Families sometimes interpret that as hastening death, but Dobbie doesn't see it that way.
"Sometimes when a patient gets comfortable, they let go. The pain has been taken away; the agony is gone."
Their breathing slows and becomes irregular, and while there still may be sounds like labored breathing or gasps, they are near the end.
She has seen some people die in peace and others go out so fitfully they need a sedative to stop thrashing around. Maybe they're afraid, or have unfinished business.
"I think most of us want to die suddenly, most of us want to die like your dad, because there's no suffering," Dobbie said. "We don't want to have to go through painful treatments, loss of independence, losing our purpose, struggling with dealing with a chronic illness."
No one knows the hour or the day when death will come. But Dobbie believes people die the way they lived, and in some situations, in a purposeful way.
She has seen people seem to wait until others are out of the room. A family member will be there 24 hours, seven days a week, and then step out a minute to make a phone call, and the relative dies.
Or, on the other hand, some people seem to hang on until that one last relative finally shows up to complete the family circle.
In contrast to movie scenes, people with chronic illness usually are unresponsive at the end, but not always, especially with young people for some reason.
Dobbie has been with people who have described seeing a light, or deceased relatives in the room waiting to take them away near the end. One 23-year-old woman dying of cancer seemed to be describing heaven to Dobbie and others in the room when she said, "It's beautiful."
Dobbie, trying for a little levity, asked whether there were dogs there. She wanted to know if hers would be waiting.
The woman couldn't summon the energy to say anything else but did leave this final response:
She smiled.
I believe my father, stubborn and practical, died the way he lived. He was in the early stages of Alzheimer's, and though he was still driving and puttering around his farm, his world was shrinking. I suspect he knew which direction life was going, including moving from the rural Missouri town he grew up in to a place that was closer to doctors.
He fought that idea.
He had a good last day, my stepmother tells me, completely free of confusion. When he failed to wake the next day, she said she felt like telling him: "I know you didn't want to move, but this is taking it to the extreme."
My mother, on the other hand, took a lot longer to die 20 years ago, more in the fashion of the patients Dobbie treats.
She'd been diagnosed with lung cancer three years earlier, and there were a lot of lousy parts to it: The despair of the diagnosis. The labored breathing at the end that sounded like she was sucking up the last drops of a milkshake. The final rush by the ambulance to the hospital at the instruction of my father, who never resigned himself to the fact that nothing more could be done.
At the end, there was morphine, which my father, like so many others, believed sped her death. He beat himself up later about that, saying, "I should have read between the lines."
Now I know there were no lines to read between.
Dying was inevitable; dying in peace was not. I was glad for the morphine.
She died alone.
I like to believe it was peaceful at the end. As a woman of faith, she was ready.
I asked Dobbie whether she thinks people who believe in God die more peacefully. This was her response: "I think some take comfort in their belief of the afterlife – while others stress over their past on earth and the concern of forgiveness of their sins. Patients who are not believers certainly wouldn't have this stress, but then also aren't necessarily looking forward to something after death."
And so ends this quest of mine that began with a slight pause over the obituary of a man who was always asking me: "Well, how do you know that?"
I'm glad I went to the trouble, even after the fact, to try and verify a sentence that 30 years of journalism did not prepare me to write:
"Dr. John Boone Simpson, a World War II veteran and large-animal veterinarian, died peacefully in his sleep at his home in Roanoke on Saturday at the age of 88."
Elizabeth Simpson, 757-222-5003, [email protected]
Copyright © 2023, The Virginian-Pilot
Health & Medicine
In your sleep: "If you have to die, this is a great way to go"
It was the phrase "died peacefully in his sleep" that made me hesitate.
Only a few hours had passed since my 88-year-old father failed to wake on the morning of April 23.
He was a stickler for accuracy, and not much on euphemisms, so I paused when writing that in his obituary. As a journalist, I try to avoid any details I can't verify.
Did he die peacefully? Could he have awakened in terror the moment before? Would someone call me and challenge this brazen claim of peace?
This single task my family doled out to me was in danger of making me miss my flight. When you're flailing a little with your own emotions, there's comfort in phrases that have been used again and again. They are legion on the obit page:
"Was preceded in death by ... " "Survivors include... " And, yes, "died peacefully in his sleep."
So I went with the cliches, every one of them, journalism be damned.
In the weeks to follow, though, I found myself returning to my initial pause, partly because of this question from friends: "What did he die of?"
My answer-that-wasn't-an-answer – "He died in his sleep" – was usually followed by this response:
"That's the way to go."
Is it?
I couldn't stop wondering, which led me on a quest to answer two questions:
What is it you die of when you don't wake up in the morning?
And, is it the peaceful death everyone assumes?
No one was reporting from the other side, so I turned to the living.
The answers are not as simple as you might think. But neither are they unsettling to investigate, mostly because the people who have answers deal with death on a daily basis. They don't see it as a macabre subject, but as a natural part of life.
First I talked with Dr. Leah Bush, the chief medical examiner of Virginia. She's done roughly 5,000 autopsies in her career, and that's not counting what she calls "external examinations," which is what my father had.
She said in cases like my father's, there usually isn't an autopsy. That's reserved for homicides, suspicious deaths and unusual deaths of people who had no other health problems.
But in the great majority of cases, a death like my father's is due to "cardiac arrhythmia" – basically, an irregular heartbeat.
In fact, that's what the coroner penned in the little box on the death certificate.
Two words, taking up an inch on the form.
That's it?
It didn't seem like enough.
Bush explained that sometimes you can die in your sleep during a massive stroke or a ruptured aneurysm. But in those cases, a person usually will have complained earlier about symptoms like a headache or other pain. A heart attack or pulmonary embolism usually will cause enough pain to lead the person to wake and go to an emergency room.
But death during sleep with no symptoms at all is likely due to the heartbeat going haywire. In Bush's opinion, it is the way to go.
Peaceful? She thinks so.
Sometimes, she said, such a person will be curled up in a sleeping position, the blankets tucked around them, no evidence of thrashing about. Their faces are serene, their eyes closed. By contrast, in cases where death comes while not sleeping, there's a 50-50 chance the eyes will be open.
For the family, peace may be a different matter. Dying overnight is unexpected and sudden and often unexplained – especially if it happens to a younger person, and families want answers that are difficult to give.
"Why, why, why?" Bush says the families will ask.
I, too, wanted more.
An emergency room doctor elaborated on the condition, which I appreciated because she used a lot of big medical words. Why did that make me feel better?
In an email, Dr. Simone Gold, a California ER doc who did her internship at Eastern Virginia Medical School, wrote:
"If a patient simply dies, without any symptoms, which of course we don't know unless it is witnessed, but when that is what occurs, absolutely and without question the most common reason would be a cardiac arrhythmia, specifically ventricular fibrillation or pulse-less ventricular tachycardia. If you have to die, this is a great way to go."
The reason ventricular fibrillation is a good way to go, she explained, is that shortly after blood stops flowing to the brain, a person falls unconscious.
"An arrhythmia is a short-circuit of the electricity. A heart attack is the interruption of the blood flow to a section of the heart. They are totally different. A heart attack is very rarely fatal and instantaneous, although it can be if the blood flow to a very critical portion of the heart was suddenly blocked."
Often, it is the absence of symptoms that leads medical examiners to the correct cause of death.
Sleep apnea – pauses in breathing during sleep – can also play a role in overnight deaths, though it's not always documented. A 2005 University of California, Los Angeles study suggested that older people, as they age, lose nerve cells in the breathing command post of the brain.
That can spark something called "central sleep apnea." Older people whose lungs and heart already are weak because of age stop breathing during sleep, and their bodies fail to rouse them again.
At the other end of the age spectrum from my father lies another type of death that strikes in slumber: sudden infant death syndrome. Every year, some 2,500 babies die in this country of this mysterious condition. The cause is determined not by symptoms, but by ruling out all other possibilities.
Most of those babies die while sleeping – seemingly peacefully – in their cribs.
Jill Crafford of Norfolk remembers the moment eight years ago when she picked up her daughter, Jessie Grayse Watson, out of a baby swing she'd fallen asleep in.
"She wasn't cold, she wasn't blue, she wasn't sick, everything looked normal, she just looked like she was asleep."
But she was limp and lifeless, a victim of SIDS.
Her age? Three months, one week and five days, says her mother, a clue that peaceful deaths aren't necessarily so for those left behind.
Since then, Crafford has talked with dozens of other parents who have experienced the same sentiment of believing their SIDS babies died in bliss.
"She did die peacefully, that I know."
I posed the subject of dying in your sleep to colleagues who belong to the Association of Health Care Journalists. Their personal anecdotes gave a surprising range of responses.
One writer described her grandfather who died at 87 in his sleep:
"I was 17 and decided that was how I wanted to go. Twenty-five years later, when my mother was dying of cancer, I learned that, in fact, he had committed suicide. He had cancer and did not want to be a burden to his family. That's what he wrote on the note that he left for my grandmother and mother, pinned to his pajamas. He was a doctor and evidently had stowed away enough pills for when the time came."
Another colleague wrote about his mother, noting that he believed her death was more peaceful than his father's long battle with Alzheimer's:
"Mom died last year at age 82, most likely from a cerebral hemorrhage or stroke. She was physically active and mentally alert up until her final moment. She most likely thought warmly about her granddaughter's upcoming wedding when she went to bed that night. The TV in her bedroom was still on when her body was discovered the next morning. She was in bed leaning back against a pillow. The remote control was still in her hand."
Another journalist recited a line from a children's prayer – If I should die before I wake, I pray the Lord my soul to take – before asking: "Could it be that the frightening prayer some of us were taught as children is now a comfort & indeed, an ideal?"
And another comment led me to delve deeper:
"I have witnessed the deaths of two relatives medicated with morphine in hospice care. Technically, they were 'asleep,' but even so there was a period of what appeared to be respiratory physical struggle which is called 'agonal breathing,' which I was told by a nurse indicates the last hours of life, when the body 'struggles' to die. This was very different from the image of just quietly slipping away."
It was an observation Dr. Krista Dobbie understands well.
Dobbie directs Sentara's palliative care program throughout Hampton Roads. She's board certified in that specialty, which focuses on lessening the pain, symptoms and stress of a serious illness.
In the movies, she said, dying looks easy. People lie comfortably in bed, say their last words, usually poignant ones, and then their heads fall slightly to the side.
It makes for great cinema, Dobbie says, but a lousy representation of reality. And she would know, having been at the bedside of hundreds of deaths.
In some ways, dying a century ago was easier.
In the natural dying process, people with the likes of heart disease, emphysema and cancer lose their appetite, stop eating, then lose their thirst and become dehydrated. Toxins build up, and organs such as the kidney and liver begin to shut down.
For a period, they can become confused and delirious, then sleepy and finally unresponsive before dying.
But today, there's a lot more medicine and machinery to keep the body going. That's all well and good when extending a good quality of life. But sometimes there's a point where all you're doing is delaying the inevitable.
Dobbie and her team offer physical, emotional and spiritual care, and, they hope, "a good death."
Dying is an active process, she says, and the body is programmed to keep going at all costs, so there can be a struggle at the end.
Often, there's a period of time when the heart rate increases, blood pressure goes up, and breathing quickens as the lungs keep trying to oxygenate the body.
Sometimes people with a disease like lung cancer will be breathing 40 times a minute when normal is 12 to 14. That's a struggle, so doctors will give patients a dose of morphine to slow down the respiratory rate. Families sometimes interpret that as hastening death, but Dobbie doesn't see it that way.
"Sometimes when a patient gets comfortable, they let go. The pain has been taken away; the agony is gone."
Their breathing slows and becomes irregular, and while there still may be sounds like labored breathing or gasps, they are near the end.
She has seen some people die in peace and others go out so fitfully they need a sedative to stop thrashing around. Maybe they're afraid, or have unfinished business.
"I think most of us want to die suddenly, most of us want to die like your dad, because there's no suffering," Dobbie said. "We don't want to have to go through painful treatments, loss of independence, losing our purpose, struggling with dealing with a chronic illness."
No one knows the hour or the day when death will come. But Dobbie believes people die the way they lived, and in some situations, in a purposeful way.
She has seen people seem to wait until others are out of the room. A family member will be there 24 hours, seven days a week, and then step out a minute to make a phone call, and the relative dies.
Or, on the other hand, some people seem to hang on until that one last relative finally shows up to complete the family circle.
In contrast to movie scenes, people with chronic illness usually are unresponsive at the end, but not always, especially with young people for some reason.
Dobbie has been with people who have described seeing a light, or deceased relatives in the room waiting to take them away near the end. One 23-year-old woman dying of cancer seemed to be describing heaven to Dobbie and others in the room when she said, "It's beautiful."
Dobbie, trying for a little levity, asked whether there were dogs there. She wanted to know if hers would be waiting.
The woman couldn't summon the energy to say anything else but did leave this final response:
She smiled.
I believe my father, stubborn and practical, died the way he lived. He was in the early stages of Alzheimer's, and though he was still driving and puttering around his farm, his world was shrinking. I suspect he knew which direction life was going, including moving from the rural Missouri town he grew up in to a place that was closer to doctors.
He fought that idea.
He had a good last day, my stepmother tells me, completely free of confusion. When he failed to wake the next day, she said she felt like telling him: "I know you didn't want to move, but this is taking it to the extreme."
My mother, on the other hand, took a lot longer to die 20 years ago, more in the fashion of the patients Dobbie treats.
She'd been diagnosed with lung cancer three years earlier, and there were a lot of lousy parts to it: The despair of the diagnosis. The labored breathing at the end that sounded like she was sucking up the last drops of a milkshake. The final rush by the ambulance to the hospital at the instruction of my father, who never resigned himself to the fact that nothing more could be done.
At the end, there was morphine, which my father, like so many others, believed sped her death. He beat himself up later about that, saying, "I should have read between the lines."
Now I know there were no lines to read between.
Dying was inevitable; dying in peace was not. I was glad for the morphine.
She died alone.
I like to believe it was peaceful at the end. As a woman of faith, she was ready.
I asked Dobbie whether she thinks people who believe in God die more peacefully. This was her response: "I think some take comfort in their belief of the afterlife – while others stress over their past on earth and the concern of forgiveness of their sins. Patients who are not believers certainly wouldn't have this stress, but then also aren't necessarily looking forward to something after death."
And so ends this quest of mine that began with a slight pause over the obituary of a man who was always asking me: "Well, how do you know that?"
I'm glad I went to the trouble, even after the fact, to try and verify a sentence that 30 years of journalism did not prepare me to write:
"Dr. John Boone Simpson, a World War II veteran and large-animal veterinarian, died peacefully in his sleep at his home in Roanoke on Saturday at the age of 88."
Elizabeth Simpson, 757-222-5003, [email protected]
Copyright © 2023, The Virginian-Pilot
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Her smelly pussy is glued shut and stitched up by her mother since she knew she will be a whore once her legs are open.
You Loser Whore @Cottonmouth Jeremy Quek of failure biz SUPERFUTUREKIDS, TINITECH CO and SKINNYFATKIDS WORLDWIDE hide in rat hole smearing Gansiokbin a virgin as slut whore mistress to win Pui!
JEREMY QUEK
- 50 years old Catholic
- Queenstown Secondary School 1986 to 1989
- Said in his Tinitech co want to “build human dignity” but did degrading and inhuman treatment of Gansiokbin for years almost a decade
- Do prayer psalm 130 5 6 “more than just a watchman for daybreak” to seek assurance of forgiveness from God to let him go to heaven despite doing daily smearing and abuse of Gansiokbin
- Self claimed in LinkedIn that he is “not an asshole and one of the nicest people you will ever meet” while he everyday hide in rat hole to abuse, smear, trample and insult Gansiokbin a virgin as slut whore mistress
View attachment 179940
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Why so fake you Jeremy Quek son of Cantonese whore dare not do your dirty trick to post multiple fake photos smearing Gansiokbin a virgin as slut whore mistress to get the thread sent to rubbish heap? Pui! View attachment 179939Your useless cunt should be burned.
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Why so fake you Jeremy Quek son of Cantonese whore dare not do your dirty trick to post multiple fake photos smearing Gansiokbin a virgin as slut whore mistress to get the thread sent to rubbish heap? Pui!
View attachment 179942
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Excellent article posted by Thread S tarter @nayr69sgwww.pilotonline.com
Health & Medicine
In your sleep: "If you have to die, this is a great way to go"
Dr. John Boone Simpson father to the author, Elizabeth Simpson, a staff writer for The Virginian-Pilot.
It was the phrase "died peacefully in his sleep" that made me hesitate.
Only a few hours had passed since my 88-year-old father failed to wake on the morning of April 23.
He was a stickler for accuracy, and not much on euphemisms, so I paused when writing that in his obituary. As a journalist, I try to avoid any details I can't verify.
Did he die peacefully? Could he have awakened in terror the moment before? Would someone call me and challenge this brazen claim of peace?
This single task my family doled out to me was in danger of making me miss my flight. When you're flailing a little with your own emotions, there's comfort in phrases that have been used again and again. They are legion on the obit page:
"Was preceded in death by ... " "Survivors include... " And, yes, "died peacefully in his sleep."
So I went with the cliches, every one of them, journalism be damned.
In the weeks to follow, though, I found myself returning to my initial pause, partly because of this question from friends: "What did he die of?"
My answer-that-wasn't-an-answer – "He died in his sleep" – was usually followed by this response:
"That's the way to go."
Is it?
I couldn't stop wondering, which led me on a quest to answer two questions:
What is it you die of when you don't wake up in the morning?
And, is it the peaceful death everyone assumes?
No one was reporting from the other side, so I turned to the living.
The answers are not as simple as you might think. But neither are they unsettling to investigate, mostly because the people who have answers deal with death on a daily basis. They don't see it as a macabre subject, but as a natural part of life.
First I talked with Dr. Leah Bush, the chief medical examiner of Virginia. She's done roughly 5,000 autopsies in her career, and that's not counting what she calls "external examinations," which is what my father had.
She said in cases like my father's, there usually isn't an autopsy. That's reserved for homicides, suspicious deaths and unusual deaths of people who had no other health problems.
But in the great majority of cases, a death like my father's is due to "cardiac arrhythmia" – basically, an irregular heartbeat.
In fact, that's what the coroner penned in the little box on the death certificate.
Two words, taking up an inch on the form.
That's it?
It didn't seem like enough.
Bush explained that sometimes you can die in your sleep during a massive stroke or a ruptured aneurysm. But in those cases, a person usually will have complained earlier about symptoms like a headache or other pain. A heart attack or pulmonary embolism usually will cause enough pain to lead the person to wake and go to an emergency room.
But death during sleep with no symptoms at all is likely due to the heartbeat going haywire. In Bush's opinion, it is the way to go.
Peaceful? She thinks so.
Sometimes, she said, such a person will be curled up in a sleeping position, the blankets tucked around them, no evidence of thrashing about. Their faces are serene, their eyes closed. By contrast, in cases where death comes while not sleeping, there's a 50-50 chance the eyes will be open.
For the family, peace may be a different matter. Dying overnight is unexpected and sudden and often unexplained – especially if it happens to a younger person, and families want answers that are difficult to give.
"Why, why, why?" Bush says the families will ask.
I, too, wanted more.
An emergency room doctor elaborated on the condition, which I appreciated because she used a lot of big medical words. Why did that make me feel better?
In an email, Dr. Simone Gold, a California ER doc who did her internship at Eastern Virginia Medical School, wrote:
"If a patient simply dies, without any symptoms, which of course we don't know unless it is witnessed, but when that is what occurs, absolutely and without question the most common reason would be a cardiac arrhythmia, specifically ventricular fibrillation or pulse-less ventricular tachycardia. If you have to die, this is a great way to go."
The reason ventricular fibrillation is a good way to go, she explained, is that shortly after blood stops flowing to the brain, a person falls unconscious.
"An arrhythmia is a short-circuit of the electricity. A heart attack is the interruption of the blood flow to a section of the heart. They are totally different. A heart attack is very rarely fatal and instantaneous, although it can be if the blood flow to a very critical portion of the heart was suddenly blocked."
Often, it is the absence of symptoms that leads medical examiners to the correct cause of death.
Sleep apnea – pauses in breathing during sleep – can also play a role in overnight deaths, though it's not always documented. A 2005 University of California, Los Angeles study suggested that older people, as they age, lose nerve cells in the breathing command post of the brain.
That can spark something called "central sleep apnea." Older people whose lungs and heart already are weak because of age stop breathing during sleep, and their bodies fail to rouse them again.
At the other end of the age spectrum from my father lies another type of death that strikes in slumber: sudden infant death syndrome. Every year, some 2,500 babies die in this country of this mysterious condition. The cause is determined not by symptoms, but by ruling out all other possibilities.
Most of those babies die while sleeping – seemingly peacefully – in their cribs.
Jill Crafford of Norfolk remembers the moment eight years ago when she picked up her daughter, Jessie Grayse Watson, out of a baby swing she'd fallen asleep in.
"She wasn't cold, she wasn't blue, she wasn't sick, everything looked normal, she just looked like she was asleep."
But she was limp and lifeless, a victim of SIDS.
Her age? Three months, one week and five days, says her mother, a clue that peaceful deaths aren't necessarily so for those left behind.
Since then, Crafford has talked with dozens of other parents who have experienced the same sentiment of believing their SIDS babies died in bliss.
"She did die peacefully, that I know."
I posed the subject of dying in your sleep to colleagues who belong to the Association of Health Care Journalists. Their personal anecdotes gave a surprising range of responses.
One writer described her grandfather who died at 87 in his sleep:
"I was 17 and decided that was how I wanted to go. Twenty-five years later, when my mother was dying of cancer, I learned that, in fact, he had committed suicide. He had cancer and did not want to be a burden to his family. That's what he wrote on the note that he left for my grandmother and mother, pinned to his pajamas. He was a doctor and evidently had stowed away enough pills for when the time came."
Another colleague wrote about his mother, noting that he believed her death was more peaceful than his father's long battle with Alzheimer's:
"Mom died last year at age 82, most likely from a cerebral hemorrhage or stroke. She was physically active and mentally alert up until her final moment. She most likely thought warmly about her granddaughter's upcoming wedding when she went to bed that night. The TV in her bedroom was still on when her body was discovered the next morning. She was in bed leaning back against a pillow. The remote control was still in her hand."
Another journalist recited a line from a children's prayer – If I should die before I wake, I pray the Lord my soul to take – before asking: "Could it be that the frightening prayer some of us were taught as children is now a comfort & indeed, an ideal?"
And another comment led me to delve deeper:
"I have witnessed the deaths of two relatives medicated with morphine in hospice care. Technically, they were 'asleep,' but even so there was a period of what appeared to be respiratory physical struggle which is called 'agonal breathing,' which I was told by a nurse indicates the last hours of life, when the body 'struggles' to die. This was very different from the image of just quietly slipping away."
It was an observation Dr. Krista Dobbie understands well.
Dobbie directs Sentara's palliative care program throughout Hampton Roads. She's board certified in that specialty, which focuses on lessening the pain, symptoms and stress of a serious illness.
In the movies, she said, dying looks easy. People lie comfortably in bed, say their last words, usually poignant ones, and then their heads fall slightly to the side.
It makes for great cinema, Dobbie says, but a lousy representation of reality. And she would know, having been at the bedside of hundreds of deaths.
In some ways, dying a century ago was easier.
In the natural dying process, people with the likes of heart disease, emphysema and cancer lose their appetite, stop eating, then lose their thirst and become dehydrated. Toxins build up, and organs such as the kidney and liver begin to shut down.
For a period, they can become confused and delirious, then sleepy and finally unresponsive before dying.
But today, there's a lot more medicine and machinery to keep the body going. That's all well and good when extending a good quality of life. But sometimes there's a point where all you're doing is delaying the inevitable.
Dobbie and her team offer physical, emotional and spiritual care, and, they hope, "a good death."
Dying is an active process, she says, and the body is programmed to keep going at all costs, so there can be a struggle at the end.
Often, there's a period of time when the heart rate increases, blood pressure goes up, and breathing quickens as the lungs keep trying to oxygenate the body.
Sometimes people with a disease like lung cancer will be breathing 40 times a minute when normal is 12 to 14. That's a struggle, so doctors will give patients a dose of morphine to slow down the respiratory rate. Families sometimes interpret that as hastening death, but Dobbie doesn't see it that way.
"Sometimes when a patient gets comfortable, they let go. The pain has been taken away; the agony is gone."
Their breathing slows and becomes irregular, and while there still may be sounds like labored breathing or gasps, they are near the end.
She has seen some people die in peace and others go out so fitfully they need a sedative to stop thrashing around. Maybe they're afraid, or have unfinished business.
"I think most of us want to die suddenly, most of us want to die like your dad, because there's no suffering," Dobbie said. "We don't want to have to go through painful treatments, loss of independence, losing our purpose, struggling with dealing with a chronic illness."
No one knows the hour or the day when death will come. But Dobbie believes people die the way they lived, and in some situations, in a purposeful way.
She has seen people seem to wait until others are out of the room. A family member will be there 24 hours, seven days a week, and then step out a minute to make a phone call, and the relative dies.
Or, on the other hand, some people seem to hang on until that one last relative finally shows up to complete the family circle.
In contrast to movie scenes, people with chronic illness usually are unresponsive at the end, but not always, especially with young people for some reason.
Dobbie has been with people who have described seeing a light, or deceased relatives in the room waiting to take them away near the end. One 23-year-old woman dying of cancer seemed to be describing heaven to Dobbie and others in the room when she said, "It's beautiful."
Dobbie, trying for a little levity, asked whether there were dogs there. She wanted to know if hers would be waiting.
The woman couldn't summon the energy to say anything else but did leave this final response:
She smiled.
I believe my father, stubborn and practical, died the way he lived. He was in the early stages of Alzheimer's, and though he was still driving and puttering around his farm, his world was shrinking. I suspect he knew which direction life was going, including moving from the rural Missouri town he grew up in to a place that was closer to doctors.
He fought that idea.
He had a good last day, my stepmother tells me, completely free of confusion. When he failed to wake the next day, she said she felt like telling him: "I know you didn't want to move, but this is taking it to the extreme."
My mother, on the other hand, took a lot longer to die 20 years ago, more in the fashion of the patients Dobbie treats.
She'd been diagnosed with lung cancer three years earlier, and there were a lot of lousy parts to it: The despair of the diagnosis. The labored breathing at the end that sounded like she was sucking up the last drops of a milkshake. The final rush by the ambulance to the hospital at the instruction of my father, who never resigned himself to the fact that nothing more could be done.
At the end, there was morphine, which my father, like so many others, believed sped her death. He beat himself up later about that, saying, "I should have read between the lines."
Now I know there were no lines to read between.
Dying was inevitable; dying in peace was not. I was glad for the morphine.
She died alone.
I like to believe it was peaceful at the end. As a woman of faith, she was ready.
I asked Dobbie whether she thinks people who believe in God die more peacefully. This was her response: "I think some take comfort in their belief of the afterlife – while others stress over their past on earth and the concern of forgiveness of their sins. Patients who are not believers certainly wouldn't have this stress, but then also aren't necessarily looking forward to something after death."
And so ends this quest of mine that began with a slight pause over the obituary of a man who was always asking me: "Well, how do you know that?"
I'm glad I went to the trouble, even after the fact, to try and verify a sentence that 30 years of journalism did not prepare me to write:
"Dr. John Boone Simpson, a World War II veteran and large-animal veterinarian, died peacefully in his sleep at his home in Roanoke on Saturday at the age of 88."
Elizabeth Simpson, 757-222-5003, [email protected]
Copyright © 2023, The Virginian-Pilot
Good reading. Goodness me, if not for this thread floating in Page 1 now, I wouldn't have read it.
Many thanks TS!
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this means end of humans?Imusho (my uncle selfish humble opinion) best way to die is when everybody dies together there will be no fear no worrlees and no one will be left behind
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knocked out by batu bahu lah not by drinking.
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Batu bawu is your whore mother wife daughters Pui!
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don't need bro. These days, the families of the deceased can keep the IC intact.You go ICA to hand over your IC and let them punch hole....
Just need a doctor to file death notice with ICA, within hours, nobody can login to your CPF, your hospital appointments cancelled, etc
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if you willed it, distribution will be faster.
else, it will be distributed based on intestate succession
