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  • How We Die: Reflections of Life s Final Chapter by Sherwin.
  • How We Die: Reflections on Life s Final Chapter - Sherwin.

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The book delivered what I needed in the chapter “Murder and Serenity.” When someone is bleeding to death, he goes into shock, his heartbeat ceases, and his muscles spasm in what are known as death agonies. For a few minutes he is “clinically dead,” which means his brain is receiving no oxygen, but with medical intervention he might be revived. Doctors can tell by examining the person whether the effort is likely to succeed. One important clue is the eyes.

If open, [the eyes] are at first glassy and unseeing, but if resuscitation does not commence they will in four or five minutes yield up their sheen and become dulled, as the pupils dilate and forever lose their watchful light. It is as though a thin cloud-gray film has been laid down over each eye . . [T]he eyeball soon flattens out, just enough to be noticeable. It is a flatness from which there is no rising. (122-123)

Nuland goes on to discuss the serenity and freedom from pain observed in victims of trauma. When the body is damaged, it produces endorphins, pain-killing chemicals like those in narcotics. He provides several examples of when and how this happens, including soldiers wounded during battle and a child who is murdered.

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