All language subtitles for BBC - 07 - The End Of Life.eng

We go about our daily lives
hardly ever considering our final fate.

Yet at every moment,
we are surrounded by death.

Around 60 people will die in the United Kingdom
before the end of this programme.

We seldom witness death. 0ften our only
experience is from films and television,

which can present it
as a violent and painful event.

We are reluctant
to face up to our own mortality,

to confront the truth
that in the midst of life, we are in death.

In this final part of the story of the human body,
we take a difficult journey to see what happens

when this mass
of biological activity ceases to be,

to see how all the previous ages of our existence
are undone in the final act.

The processes of death
in the human body are remarkable.

This is what it would look like if you could see
the human body cool down over 24 hours.

Death comes not as a single quick event,
but a slow winding down.

It is difficult to say when every cell
in the body ceases to have life.

Long before we stop breathing,
our brain may die, our personality lost for ever.

But the biology of death can seem cold,
and distant from the human story.

(MAN, GERMAN ACCENT) I want to die at home
because it is not nice to die in a hospital.

There's nothing in there,
you're only a number there, you know.

At home you can die in peace.

Herbie and his wife Hannelorre
fell in love with Ireland,

and decided to move here from Germany in 1981.

We started filming Herbie
a year after he learnt he had a fatal cancer.

I was driving in the car to Loch Rae,
and on the way to Loch Rae, I collapsed.

I had pain in the stomach,
here in this area.

Then we called an ambulance,
and they took me to hospital in Galway.

The surgeon told Hannelorre
it was very bad.

The tumour was the size
of two soccer balls - very big.

It's hard to get it into your head.
When you first hear the news,

it's like a shock,
and you can't really think about it.

There's only a couple of months,
and, all the ideas - it's terrible!

It's now 0ctober. As the tumour
expands in Herbie's stomach region,

it threatens vital organs.

The doctors are amazed that his body
has been able to cope for this long.

A couple of months ago,
we created this small garden here.

I got from a good friend from Switzerland
a couple of roses and planted them here,

because when I die and get cremated,

Hannelorre will put the ashes,
afterwards,

around these roses that you see here.

This is my greatest wish and my will,
where I want to be buried forever.

And my spirit is around the land,
and the house.

The modern way to die
is often hidden from view

in the sanitised world of the hospital.

But we have not always been so uneasy
about confronting death.

In the Capuchin catacombs in Sicily,
8,000 bodies are preserved.

Here, families would come
to visit their loved ones.

To our eyes, this may seem
a gruesome spectacle,

but to 19th-century Sicilians, death was not
something to recoil from in fear and dread.

Walking along these narrow corridors,

I must confess to feeling both fascinated
and repulsed by this spectacle of death.

For today it's death,
not sex, which is the last taboo.

But an understanding
of what happens to us when we die

can do much to ease our fears
and dispel our anxieties.

The human body has many attributes
which are unique,

but I think our ability to face our own death
is perhaps the most remarkable.

- Are you comfortable there, Herbie?
- Yeah, that's OK.

Herbie, together with Hannelorre,

has decided to let us film
the final moments of his life.

I know I will never see
this film in my lifetime.

(D0CT0R) No, it has spilled out
a little bit more here, on top,

- hasn't it, over the last week?
- Yes, yes.

I like it that everybody can see

that a human being
can manage an illness like mine.

Everybody can see in this film

that there is a way to make the best
of the end of your life.

OK, that seems fine.
Your bowel sounds are perfectly normal.

How is your energy at the moment?

I can walk around, so my energy's good.

I can't lift much any more,
I'm not so strong.

Herbie receives regular visits
from his local hospice workers.

They look after his pain control

and help Herbie and Hannelorre
cope with the prospect of his dying.

They're gorgeous.
They've gotten so big, haven't they?

Oh, they're lovely.

The hospice worker and I, we talk very
close together, and we trust each other.

I'm not worried about when I die,
tomorrow, today, in a couple of months.

I know what's coming, and I face it.

Death seems an entirely cruel and negative
event, bringing loss and bereavement.

Yet, from the very start, there is a fundamental
link between life and death in our bodies.

0ur bodies are built
from organised colonies of cells.

What we see when we look at ourselves
are vast communities of cells, billions of them.

Each one plays a particular role - a heart cell,
a muscle cell, a brain cell.

In an incredible act of harmony
and organisation, they work together,

performing the functions
of the organ they belong to.

From the very start of our lives,

this tireless dedication to duty
often requires our cells to die.

Some cells in the foetus
actually receive signals to self-destruct.

Here, the developing hand
grows as an enormous bundle of cells.

Then cells are systematically destroyed,
sculpting the fingers and the gaps between,

in much the same way
a sculptor chips away a block of stone.

From the very beginning of the human body's
journey, death becomes an essential part of life.

Under the microscope,
we can see how cells are destroyed.

This process continues throughout our lives,

as cells become damaged, or just worn out.

During the course of this programme,
around a billion cells in your body will die.

This programmed cell death
keeps us healthy and alive.

In this way we can think of death
as part of the creative force of life.

But do our own deaths
play a part in the larger human story?

Are we like cells in some cosmic machine,
our deaths serving a greater unseen purpose?

Well, sadly not.

It seems that death
is the price we pay for having sex.

When we have sex, we can create new life.

But we do not just produce copies of ourselves.

Each one of these babies is unique, the result of
the particular mix of their parents' genes.

Through evolution,
winning combinations of genes

get passed on from generation to generation.

This process, which we call natural selection,

has speeded up our ability to adapt and evolve.

Without sex, and the mixing of genes,

we would never have evolved
into such complex organisms.

But as individuals,
we do pay a price for such success.

0nce you've had sex and passed on
your genes, your job is done.

You hand over the genetic baton
and the relay race carries on without you.

Your own fate is unimportant,
and death waits to catch you up.

So, it seems that we are just vehicles
for our genetic material.

We die. 0nly our genes are immortal.

With the arrival of winter in Ireland,
Herbie's health gradually declines.

He has good days and he has bad days.

Hannelorre phoned this morning
and said that you had a lot of pain.

- Was it during the night or this morning?
- It was the whole night.

When he wake me
this morning before 5 o'clock,

I looked at him and said to myself, this is
the time that he is dying, or something.

- He was so sick?
- Everything was so different.

His face, it was so strange to me.

When I saw you, you were in agony.

And this is only with the pain.
I don't like the pain.

I was so frightened...it's unbelievable.

I was thinking, it's the end,
it's the end of...his life,

but he was lucky enough.

He's a very strong person,

and he fights.

- I hope I'll see the springtime.
- Oh, but you will. Why won't you?

- Keep doing what you're doing now.
- I had a couple of bad moments.

Very bad.

Very, very bad.

A couple of weeks ago,

at that time I thought I was dying,
honestly.

Ever since, I've had this
syringe driver here, because of the pain.

The syringe driver.
It just runs automatically, 24 hours.

When I have trouble with pain,
I can give myself a boost.

Now I get a bit extra.

When I'm in pain,
it is very, very bad.

I get in a bad mood, and feel low,
you know. I can't do anything,

neither lie down nor sit.

No matter what,

I have to have this medication.
I can't do without it any more.

Modern advances in pain relief

mean that we can now control
many aspects of dying.

And our modern medicine has also changed
many of the causes of death.

Better health care, combined
with better nutrition and cleaner water,

mean that we now live twice as long
as we did a hundred years ago.

We are more likely to die from the diseases
of old age, such as cancer, stroke,

and the number one killer, heart disease.

Today, heart disease kills a quarter
of the population in the western world.

The most violent form is the heart attack.

'He wanders to the outside. He's gotta
look on his backside. He hit the 40.'

(AMERICAN ACCENT) I was sitting in this chair
watching a football game on television.

I got my first surge of pain from
my heart to the right side of my chest.

The pain started to travel in my back,
to my back area,

and I figured that it was a heart attack.

The human heart
pumps 7,500 litres of blood a day.

These small arteries, less than a millimetre wide,
supply blood to the heart muscle.

Here, a tiny blockage
is hampering the supply to one of the arteries.

They had me
on the table at about 12 o'clock,

and I watched on a monitor
as they went through each of my arteries.

It was one little clot
that caused all that problem.

The patient starts
to feel a variety of symptoms.

I literally felt the pain
start from the centre of my chest,

and I felt
the whole thing go down both arms.

It was almost like my chest was
in a vice and I was being crushed

as the vice was being turned,
tighter and tighter.

(HIGH-PITCHED BEEP)

When the cardiologist came in,
he had seen my EKG,

and he went into the hall with
the other doctors and interns and so on,

Severe attacks can lead to cardiac arrest,
where the heart stops beating altogether.

Now, the blockage stops the flow of blood.
Starved of oxygen and glucose,

it is only minutes before the heart muscle dies.
Time is running out.

Electrical instability
causes the heart to beat erratically.

As the heart quivers, it is unable
to pump the blood around the body.

This is the critical moment.

Without a supply of blood,
the brain fails within five minutes.

Then breathing and respiration stops.
Death is moments away.

In a few moments,
this beating human heart will be stopped,

this time not by a heart attack,
but for an operation.

The patient is no longer breathing. A machine
takes over the task of the heart and lungs.

A small electric current
breaks the heart's rhythmic beat,

leaving it quivering,
as if gripped by a heart attack.

(SURGE0N) OK, that's better.

- Now the heart's just twitching?
- Just flickering.

This is a heart bypass operation.

While the heart is not moving,
the surgeon can reroute blood vessels

to parts of the heart muscle
where clogged arteries are restricting the flow.

Another stitch, please...

The bizarre thing is, that if I saw somebody
in this condition outside the operating theatre,

I'd think they were dead. He's no pulse, he's not
breathing, and the heart's not beating at all.

A little bit towards me, please.

Yet, in a short time, this patient will
be awake and chatting with his family.

These days, we can't decide that a person
is dead just by seeing if their heart has stopped.

Instead, we look to the brain,

and to one vital part - the brainstem.

Buried at the back of the head,
the brainstem is a relic of our ancient past.

Millions of years ago,
this was all the brain our distant ancestors had.

They were primitive creatures;
in fact, it is still called the reptile brain.

Evolution has buried it
under layers of a more complex brain,

but it is still the foundation of life.

It controls our most basic functions:

keeping our heart beating, breathing, regulating
blood pressure and the body's temperature.

That's why, when the brainstem dies,

doctors can be certain
that a patient is clinically dead.

(W0MAN) I had to take them
out of the water this morning.

(HERBIE J0KES IN GERMAN)

Isn't he horrible!

(HERBIE) Now we're ready for Christmas.

(HANNEL0RRE) Happy Christmas, Herbie.

Christmastime was really nice, as Herbie
was feeling so well, and friends came.

We had a lovely dinner, and Herbie
had three glasses of champagne.

But when the new year started,
he got weak and he got depressed.

I thought that every day
he was going downhill.

This was for me
very disappointing and sad.

I wanted...
I decided to get an injection...

You know, I didn't want to live any more
feeling like this.

You know, normally I'm not a man
who gives up so quickly, never.

But at that moment I wanted to give up.

So, I asked the nurse,

And I agreed with this.

My feeling is,

I have maybe only a couple of weeks
to live, that's my real feeling.

(ALARM S0UNDS)

Oops-a-daisy.

Now.

Up... So.

One moment.

- There.
- OK?

First I have to stand up for a moment,
for a while,

to walk around
and get everything settled

before I can
move around a little bit now.

When someone dies, we miss
all the things which make them human:

their personality, their unique identity,
their emotion and warmth.

What is that sense of being,
that consciousness which goes?

Is there a place in our brain
where it can be found?

In this experiment,
we will be able to see the brain at work.

A hundred and twenty eight sensors
pick up tiny electrical signals

emitted as my brain cells fire.

This is the pattern produced when I am relaxed.

All this activity
is simply the result of doing nothing.

As soon as I open my eyes,
the brain leaps into action.

Even the simple task of watching television
involves my brain in millions of actions.

A single second
stretched into a thousand steps

shows swirls of activity
sweeping all over my head.

First, the information travels
to the back of my brain.

From there, the activity moves
through the short-term memory areas,

and then to the front of the brain,
the part actually involved in thinking.

The question is, can we find a single part
of the brain that gives me my sense of myself,

that makes me Robert Winston?

Well, it seems that the brain
is just a bit more complicated than that.

In fact, it appears
to work something like an orchestra.

There are areas that do different things:

the string section, the conductor,
the brass players.

But the output - the music, if you like -
isn't just about the areas that work,

but about the order that they work in.

Just as an orchestra
can produce an infinite variety of music,

depending on which instruments play, and when,

so, too, the brain
can produce limitless results,

depending on the sequence in which
the clusters of brain cells connect.

But the brain has more
than a hundred musicians making music.

If you counted the connections
between cells, just on the surface,

it would take you 32 million years.

This sheer complexity leads scientists
to believe it is our brain,

taken as a whole, that creates our conscious self,
the self we lose when we die.

- Hi, Herbie. Look who's here.
- Hello, Dr Murphy.

- Hello, Herbie. How are you?
- Nice to see you.

Good to see you, always.
I come out here to get cheered up.

It keeps me away from ordinary patients.

Any complaints?

Herbie's tumour presses against vital
organs, such as the liver and kidneys.

That's good, Herbie.
That's lovely, no change.

They keep our cells healthy

by regulating the delicate
chemical balances in the body.

Show me your pulse, Herbie.
It's very important.

If these organs fail, the balance is lost,

and the body can no longer sustain life.

Is your brother coming to see you?

- My brother is coming tonight.
- So that'll be fun.

- Maybe it's the last time I'll see him.
- Oh, I don't think so. I hope not.

I feel it myself,
it's coming to the end now.

- You think that?
- I feel it, yeah.

- And that doesn't worry you unduly?
- No, it doesn't worry me. I KNOW it.

I think you're extraordinary.

- Sunday's his birthday.
- It's your birthday?

I didn't know that.
So what age will you be?

- Sixty-three.
- Sixty-three. Not a bad age.

I'm absolutely delighted
that I can see another springtime.

The season has changed. The weather is
a little better, the sun is coming out.

Anyway, I'm a man, I like nature,

the flowers and the trees,
when they start to bloom.

I never know
what will happen tomorrow.

The tumour in my belly is a time bomb.

A real time bomb. I never know
what will happen tomorrow,

and I enjoy the moment, every day.

We can never know
what it's like to die.

But some people have come very close to death,

only to revive at the final moment
to tell the tale.

Their near-death experiences
might offer some insight

into what happens in the dying brain.

I was in a motorcycle accident
in which I suffered a fractured skull

and numerous broken bones in my head.

It was at that point that
I felt myself separating from my body

and entering
into the near-death experience.

I became aware that I was in a tunnel,
there's no other way of describing it.

You couldn't see it, you could sense it.
And then, down in the distance,

you could see this little speck of light,
which gradually got bigger and bigger,

as it would if you were in a tunnel,
and there's light at the end of it.

(W0MAN) We travelled at some great
speed and distance through the tunnel.

Everything that ever was,
is, and will be

was contained in this radiance.

Nearly all who have come close to death
give the same accounts

of out-of-body sensations
and tunnels of light.

Similar experiences
are also reported by fighter pilots

when, subjected to massive acceleration,
they lose consciousness.

Video tapes are on,
platform and gunwale have been secured.

Flight deck is ready.

This is the world's largest centrifuge.

It is used to investigate
the effects of high G forces on pilots.

Subjects can be spun so fast

that the blood drains from their brain
and they black out.

OK, the run will begin on my mark.
Three, two, one, mark.

We feel that our investigation
of loss of consciousness

is about as close as you can get to
investigating that next state, death.

As the subject enters G-L0C,
a gravity-induced loss of consciousness,

their experiences are recorded.

I can't get to the damned thing.

- Is there a light loss?
- Shit, I don't know where I am.

The sensations that we have
associated with blackout

nearly always include
a tunnelling of the vision

down to a central point
where you just have light ahead of you.

So why do extreme G forces
and near-death experiences

produce the effect of seeing tunnels of light?

While the brain is starved of oxygen, neurones
which deal with vision fire at random.

This creates the sensation of bright light.

As there are more neurones devoted to the
centre of our visual field, and less at the edges,

the light appears to be brightest in the centre,
creating a tunnel effect.

Had I had the choice,
I would never have wanted to leave.

This was just so perfect, so wonderful.

Can't describe it, it was just total love,

happiness, bliss, knowledge.

Three, two, one, pressure.

Just try to relax, you're 100%.

I've had about 35
loss-of-consciousness episodes.

Nearly all of those have been such
that they are very pleasant,

and almost give you a sense of euphoria.

The sensations of euphoria may be

because the brain releases opiate-like
substances to relieve the acute distress and pain.

These produce hallucinations in the parts of
the brain that deal with memories and emotions.

This research has certainly allowed me
to have a much greater understanding

and reduction in the fear associated
with losing consciousness and then dying.

I believe when I'm dead,
I'm dead, and that's it.

There is no other life. There is nothing.
When you die, you have gone, for ever.

You can say, dust to dust.
Dust, it's what's left - nothing.

A handful of ash is left.

(HANNEL0RRE) Monday.
It was just a normal day.

We had breakfast together.

Just like every day.

When we went to sleep,
everything was normal.

On the Tuesday morning,
Herbie called me around 5 o'clock.

He said - his breathing was very heavy,
and he was feeling very uncomfortable -

When I talk to him now,
do you think he can hear me?

The hearing is the last thing to go,
even when they cannot speak.

That's why it's so important
never to say anything

that you wouldn't say
if they were in their full senses.

People who have recovered
from being at death's door have told

how they heard
every single thing that was said.

It's most important never to...you know.

(HANNEL0RRE SPEAKS GERMAN)

Herbie wants something.
He's reaching there, for the holder.

In the final hours,
Herbie receives visits from friends.

Brendan and his young daughter, 0rla,
come to see him for the last time.

Just put those into Herbie's hand.

Hold his hand,
because he's lovely and warm.

If I was loaded with morphine
I think I'd be pretty warm, too.

Herbie hasn't got long
for this world, I suppose.

But he can hear you
when you speak to him.

(BRENDAN) He's been preparing
for this for a long time.

(HANNEL0RRE) Sing him the song
about the heather.

- Why not?
- Yeah, please.

You know the chorus?
Will you go, lassie, go?

- Yes.
- OK.

Oh, the summertime is comin',

And the leaves are sweetly bloomin',

And the wild mountain thyme

Grows around the bloomin' heather.

Will you go, lassie, go?

And we'll all go together,

To pluck wild mountain thyme

All around the bloomin' heather.

Will you go, lassie, go?

The last time I walked in here, I did the
same. I'm not going to be deprived now.

Herbie, take care.

Hello, Doctor Murphy.
It's Peggy, the nurse with the hospice.

I'm with Herbie at the moment.
He's very rattly at the moment.

By morning, Herbie's breathing
becomes increasingly noisy.

It's a very common condition.

It doesn't trouble Herbie,
and is easily helped by medication.

- I don't think he has pain, it's...
- No, no, it's not pain.

It's only this rattling, and this shaking.
It just started.

It just started today, this morning?
Just before I came in?

He was shaking like this.

- Is this normal?
- It happens. It does happen.

Hey, love.

(SHE SPEAKS GENTLY IN GERMAN)

Happy? Mmm?

(SPEAKS GERMAN)

Now you're in peace.

Now you're in peace.

Now you're in peace...

Mary...Herbie's just died. Yeah.

OK. Yeah.

(HANNEL0RRE SPEAKS GERMAN)

Cause of death is this inoperable huge cancer
that he had, retroperitoneal liposarcoma.

His heart gave away, then his lungs failed,
his liver failed, his kidneys failed.

General failure, due to the effect of the
cancer over the last one and a half years.

It's extraordinary
that he has lived so long.

(SPEAKS GERMAN)

(HANNEL0RRE) Afterwards,
when they laid him down,

he was so peaceful-looking,
he was really nice-looking.

I couldn't cry. I couldn't cry.

It was just...

nice.

For me it was a relief
that Herbie is now in peace,

and everything is over, for him.

Not for me, but for him.

I was happy for him.

We find it hard
to contemplate our own deaths,

to imagine that one day we will
no longer live in this world.

But there is a way in which
our bodies continue after we die.

The cells in our bodies are made up of atoms

which have existed
since the start of the universe.

They are constantly being
exchanged and recycled,

so what today are our bodies
were once parts of plants, animals, trees -

indeed, other humans.

And in the future - well, this journey
that each of us takes from birth to death

is just one tiny step
in a much bigger journey,

part of an endless repeating cycle,
from life to death.

For the summertime is comin',

And the leaves are sweetly bloomin',

And the wild mountain thyme

Grows around the bloomin' heather.

Will you go, lassie, go?

And we'll all go together.

To pluck wild mountain thyme

All around the bloomin' heather.

Will you go, lassie, go?

Dear friends, it was Herbie's wish

to read his epilogue

before we spread
the ashes around the roses.

In 1981, my wife Hannelorre and I decided to
go to live in peace and harmony in Ireland.

(HANNEL0RRE AND HERBIE) I can look
back on many fulfilling years with her.

(HERBIE) And I thank her, deeply,
for sharing her life with me.

My wish is that all my friends
and neighbours live together in peace,

without jealousy and animosity.

May you all hold me in good memory.

(BRENDAN) Will you go, lassie, go?
Sing it like Herbie would.

And we'll all go together.

To plant wild mountain thyme

All around the bloomin' heather.

Will you go, lassie, go?