As wonderfully unique and individual as you are, you, me, and everyone we know will share the same one experience, and we’ll be taking it alone.

It isn’t age-dependent; however, your current circumstances, what you do, where you live, and we’d be naive not to factor in genetics, your overall health, and I’ll toss a bit of luck into the mix. Will all influence the outcome.

Globally, causes of death are classified using the International Statistical Classification of Diseases and Related Health Problems (ICD-11).

Once Time Was Limitless

There was a time when we Boomers and Generation X’ers would have considered the notion of turning the last page on the closing moments of life’s good book as inconceivable. We were, and quite rightly so, too busy having a good time. The plan was simple: to live forever.

But tucked away at the foot of our last page, patiently waiting was the Big D, the final full stop, the definitive period. Ready to close proceedings on a life well lived.

Defined by the World Health Organisation, the underlying cause of death is selected from the medical condition or conditions mentioned on the Medical Certificate of Cause of Death or on the coroner’s certificate:

(a) The disease or injury which initiated the train of morbid events leading directly to death.

(b) The circumstances of the accident or violence which produced the fatal injury.

So, you’ve crossed the finishing line, and in doing so will posthumously be awarded the Certified Copy of Entry, or, as it’s colloquially known, the Death Certificate and that, my friend, is the clinical end.

A Helping Hand to Get Your Head Around the Inevitable

On hand to offer Boomers and Generation X’ers around the world comfort and solace regarding The Big D are a collection of religions. In the UK, we enjoy a rich diversity of life, living in a multi-cultural, multi-faith society, including but not limited to Christianity - Anglicanism, Catholicism, Presbyterianism, Methodism, Baptists, Protestant, Orthodox Christianity. Islam, Hinduism, Sikhism, Judaism, Buddhism, Paganism, Jainism and the Baha’i Faith- all bringing with them a rich range of different traditions, so there is no shortage of options.

Just as many of us who follow a faith may not regularly practise it, as many again might be non-religious, having discovered their own individual path of enlightenment, such as Atheism, Agnosticism, and Humanism; a growing demographic who follow their own doctrine possibly reflects more modern secular trends. One hat certainly does not fit all.

I choose to wear the hat that refuses to acknowledge or enter into discussions of my own inevitable Big D. It certainly doesn’t feature in dinner-party conversation. Or over a pint of beer and a game of 8-ball pool or darts down the pub. This undoubtedly explains why I’ve struggled to get my head around the inevitable and to make sense of my mix of thoughts and emotions on what comes next.

The not knowing is precisely why The Big D features in the publication, for people like me, uncomfortable, unaccustomed or simply uncertain when it comes to the BiD, who are searching for answers to be better prepared for the inevitable.

Top Causes of Death

Globally, noncommunicable diseases dominate mortality, accounting for 7 of the 10 leading causes of death. The world’s deadliest condition is ischemic heart disease, which occurs when narrowed arteries reduce blood flow to the heart, causing approximately 13% of all global deaths. Stroke ranks next, responsible for about 10% of deaths, followed by chronic obstructive pulmonary disease (COPD) at roughly 5%.

The Inevitable Doesn’t Take Holidays

There may be occasions in your busy life when you find yourself in the fortunate position to circle out a few days on the calendar to enjoy a little downtime. As relaxing as holidays are for many, the need to travel and social activities can have the opposite effect. Both can affect mortality statistics due to increased travel-related accidents, medical emergencies, and heightened stress or behavioural patterns.

The Oxford Academic Journal of Travel Medicine highlights a significant spike in injuries, medical emergencies, or worse associated with holidays. World Health Organisation data identifies a jaw-dropping 25% of deaths in travellers are down to injuries, many of which could have been avoided.

Health Emergencies Increase Due to Holiday Behavioural Changes

• Over-eating, alcohol consumption, or fireworks usage.

• Sudden changes in routine, stressful travel, and exposure to extreme weather events.

• 60% of U.S. adults travel for Thanksgiving, coinciding with increased road accidents.

• 50%+ of Japanese households travel internationally during the Festival of Obon, with potential heatstroke or accident risks.

• Large-scale celebrations of Christmas, Diwali, and Eid can expose millions to crowd-related risks.

Stay safe, try to relax, don’t forget your toothbrush, always use sunscreen, and ensure you have appropriate, up-to-date travel insurance!

Your Roadmap

For a proportion of our lives, we inhabit a well-travelled roadmap. Indeed, we might innocently believe what happens next is out of our control and down to fate or circumstance. But our map is a well-trodden one, and much of what we will experience has occurred a thousand times before to someone else. But sometimes that someone else is you.

Kicked Where it Hurts

Maslow’s Hierarchy of Needs categorises the need for safety and security as paramount. However, delivering on these needs is not always possible. But help is on hand in the form of a variety of insurance policies to cover those just-in-case moments - for a fee.

You can have all the insurance policies in the world, but sometimes life seems to want to kick you in the privates.

A recent conversation centred on how desperately unfair and tragic it is to end one’s days suffering from an illness or medical condition that is intentionally working to shorten one’s life, killing you off bit by bit.

How bloody angry, upset, damned, doomed, crushing, and sickened you would feel, and the associated pain, suffering and sense of helplessness you and your loved ones would experience.

By the end of the conversation, we had determined that this was not the way we wanted to go. Incapable of wiping our own arse following a visit to the bathroom, or in a hospital, hooked up to a life support machine and zonked out on drugs. This is not what we considered to be living.

In such an awful situation, if compos mentis or with the forethought to communicate our wishes to trusted individuals, they’d have our blessing and consent to raise our hand metaphorically and have the plug pulled for lights-out.

Turn the Lights Out When You Leave

If fortunate enough to have such a choice, I’d be sitting alone on a picnic rug with a good book I’m about to finish. Perched on the west-facing side of a hill in a wildflower long grass meadow, with busy buzzing bees for company, sniffing out their delicate prize tucked deep inside the bulging hearts of thousands of colourful flower heads.

As a cooling late-afternoon breeze ripples across the hillside, the tips of long grass and flower heads shiver into life, and the air fills with the sweetest smell of freshly mowed grass.

In the distance, the sky-blue horizon fades, turning cotton-wool soft clouds from yellow to orange. In the moment, even time itself decides to pause, to sit back and soak up the magnificence of our day as it slips into night, as the blood-orange sky melts into reds. Reds so deep you could raise your hand to a passing fluffy cloud and scoop the ice cream into your hand.

The last busy bee heads off to bed; there is silence; there is nothing to say; it’s your final sunset, your final memory before you close your eyes for the last time.

I sense I’m not alone, and this comforts me. I want to hug them all, to join in the storytelling and laughter, to let them know I’m at peace. A warm hand squeezes mine; a soothing voice whispers in my ear as raindrops fall on my cheek. But there’s no rain today, only goodbye tears soaked in the happiness of memories that fill my heart with love.

I, too, in the quiet moments, have shed a few tears. Not tears of regret for stuff I’d wished I’d said. Indeed, often, I’d wished I’d kept quiet. But tears of forgotten happiness. Some big, but mostly small, tiny, brightly glowing firefly instants that at the time went unnoticed and under the radar, yet now I’m overwhelmed by these beautifully poignant memories of a life well lived.

The Clinical End: Overview of What Physically Happens

Death is not instantaneous but rather a gradual sequence of events. The body undergoes a series of physical changes when the heart stops beating. Blood flow ceases, depriving the brain and other organs of oxygen and nutrients. Typically, consciousness is lost within seconds, as neurons in the brain begin to die rapidly, with electrical activity in the cerebral cortex flatlining within 20 seconds to a few minutes.

Pallor Mortis:

Pallor mortis is defined as the first stage of death, characterised by the skin turning pale due to the cessation of blood circulation. This change typically occurs within 15 to 30 minutes after death and is most noticeable in individuals with fair skin. It results from the collapse of capillary circulation, leading to a waxy, ashen appearance across the body.

Algor Mortis:

The body cools to the ambient temperature, typically dropping at a rate of 1.5°F (0.8°C) per hour.

Rigor Mortis:

Muscles stiffen within 12 hours after death, starting in the smaller muscles of the face and jaw.

Autolysis:

Cells begin to break down due to the accumulation of carbon dioxide, which creates an acidic environment within them.

Putrefaction:

Bacteria begin breaking down tissues, producing gases that cause the body to bloat and emit strong odours.

Skeletonization:

The body continues to decompose, eventually leading to skeletonization, influenced by factors such as temperature, humidity, and the presence of insects or scavengers. These changes are part of the natural process of death and decomposition.

A Roadmap with Limitations

For some, our well-travelled roadmap will have limitations ending with lights out. Others flip the map over to reveal their path of enlightenment. Unfortunately, I’m parked on the limitation roadmap side. Because everything about what comes next immediately starts to sound as though I’ve been toking on a very large 60-ring-gauge, 8-inch fat Presidente cigar-sized Joint.

I attempted the impossible: to make sense of what comes next; however, my foundations are built on a lifetime of mixed-up emotions, unfortunate experiences, preconditioned thinking, preconceived notions, and, for good measure, let’s chuck in societal influences and weird assumptions.

Engaging in a little critical thinking to arrive at a conclusion based on available unbiased information, facts, and verifiable evidence is an impossible challenge. How could it not be, as where do you go to find information gleaned from real-life experiences?

A Leap of Faith

We created Life, Love, Doughnuts and The Big D for Boomers and Generation X’ers; however, I hope anyone stopping by will take a little something away from the publication. My hope, too, in weaving The Big D into regular conversation slots, is that we will collectively feel less uncomfortable sharing our thoughts on what comes next. Not for the body we leave behind; I think we’re all pretty much in agreement on that aspect of what happens.

But on the unknown, the not quite so sure, the intangible, that invisible piece of magic, the entity inside us all that doesn’t appear in any X-ray. Our Jedi-life force, wairua, vis vitalis, and what some refer to as our spirit or soul.

Before I began putting pen to paper, I knew the Earth wasn’t flat. But there was a time when people thought we would fall off it at the end of the world. There was a time when we would make sacrifices to the gods for safe passage across the sea or for a better harvest. There was a time when humanity dreamed of flying or travelling to the moon, and now, at some point in the not-too-distant future, in the greater scheme of things, if you can afford the ticket, you’ll be able to take a day trip in a spacecraft to check out the moon yourself.

I’ve concluded that, as human beings, if we want to do something, dream of something, get to somewhere, somehow, there is a pretty good chance that something will happen as someone, someplace, will discover, create, invent and build it at some point in the future.

In my lifetime, I suspect somebody will live to be 150 years old. Already, science has enabled blind people to regain their sight and deaf people to hear. Just because we can’t see it, touch it, or taste it does not mean it doesn’t exist. We simply haven’t found it yet.

The Roadmap Flips

Feeling slightly lightheaded in the darkness, a blanket of cooling night air wraps itself around me. I’m uncertain if my eyes are closed or if it’s just darker than dark?

I must be awake as I’m alert to movement. But unsure if I’m moving? Or are my surroundings moving and I’m still, and how is that possible?

The darkness lifts, and in its place is light. Colours flood through the light. Colours I cannot name formed from a hundred incompatible rainbow spectrums. Colours that pass through me, and pass me, and how, too, is it possible I can see everything, in every direction, at the same time?

As disconcerting, unlikely, and baffling as it seems, my roadmap has flipped, as the first page of a new book fills with indescribable colour and light. Is this my path to enlightenment? I don’t know, but I am in awe and bubbling with excitement. Ready to rock n roll and experience this next great adventure, and who knows what I’ll find.

It’s your choice what you choose to believe. I’ve made mine. No regrets, my time with you was the greatest, big loves.

References

_{England, K. (2015). Pitfalls in death certification.}

_{wikipedia.org}

_{Walker, S., Rampatige, R., Wainiqolo, I., & Aumua, A. (2012). An accessible method for teaching doctors about death certification. https://doi.org/10.1177/183335831204100101}

_{https://www.voronoiapp.com/healthcare/The-Top-20-Causes-of-Death-Globally-in-2021--2657}

_{The last breath. https://bangaloremirror.indiatimes.com/bangalore/cover-story/the-last-breath/articleshow/100631361.cms}

_{The journey of decay: How long does it take for a body to decompose? | Penprofile. https://penprofile.com/the-journey-of-decay-how-long-does-it-take-for-a-body-to-decompose/}

_{AC and Associates. https://www.dipac.com.au/what-is-stress/}

_{Mboera, L., Lyimo, E., Chiduo, M., Mangu, C., Mremi, I., Kumalija, C., Joachim, C., Massawe, I., Matemba, L., Kimario, E., Bwana, V., & Mkwashapi, D. (2018). Cause-specific mortality patterns among hospital deaths in Tanzania, 2006-2015. PLoS One, 13(10), e0205833.}

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