Rod Kersh
Person-centred physician

Time of death

Kfar Nahum, Photo by Rod Kersh 2023

I suspect that most readers will not have considered the matter of the time of death.

There are all kinds of dimensions to this consideration.

The last breath?

final heartbeat?

The ending fizzle or fibrillation that follows the synchronous contraction of the ventricles?

The concluding flicker of neuronal activity?

What about the hair and nails which supposedly grow post-mortem?

And then there is the recognition or identification.

The moment of death is followed by the time.

The time likely being when another recognizes the passing.

In many instances, the onlooker, unless familiar with death or the process of dying might not be certain, particularly if the phase is prolonged or accompanied by periods of apnoea – non-breathing, interspersed by recovery then a return to normal breaths followed again by more.

Then there is the final pause after which there is no more.

The relative or perhaps the nurse or carers consider to themselves, ‘They’ve gone,’ and take next steps.

For me, this realization or identification is the moment of death when observed; if unwatched we can never tell – this is a situation where a person is found to have died, perhaps in the night, in their sleep or when no one was around.

What follows is an in-between, a death-limbo whereupon local processes are enacted –  a doctor or nurse will verify death; this is the final confirmation of life extinct; gone. No heartbeat, breath sounds, pupil response or movement.

This is the time of verification, or the time of death.

Sometimes this can cause problems, particularly if there is a delay between the moment of death as witnessed by a relative and the arrival of the person to conduct their assessment.

In these days of financial constraint, in certain places, doctors, nurses or those trained in verification are not readily available and families wait on occasion many hours for completion, before the undertaker can take the body and the process of burial, cremation and grief can begin.

I have witnessed confusion when the person dies before midnight and the verification is after leading to distress when the family believe their mum or dad died on Monday and the official record says Tuesday.

For the most, these considerations are addressed and I, when certifying, that is completing the death certificate, usually base my documentation on the moment or time of death rather than the verification.

It can be complicated.

All of this makes me think of two recent situations, one close to home, the other far away.

An old man, 95 years old, solid and certain in his ways, proud and clear minded until the end, dies in his home, alone. His family away, friends for the most, dead themselves. Who will know when he dies? When the carers who visit to re-position him arrive? When the nurse visits? It is all uncertain and perhaps moot. The old man is gone. Did he worry at being alone in his last moments? Was he calling for reassurance, a hand to hold or kind word? We will never know.

And the other death, Daniel Perez, died on October the 7th, only confirmed dead 163 days later; his body having been taken hostage into Gaza.

The family only received confirmation following the identification of verified video which demonstrated his corpse paraded around Gaza on the back of a motorbike.

I regularly see pictures of Israeli soldiers killed in battles with Hamas on my Instagram feed. For the most they are men in their early 20’s, starting out in life. Everything before them, then, nothing.

I felt an affinity to Daniel’s story as he had moved to live in Israel as a teenager with his family; volunteering to a combat unit, he had joined an officer’s course. And now dead.

The valor of his dad as he describes his experiences on this podcast is stunning.

I don’t know if valor is the most appropriate word; courage; stoicism; dignity.

And yes, I don’t forget the thousands killed in the bombings. I must mention the other victims, the collateral damage, as if focusing on Daniel’s death signifies a lack of compassion for others. No, it is solely that his story has been told and his loss resonates with me.

I moved to live in Israel as a teenager. It could have been me or my friend or family. Dead then paraded as a trophy of terror.

The present and past combine.

A swirling of time and place.

Death, dead, verification, past.

All for what?

The life of a man in his 90’s that has gradually ebbed and the sudden violent death of a man in his 20’s.

70 years of existence dividing them.

Unnecessary pain. Unnecessary isolation.

Who are we humans?

About the Author
Dr Rod Kersh is a Consultant Physician working in Rotherham, South Yorkshire. He blogs at
Related Topics
Related Posts