Kathy E. Magliato

MD, MBA, FACS

This morning my two-year-old son asked me, “Mommy, what does the heart say?” “Lub-Dub,” I replied with a nurturing smile. “Lub-Dub.” The heart makes two sounds in sequence with each beat. And your heart, a very persistent organ indeed, beats 80 times each minute, 100,000 times each day and 42 million times in an average lifetime.

Until it stops.

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Until you die.

But what is death? Is it a process? Is it a moment? Does death occur when the heart ceases to beat? As a heart surgeon, it is my honor and privilege to make the heart stop beating each day in order to repair it and yet, this is not death. The definition of death has evolved over time. A person can be clinically brain dead and have no viable brain function but still have a beating heart. So when is the moment of death and what is is the process? Having been at the bedside of many patients that cross the threshold between life and death, I can tell you that there is a distinct change that occurs in a person when both their brain function and heart function cease. While the death of a loved one is truly a tragic event, the actual process can be quite beautiful. There is a stillness that washes over the dying body and culminates in a peacefulness that is far more serene than is seen in a sleeping state. This is followed by a distinct moment when death overtakes a person - their features seem to change and become less lifelike. It is as if their essence, or that which made them who they were in life, leaves their body. The shell of who they once were is left behind for those to mourn. It is not a frightening process. It is simply a part of life, for without life there can be no death and without death there can be no life. They coexist in a meaningful and necessary relationship that constitutes the journey we all must take. And sometimes, people teeter on the edge between the two. I have borne witness to patients who have survived a near-death experience. They all have one thing in common: they have experienced something extraordinary. They have stood on that line between life and death, hesitated for a moment, and simply took a step back. And they are forever changed. So when your heart no longer says “Lub-Dub” and your brain no longer functions, please understand that you are in the moment of a process on a journey that is as much a part of your life as life itself. Dr. Kathy Magliato is one of the few female cardiothoracic surgeons in the world. She is the director of Women’s Cardiac Services at Saint John’s Health Center in Santa Monica, California.