The Human Body

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.

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.

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.'

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.

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.

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.