Explanation About the Process of Rigor Mortis

By Anuj Mudaliar

An important process in the physiology of the human body after death, rigor mortis is one of the most reliable subjects of study to determine the time of death of a living being. In this article, we will learn more about this term, its causes, and its various stages.

Rigor Mortis

What is Rigor Mortis and How is it Caused?

Within a few hours of death, the body of a person or animal gets stiff and locked in place. This phenomenon is called rigor mortis or postmortem rigidity. Medically, the term is defined as the temporary rigidity of body muscles occurring soon after death.
Rigor mortis occurs due to biochemical changes in muscle tissue, when the formation of an enzyme called ATP (Adenosine triphosphate) stops after death due to a lack of oxygen in the body. Since ATP provides energy for the muscles to move, this stoppage results in proteins such as myosin molecules sticking to actin filaments, causing contraction and stiffening the tissue. Depending on factors such as temperature, the condition can last for as long as 72 hours. The process is a valuable tool to death investigations, as studying the stage of rigor mortis of the body greatly narrows down the time frame of death.

Timeline and Stages

There are a lot of things to consider when examining rigor mortis to make any conclusive statements about a death. Under normal conditions, the process should follow a fixed timeline.

0 – 8 Hours After Death: Till around 10 minutes after death, the muscles in the body are relaxed. This state is called primary flaccidity, and any stiffening is absent. However, after this period, rigor mortis begins to set in gradually; the skin pales, and the body starts cooling (two degrees Celsius in the first hour; one degree each hour thereafter). Muscle stiffening is minimal during these hours, and the hair stands on end because the muscles start to push on the follicles. After 4 – 6 hours, the stiffening of the muscles becomes moderate, and spreads all around the body. At the end of this period, one may observe sporadic twitches in the muscles. At the end of eight hours, the body should have cooled completely.

8 – 12 Hours After Death: During this period, the stiffening of the muscles goes from a moderate to an advanced stage, and by the time 12 hours have passed, there is absolutely no flexibility in the muscles, and the skin gets discolored due to the collection of blood.

12 – 24 Hours After Death: The rigor mortis is now complete, and at its peak, and the body remains fully stiff for around 12 hours more. It is nearly impossible to move or manipulate any body part without applying a lot of force.

24 – 36 Hours After Death: The stiffness gradually begins to dissipate due to the degradation of proteins in the body, and by the end of the 36th hour, the muscles should have become pliable again. This is the time when undertakers in mortuaries begin the process of embalming dead bodies, and making them presentable for funerals by adjusting the body position appropriately, before putrefaction begins.

Factors Affecting Rigor Mortis

This timeline is appropriate only under regular conditions. However, there are a few factors which alter the timeline, and speed up or slow down the process:

  • Exercise Before Death: If a person is involved in strenuous activity just before death, rigor mortis sets in immediately. This is because, at the time of death, the working muscles were depleted of ATP and oxygen.
  • Surrounding Ambient Temperatures: If death occurs under warm conditions, the conditions for decay and multiplication of bacteria are hospitable, increasing the pace of rigor mortis. However, if the person died in a cold environment, or of hypothermia, rigor mortis can last for many days. In these cases, one cannot use it to determine the time of death.
  • Fat Distribution: More fat in the body adds extra insulation, which causes the process of postmortem rigidity to slow down.
  • Disease and Age: People with low muscle mass, such as children, the elderly, or people suffering from diseases go through the process faster than those with high muscle mass. This is also true when comparing the rate of rigidity between humans and different animals, i.e., rigor mortis in a cat will set in faster than humans, while that of an elephant will be slower.

As you can see, this condition has great medico-legal importance, and gives investigative agencies a lot of information while looking at cases of suicides and murder.

Complete Article HERE!

At my father’s bedside, I learned what death looks like

NHS end-of-life and palliative care must focus more on the dying person’s needs and wishes – but for that we need to have proper conversations

By 

Jon Henley with his father, mother and son in 2003
Jon Henley with his father, mother and son in 2003

My father spent 10 days dying.

He was 84 and he had lost his wife – my mother, whom he adored, and without whom he felt life was a lot less worth living – three years earlier. He died of old age, and it was entirely natural.

The process, though, did not feel that way at all, at least not to me. Dad had been bedridden for months and was in a nursing home. He stopped eating one day, then started slipping in and out of consciousness. Soon he stopped drinking.

For 10 days my sister and I sat by his bedside, holding his hand, moistening his lips. Slowly his breathing changed, became more ragged. During the last few days, the tips of his fingers turned blue. His skin smelled different. His breath gradually became a rasp, then a rattle.

It sounded awful. We were sure he was in pain. The doctor reassured us he wasn’t; this was a human body dying naturally, shutting down, one bit at a time. We had not, of course, talked about any of this with Dad beforehand; we had no plans for this, no idea of what he might have wanted. It would have been a very difficult conversation.

The doctor said he could give him something that would make him at least sound better, but it would really be more for us than for my father. “My job,” the doctor said, “is about prolonging people’s lives. Anything I give to your father now would simply be prolonging his death.”

So we waited. When it finally came, death was quite sudden, and absolutely unmistakable. But those 10 days were hard.

Death is foreign to us now; most of us do not know what it looks, sounds and smells like. We certainly don’t like talking about it. In the early years of the 20th century, says Simon Chapman, director of policy and external affairs at the National Council for Palliative Care, 85% of people still died in their home, with their family.

By the early years of this century, fewer than 20% did. A big majority, 60%, died in hospital; 20% in care homes, like my father; 6% in hospices, like my mother. “Death became medicalised; a whole lot of taboos grew up around it,” Chapman says. “We’re trying now to break them down.”

There has been no shortage of reports on the question. From the government’sEnd of Life Care Strategy of 2008 through Julia Neuberger’s 2013 review of the widely criticised Liverpool Care Pathway to One Chance to Get it Right, published in 2014, and last year’s What’s Important to Me [pdf] – the picture is, gradually, beginning to change.

The reports all, in fact, conclude pretty much the same thing: the need for end-of-life care that is coordinated among all the services, focused on the dying person’s needs and wishes, and delivered by competent, specially trained staff in (where possible) the place chosen by the patient – which for most people is, generally, home.

“It’s not just about the place, though that’s important and things are moving,” says Chapman: the number of people dying in hospital has now dropped below 50%.
“The quality of individual care has to be right, every time, because we only have one chance. It’s about recognising that every patient and situation is different; that communication is crucial; that both the patient and their family have to be involved. It can’t become a box-ticking exercise.”

Dying, death and bereavement need to be seen not as purely medical events, Chapman says: “It’s a truism, obviously, but the one certainty in life is that we’ll die. Everything else about our death, though, is uncertain. So we have to identify what’s important to people, and make sure it happens. Have proper conversations, and make proper plans.”

All this, he recognises, will require “a shift of resources, into the community” – and funding. Key will be the government’s response to What’s Important to Me, published last February by a seven-charity coalition and outlining exactly what was needed to provide full national choice in end-of-life care by 2020. It came with a price tag of £130m; the government is expected to respond before summer.

In the meantime, though, a lot of people – about half the roughly 480,000 who die in Britain each year – still die in hospital. And as an organisation that has long focused on curing patients, the NHS does not always have a framework for caring for the dying, Chapman says.

But in NHS hospitals too, much is changing. There has been a specialist palliative care service – as distinct from end-of-life care, which is in a sense “everyone’s business”, involving GPs, district nurses and other primary care services – at Southampton general hospital and its NHS-run hospice, Countess Mountbatten House, since 1995, says Carol Davis, lead consultant in palliative medicine and clinical end-of-life care lead.

People die in hospital essentially in five wards: emergency, respiratory, cancer, care of elderly people and intensive care, she says: “Our job is about alleviating patients’ suffering, while enabling patients and their families to make the right choices for them – working out what’s really important.”

Palliative care entails not just controlling symptoms, but looking after patients and their families and, often, difficult decisions: how likely is this patient get better? Is another operation appropriate? What would the patient want to happen now (assuming they can’t express themselves)? Has there been any kind of end-of-life planning?

Of course many patients in acute hospital care will not be able to go home to die, and some will not want to, Davis says: “Some simply can’t be cared for at home. If you need two care workers 24/7, it’s going to be hard. Others have been ill for so long, or in and out of hospital so often, they feel hospital is almost their second home. So yes, choice is good – but informed choice. The care has to be feasible.”

In 2014, the report One Chance to Get it Right [pdf] identified five priorities in end-of-life care: recognise, communicate, involve, support, and plan and do. (“Which could pretty much,” says Davis, “serve as a blueprint for all healthcare.”) The first – recognise, or diagnose – is rarely easy. How does a doctor know when a patient is starting to die?

“There are physical signs, of course,” says Davis. “Once the patient can’t move their limbs, or can no longer swallow.” But, she says, “we have patients who look well but are very ill, and others who look sick but are not. In frail elderly people – or frail young people – it can be hard to predict. Likewise, in patients with conditions like congenital heart disease, where something could happen almost at any moment.”

Quite often, Davis and her team face real doubts. “Right now,” she says, “I have a patient in intensive care, really very ill. They probably won’t pull through, but they might. I have another doing well, making excellent progress – but they’ve been in hospital for three months now. They’re very, very weak, and any sudden infection … You just can’t predict.”

Which is why communication, and planning, and involving the family – all those difficult and painful conversations that we naturally shy away from – are so very important.

It could well be, for example, that my father would actually have wanted his death to be prolonged: he certainly clung on to life with a tenacity that startled my sister and me. We will never know, though, because we didn’t talk about any of it.

“It is our responsibility – all of our responsibility – to find the person behind the patient in the bed,” Davis says. “One way or another, we have to have those conversations.”

Complete Article HERE!

Beyond Surface Treatments: 6 Trite-Free Tribute Tattoos

By

In the year since I first wrote about cliché-free memorial tattoos for Modern Loss, I’ve encountered people’s ink tributes in bathroom lines at concerts, at book readings and all over the Internet. I’ve heard about a wedding party who got a mass tattoo for a late groom and from a reader who inked the title of my memoir on her forearm to honor her late brother.

I confess that I’m still contemplating tattoo designs for my late husband and brother, but not for lack of exposure to meaningful, aesthetically stunning tributes. The memorial tattoos included below reach beyond rose-wrapped crosses and words like “R.I.P.,” and into the realm of the remarkably personal. Some take a high-design approach and some are unassumingly simple, but all use unexpected symbolism to honor the deceased.

Redford Reid
Redford Reid

Name: Redford Reid
Age: 34
Current City: Brooklyn, N.Y.
Date of Loss: Feb. 8, 2014
Tattoo Artist: Thomas Hooper of Rock of Ages in Austin, Texas

Who does your tattoo memorialize?
My father, Gary R. Parker.

How did you lose him?
In a tragic skiing accident.

Did you get the tattoo on a significant date?
No, the timing was based on the artist’s availability.

Tell us about the tattoo’s design:
My dad often wore ties, so I chose several from his closet that had design potential for a tattoo. Then I asked the artist to create a mandala inspired by those ties.

Meghan Schuttler
Meghan Schuttler

Name: Meghan Schuttler
Age: 25
Current City: Santa Rosa, Calif.
Date of Loss: June 3, 2011
Tattoo Artist: Brandon Bartholomew of The Hole Thing in Santa Rosa, Calif.

Who does your tattoo memorialize?
My father, Scott Schuttler.

How did you lose him?
Sudden heart attack.

Did you get the tattoo on a significant date?
Following my college graduation, and almost exactly one year after he passed.

Tell us about the tattoo’s design:
My dad was a musician and loved music. The design is his first name, “Scott,” represented in musical symbols. The numbers indicate his birthday (June 5) and death day (June 3). I chose to place the tattoo on my left ribcage so it would be close to my heart.

Angela Lee Bellefeuille
Angela Lee Bellefeuille

Name: Angela Lee Bellefeuille
Age: 35
Current City: Washington, D.C.
Date of Loss: February 2, 2014
Tattoo Artist: Alessandro Contu of Tattoo House Perugia in Perugia, Italy

Who does your tattoo memorialize?
My husband, Riccardo Romani.

How did you lose him?
Metastatic brain tumors. He fought for 14 months and endured five brain surgeries before losing the battle.

Did you get the tattoo on a significant date?
On March 31, 2014, after a bout of depression left me contemplating suicide.

Tell us about the tattoo’s design:
In order to feel the pain of slitting my wrists — so I’d never do it — I decided to get a tattoo there. The act of tattooing represents curbing my desire to end my life (and the pain) after losing my husband. Literally, the three birds represent the three souls lost: his, mine, and our 19-year old cat who died two weeks before Riccardo did. But it also symbolizes the hope of flying away and finding a beautiful life after tragedy.

Who does your tattoo memorialize?
My husband, Riccardo Romani.

How did you lose him?
Metastatic brain tumors. He fought for 14 months and endured five brain surgeries before losing the battle.

Did you get the tattoo on a significant date?
On March 31, 2014, after a bout of depression left me contemplating suicide.

Tell us about the tattoo’s design:
In order to feel the pain of slitting my wrists — so I’d never do it — I decided to get a tattoo there. The act of tattooing represents curbing my desire to end my life (and the pain) after losing my husband. Literally, the three birds represent the three souls lost: his, mine, and our 19-year old cat who died two weeks before Riccardo did. But it also symbolizes the hope of flying away and finding a beautiful life after tragedy.

Katie Irish
Katie Irish

Name: Katie Irish
Age: 35
Current City: Brooklyn, N.Y.
Date of Loss: Nov. 14, 2012
Tattoo Artist: Sue Jeiven of East River Tattoo in Brooklyn, N.Y.

Who does your tattoo memorialize?
My daughter, Roxane Persephone Chinn.

How did you lose her?
I was 40-weeks pregnant, and it was our due date. Late in the afternoon, I became aware that Roxy wasn’t moving as much as she normally did. I attributed it the fact that she was full term and had pretty much run out of room. We called the doctor, and she had us come in for an ultrasound. We arrived at the hospital, but they could not find a heartbeat. After I delivered her the next morning, we saw that there was a true knot in her umbilical cord that had probably formed very early in the pregnancy.

Did you get the tattoo on a significant date?
It took time to decide that I wanted a tattoo (this is my only one) and once I did, to figure out what I wanted. After that all became clear to me, though, I wanted it as soon as I could get an appointment with Sue. The date itself wasn’t significant, but the act definitely was.

Tell us about the tattoo’s design:
Once I decided that I wanted to commemorate Roxy in this way, I began researching ideas. I knew that I wanted something beautiful that wasn’t immediately recognizable as a memorial tattoo. I began looking at Victorian mourning jewelry (no one has done mourning like the Victorians) and found a beautiful brooch with an outstretched hand holding some foliage. This symbolizes remembrance. I changed the foliage to Cyprus branches, which is what we had carried at Roxy’s memorial. When I met with Sue, she was thrilled by the idea of using Victorian mourning symbols for this and suggested the addition of the hair jewelry piece at the bottom. The Victorians would cut the hair of their dead and weave it into incredibly intricate pieces: bracelets, brooches, rings, and even tiaras. We decided on a bracelet that attaches to the cuff of the hand and disappears into the Cyprus. This is another symbol for remembrance but it also reminds me that Roxy was born with a full head of beautiful, dark hair.

Rita Schell
Rita Schell

Name: Rita Schell
Age: 
50
Current City: 
Colorado Springs, Colo.
Date of Loss: 
Nov. 18, 2011
Tattoo Artist:  Ron Dolocek of Lucky Devil Tattoo in Colorado Springs, Colo.

Who does your tattoo memorialize?
My only brother, Johnny Schell.

How did you lose him?
Suicide.

Did you get the tattoo on a significant date?
I chose the month of February since that’s the beginning of our astrological sign’s timeline.

Tell us about the tattoo’s design:
My brother and I had a bond that allowed us to communicate with a look and through humor that only we understood. When I lost him, I was devastated and went through a period of drug and alcohol use. I couldn’t stop thinking about what I could have done to change things. I didn’t want to stop thinking about Johnny because I thought if I did, he would disappear and I’d have nothing. But after I read the book [by the author of this column] “Splitting the Difference,” I realized that keeping my brother’s memory alive didn’t mean living my life for him and it didn’t need to come at the expense of my health. I could still love him, miss him and talk to him without destroying myself in the process. So the tattoo’s phrase refers to my choice to “split the difference” between losing him and losing myself. Johnny was a Pisces like I am, so I chose the two fish that symbolize our astrological sign. He was born on St. Patrick’s Day so the fish representing him is green; my fish is purple because my February birthstone is amethyst. The color of my fish also ties back to a pair of amethyst earrings that Johnny gave me when I was a little girl and he was a cadet at the U.S. Military Academy at West Point.

Jesika Doty
Jesika Doty

Name: Jesika Doty
Age: 40
Current City: Kansas City, Mo.
Date of Loss: Sept. 20, 2009
Tattoo Artist: Chris Orr of Mercy Seat Tattoo in Kansas City, Mo.

Who does your tattoo memorialize?
My husband, Doug Doty.

How did you lose him?
Helicopter crash.

Did you get the tattoo on a significant date?
It was close to what would have been our seventh wedding anniversary.

Tell us about the tattoo’s design:
On our wedding day, Oct. 1, 2005, my soon-to-be-husband gave me this handwritten card before we walked down the aisle together: ‘You are the love of my soul, and the soul of my life. I love you, Always, Douglas.’ He had a way of capturing the feelings that we experienced together, and these particular words from him remind me of the undying connection we have and the beautiful love we shared. It reminds me that a connection like that is real, can be real again and not to settle for anything less. It’s a daily message in his handwriting about the possibilities of love…a permanent love note directly from him.

Complete Article HERE!