In the time of COVID-19 you can be forgiven for thinking people are dying of one thing only. In a war, injury would seem the most likely way to die. Ancient infectious diseases still bring death today. Inhabiting a pathology museum you’d conclude that malignancies are what kill most people. At different times and in different places, different causes of death dominate in reality or in our imagination.
Does it matter what a person dies of, or just that they have died? Perhaps it should just be the fact of their death that is important, but I would argue that instinctively one wants to know why, or of what. Is it because the cause of death tells us something about a person’s dying, the story of their last days or hours? Perhaps it is because what others are dying of presages what will kill us.
On an individual level, we hear of a person’s death, but so often the cause is not shared. Announcements of death may give hints, such as ‘suddenly’, ‘peacefully’ or ‘after a long (or short) illness’, these differentiating a relatively few precipitous events from the many causes of slow decline. The word ‘tragically’ might flag death by accident or suicide. When the cause of death is clearly stated, this may be offered to accurately inform, or might be to avert speculation and potential stigma.
On a societal scale, accurate figures for cause of death can be difficult to source, since even official agencies have trouble collecting them. In South Africa the current top killers are HIV/AIDS, heart attacks, strokes, diabetes, tuberculosis, inter-personal violence and road accidents (1). There are of course a myriad other diseases and events which can be fatal, some of which you’d be exceptionally unlucky to succumb to. Our collection here in the Pathology Learning Centre is a reminder of such things.
Some very rare medical misfortunes, all fatal. Left: the tattered brain of SSPE, a late complication of measles. Centre: Budd-Chiari syndrome Right: a tumour carried in a transplanted kidney .
So most of us will die as dictated by statistical probability. Even during wars, combatants and civilians have mainly died of disease rather than violent injury (2). Inevitable lifestyle diseases claim most lives in developed nations. The number of cancers in a pathology museum reflects pathology’s diagnostic focus, rather than cancer’s frequency. Despite perceptions and media attention, COVID-19 accounts for a small quota of death in the 21st century so far and a vanishingly small fraction in human history (3).
People die every second of every day, and each of us will die – this matters to us, and almost certainly it matters to us what of.
Notes
- 1. Figures for 2017 from http://www.healthdata.org/south-africa.
- 2. Ellis J. The Sharp End: The fighting man in world war II. New York: Scribner’s; 1980.