The Upside Down: The Ruffian on the Stair

I was recently reminded of some lines of poetry by the now mostly forgotten Victorian titan of letters, William Ernest Henley: Madam Life’s a piece in bloom / Death goes dogging everywhere: She’s the tenant of the room / He’s the ruffian on the stair.

That image of death as a stairwell mugger came back to me when I was trying to describe the experience of observing my father’s long-expected but still all-too-sudden death. 

I had been helping him up the stairs of his little cottage, a familiar routine, though one he had become less keen to perform in his last two weeks of life. A hot bath awaited him (hot baths and malt whisky remained the chief pleasures of that terminal period). But on that day, the stair-climbing routine failed. He seemed overcome with weakness and it was only with some awkward scrambling that my stepmother and I managed to get him to the top of the stairs.

Upright and somewhat wobbly, he asked to sit on his bed in order to catch his breath. In the short distance between the top of the stairs and the bed, with my arms around his chest to steady him, I felt him go. 

Dead weight is aptly named – there is no support of any kind and his shrunken frame sagged sack-like towards the floor. I laid him down gently and turned him onto his back. There was no evidence of breathing, his mouth was open and his eyes glassy. 

Death has a look about it, as I now know. 

My father was 87 years old when he died and that in itself borders on the miraculous. He had undergone three triple heart bypass operations (the first when he was just 48) and for 17 years he had suffered from prostate cancer. 

Five years ago, he was diagnosed with vascular dementia and more recently diabetes. It is a huge credit to the medical staff who treated him and the daily attention of my stepmother and other carers that he reached such a venerable age. His death certificate would mention both the cancer and the heart disease, but I found myself puzzled as to what precise combination of factors led to his death, the one I’d so intimately witnessed.

The Upside Down: The 18th Century’s Ultimate #BookToker

John Mitchinson explores what the novelist behind a 1759 masterpiece can teach us about the importance of marketing as a publisher

John Mitchinson

There is, I think, nothing particularly morbid in this desire to understand the mechanics of something we all will one day experience. Perhaps unsurprisingly, given what I do, I turned to a book. 

How We Die by Sherwin B Nuland, an American surgeon, was a surprise bestseller when it was originally published in 1993, and although some of the medical practices he describes have evolved in the past 30 years, the facts of death have not. Nuland quotes Religio Medici (The Religion of a Doctor) by the 17th Century physician and writer Sir Thomas Browne: “With what strife and pains we come into the world we know not, but ‘tis commonly no easy matter to get out of it.”

That was exactly what I’d felt observing my father’s final days. His dementia was not so far advanced to prevent an honest appraisal of his condition – he was ready to go, had in fact been given four to six months by his oncologist four months earlier – but the going felt protracted. The most accurate way of describing it felt like a slow vanishing act. He slept more, talked less, ate and drank very little. My stepmother and I both expected we would wake up to find him gone. But that’s not what happened. None of us – and certainly not him – expected it to happen on that particular Friday afternoon.

The likely cause of my father’s death was that the final exertion on the stairs brought on cardiac failure, specifically his scarred, patched-up heart had found itself unable to pump enough oxygenated blood to maintain consciousness. I remember his doctor saying years earlier that he needn’t worry about the prostate cancer: his heart would give out long before the cancer took him. This turned out to be true, except for the ‘long before’. 

The speed of it was what surprised me – no obvious agonal agonies, no severe pain, no death rattle, just a sudden deflation – as Nuland puts it, “a man’s coronary arteries have been unable to bring sufficient blood to nourish the muscle of his heart; the heartbeat became ineffective, the brain went too long without oxygen, and the man died”.

In the end, my father’s death has been both natural and ordinary. For me, the realisation that the sequence of 31,602 days – and all the hopes, fears, plans, thoughts, ideas, arguments, meals and celebrations that had filled them – had finally ended in my arms was profound enough. 

I felt close to my father and I knew he was gone. An ordinary mystery: the best kind.