The following column is excerpted from Sara Engram's book "Mortal Matters: When a Loved One Dies."
During a classroom discussion, a first-grader asked: "How does my body know when it's time to die?"
This young boy was seeking factual information about a subject that seems to turn even the most matter-of-fact adult into an armchair philosopher, ready to give the child every kind of explanation except the one he needs most.
Often, questions about death turn into occasions when adults need to think about the question from a child's point of view.
Dr. Kathleen McCarty, a psychiatrist in Tampa, Fla., who frequently works with terminally ill patients and their families, suggests some guidelines. First, she says, it's a good idea to think about what may have prompted the question.
In this case the boy had recently lost a grandparent. The death of a family member, or of anyone the child knows, will prompt questions that deserve appropriate answers. Dr. McCarty suggests that adults be specific and accurate. They should address the concerns that are uppermost in the child's mind.
When children confront a reality as big as death, it's natural for their next thought to be centered on themselves: "What about ME? If Grandpa died, am I going to die, too?" (Adults wonder the same thing, but we've learned not to ask.) Next, they will wonder about the people they're closest to -- usually their parents: "If Grandpa died and left me, will Mommy or Daddy die and leave me, too?"
Children's worries about death can be compounded by the explanations they get. For instance, if a child is told that Grandmother "went to sleep," the child might worry that if she goes to sleep, she'll die, too. Or if the first-grader was told that his grandfather died because he was tired or sick -- both of which could have been true -- he might worry the next time he hears Daddy say he's really tired, or the next time Mom complains she isn't feeling too well that day.
"Always address the fears the child has about death for himself and those who take care of him," Dr. McCarty says. Explain to the child that "the way that person felt weak or tired is different from the way we feel weak or tired."
Which brings us back to that simple but mysterious question: "How will my body know when it's time to die?"
"Bodies do know," says Dr. McCarty. She points to animals as an example that will help children to understand that when we use words like "weak" or "tired" to explain death, we're not talking about the way we feel tired at bedtime, or how we feel when we have a cold or even the flu.
"Animals go off and curl up. They let you know when they're ready to die," Dr. McCarty says. "People go through the same thing."
Death is not a simple question for adults. When a child asks for facts on "how" we know it's time to die, the adult is probably busy wondering, more philosophically, "whether" we know when it's time to die.
When you're old enough to understand something about the loss that death involves, and when you know how final it is, it's harder to speak of the moment life leaves our bodies in a way that sounds as casual as mentioning what time dinner will be served. Yet for children the question comes naturally.
It helps when adults can with equal ease provide answers that include both the factual information asked for and the fears that are often lurking behind the questions.