Any discussion of water-cooler television these days has to include HBO’s Game of Thrones. The show is based on a best-selling series of fantasy novels by George R.R. Martin, with five books presently in print and two more to come. I first discovered the books over ten years ago, and I find it amusing to see a whole new audience react to the many shocking plot twists and unexpected deaths of major characters through a different medium. With a new season set to premiere this Sunday, the buzz is heavy around who’s survived the events at the end of the previous season, and who’ll be next to go. Though set in a fantastical medieval world where seasons last for years, the reality of death is a constant in Martin’s universe. The nation of Westeros (or The Seven Kingdoms) is rarely at peace and, even in peacetime, disputes between various feudal lords, bandits, drought, famine, disease, and the ever-approaching threat of winter and its accompanying deprivation make the threat of sudden death routine for its inhabitants.

As the series opens, the realm is enjoying one such brief era of relative peace and stability. However, as the reader or viewer soon learns, longstanding tensions between noble houses will erupt in civil war before the first book is over. Also, unbeknownst to all but a small group of characters, a supernatural force is stirring in the frozen north of Westeros, which is nothing less than the embodiment of death itself. Amid the high fantasy battles, dragons, tournaments and court intrigue, Martin finds considerable space in his epic for rumination and exploration of the pervasiveness of death that attends these more expected aspects of the genre.

As the series progresses, we learn more and more about the myriad of cultures, faiths and organizations that make up Martin’s world. One major character finds herself unwittingly involved with a religious organization dedicated exclusively to the worship of death, as embodied by the Many-Faced God. People find their way to the temple, seeking ultimate relief from their particular suffering and there receive the “gift” of the Many-Faced God in return for their more worldly possessions or an act of service. The reader is able to piece together a jumble of religious icons populating a corner of the temple which are various gods of death from the world’s many religious sects. Here, the universality of dying is embraced as being of primary importance as the unifying existential problem of an entire world.

One of the regional cultures of the Seven Kingdoms, inspired by the Vikings of our history, simulates the act of dying as part of its more orthodox religious practices. The Ironborn, represented on HBO by Theon Greyjoy and his sister Yara, engage in a “drowning” ceremony, rendering those who undergo it technically dead, or at least unconscious and water-logged. Those who are “drowned” are brought back by CPR masked as religious ritual, to a chorus of “What is dead may never die.” In a world characterized by constant violence and the less glamorized ravages of poor sanitation and a lack of scientific medicine, the Ironborn react by glorifying a premature death, assigning a high honorary and spiritual value to deaths in battle and pervasive disdain to death from natural causes and the infirmities of old age. To them, living to old age and becoming increasingly dependent on others is a point of dishonor. While they take it to a particular extreme, there are few corners of this world that don’t share the Ironborn contempt for the vagaries of aging.

In the world Martin unfolds for us, death is both understood as an inevitable part of life and enveloped in a cloak of superstition and cultural judgments. As the books progress, the magic and sorcery one would expect of the genre starts to come into play. Many of these otherworldly powers are expressed as a defiance of death, as characters are resurrected through sorcery and corpses walk in the northern regions. The reaction to these deviations from the laws of nature is one of fear, distrust, or aggression among other characters. One character who’s been brought back more than once has an ambivalent reaction to being spared, becoming increasingly disconnected from his own history and identity. “It all fades. Sometimes I think I was born on the bloody grass in that grove of ash, with the taste of fire in my mouth and a hole in my chest,” he says. When such intervention is offered as a possibility, it’s generally discouraged, treated as a taboo and provides an imitation of life if successful. Also, undoing a person’s death always comes with a terrible and often unforeseen price.

The line between science, most commonly represented by a monkish order known as the Maesters, the healers of Westeros, and magic is generally blurred in this world. While the Maesters severely discourage their members from practicing sorcery, their science isn’t sufficiently advanced to contend with the many ways of dying they attend to. Most commonly, we see a Maester take what limited actions he can in the face of a serious injury or illness and focus on what we know as palliative care, often adding the patient’s fate is in “the hands of the gods.” Considering active intervention involves leeches and other primitive artifacts of medieval medicine, the treatment often boils down to controlling pain with “dreamwine” and “milk of the poppy.”

In one such scene, which will be memorable to anyone who’s been watching the show, a prominent character has been fatally wounded while out hunting. When his closest friend hears of his condition, he rushes to his side to find everyone in the room has given up hope. The dying man knows too, saying “The stink of death, don’t think I can’t smell it.” When the Maester offers him milk of the poppy, he refuses with “Away with you. I’ll sleep soon enough.” In his last conscious moments, he insists his friend writes down his last will and testament, and when that’s done, summons the Maester again and asks him to “give me something for the pain and let me die.” As a man who has survived multiple wars, it’s clear he knows there’s nothing else to be done for him and having accepted that truth, he prioritizes controlling the manner of his death over the time that would be spent trying to fight the inevitable.

In contrast to scenes such as that one, there’s a death which seems more at home in 21st century American society. An important Lord spends the better part of two books fighting what Martin broadly hints is cancer—clearly a rarity in this world. Apart from a few loyal servants, his Maester, and his daughter, he fights a very different sort of battle with little notice. When his daughter visits him, she reflects he “had been a strong man, and proud. It hurt her to see him reduced to this.” His son manages the affairs of the domain and, along with pretty much all of the Lord’s circle, avoids dealing with the Lord’s slow dying. It becomes clear a terminal condition with no obvious external cause is a situation for which these characters lack the vocabulary and empirical understanding to discuss.

In contrast, many songs are sung and stories told about famous deaths in war. Paradoxically, through this lack of understanding, the character in question is left to die a natural death, medicated only with painkillers at the end. As his death approaches, his daughter reflects, “He was ever a fighter…a sweet stubborn man.” The Maester responds, “Yes…but this battle he cannot win. It is time he lay down his sword and shield. Time to yield.” He isn’t subjected to painful and invasive procedures that would tack on a few extra weeks because the procedures don’t exist in Westeros.

Oddly enough, the brutal realities of Martin’s fictional society plausibly align in this character to produce a way of dying that matches what most Americans describe as their ideal way to go; at home, with all possible measures taken to control the pain, and in the company of family.