I thought it could mean death too,
but it isn't number 1# on the list of stuff the card could mean.
The death card upside down is supposed to indicate negative change.
I suppose death could be a negative change in self, like from alive to dead
something else;
"
Since there is no Tarot card that specifically portrays birth, we may wonder: Is the Death card really the birth card? The cycles of life, especially birth and death are mysterious and paradoxical."